Aduh..kaki ku!

" Dan Dialah yang telah menciptakan bagimu pendengaran, penglihatan dan hati nurani, tetapi sedikit sekali kamu bersyukur.

Dan Dialah yang menciptakan dan mengembangbiakkan kamu di bumi dan kepadaNyalah kamu akan dikumpulkan.

Dan Dialah yang menghidupkan dan mematikan, dan Dialah yang (mengatur) pergantian malam dan siang. Tidakkah kamu mengerti? " ...Al Mu'minun: 78 - 80

Sungguh indah sekali kata-kata Allah...

Sekiranya kita mengamati dan merenungi bait-bait tersebut, dan seterusnya cuba untuk "relate" dengan apa yang berlaku di sekeliling kita..kita akan mendapati betapa agungnya kuasa Allah...

Insan adalah suatu makhluk yang kerdil sebenarnya..akan tetapi ia lupa akan dirinya..

Jarang sekali kita bersyukur dengan nikmat yang telah dikurniakan oleh Allah..

Sekiranya ditarik kembali nikmat itu...kita akan merana...

Sejak berada dalam posting ortopedik, suatu nikmat yang sangat dirasakan adalah nikmat "ketenangan"..sebelum ini, posting di Obstetrics dan gynaecology terasa sangat akan "keserabutan" dan juga tekanan yang amat tinggi sekali.

namun, Allah izin sangat sejak di posting ini, saya sempat sedikit untuk berfikir tentang pesakit dengan lebih mendalam.

Setiap minggu , kami akan ada sesi klinik, di mana ada segelintir doktor akan ke klinik seharian itu. Klinik otopedik bermula pukul 9 am - 5pm. Jumlah pesakit kerap mencapai angka 200.

Klinik - klinik terbahagi kepada klinik trauma, sendi, kanak-kanak,spine dan sports injury

Antara complaints yang kerap ditemui adalah sakit lutut dan sakit belakang bagi orang yang berumur.

*******************************************************************

" Doktor, sakit lutut ni makin teruklah..sekarang ni saya dah tak boleh solat macam biasa..paling sakit ialah pada duduk tahiyat" keluh Pakcik Mat...

" Aiyoo..ini belakang ah..manyak sakit oh..Tong !"

" Saya tahan je sakit ni doktor..kalau selalu ambik cuti,nanti bos bising pulak..maklum lah sekarang tengah ramai yang dibuang kerja.."jelas Mak Salmah.

*****************************************************************

Dari elok berjalak kepada limping gait..dan seterusnya menggunakan crutches..

Mungkin sakit tu disebabkan oleh degenerative disease, seperti osteoarthritis, atau injury , seperti meniscal tear.

Hakikatnya, pesakit itu telah di uji dengan kesakitan. Di uji dengan "penarik balik" suatu nikmat iaitu nikmat berjalan.

Seringkali saya cuba memikirkan keadaan mereka yang sanggup membiarkan sakit itu berterusan sehingga akhirnya mereka mengambil keputusan untuk berjumpa dengan doktor.

Dan kini, saya juga berada dalam keadaan begitu. Setelah beberapa kali terpaksa berada di dalam dewan bedah dan berdiri sehingga 6jam berdiri untuk 'Assist ' operation, kaki saya juga mula mengalami kesakitan.

Dan kini kesakitan tu makin terasa setiap kali terpaksa berdiri.

Sekarang telah berubah "role" , dimana doktor sendiri yang mengalami kesakitan seperti mana pesakit..tetapi dalam kes ini, history dan examination dan sekurang-kurangnya diagnosis perlu ada di dalam minda...

Potong kaki?

" Mak cik tak nak kaki mak cik kena potong..bukannya senang dik..nak dapat kaki ni" Makcik Muniati shook her head

We all stared at her in disbelief..Her left leg was already necrotic, most of the muscles were devitalized. The stench of the odor from her leg was filling the whole ward.

" Makcik..makcik sayang nyawa ke, atau sayang kaki lebih? makcik boleh mati kalau biarkan macam ni." Mister Jacob was stern this time

" Apa ni doktor..nak paksa-paksa saya pulak!" She scoffed

My specialist was exasperated. The wound was open for her to see. Even with the extensive
wound that we did, and the muscles, bones and the internal structure being open, she was still adamant on keeping the lower limb..

******************************************************************************

During my 2nd call recently, I had to assist my medical officer perform a wound debridement of the left leg of this lady because she had necrotizing fasciitis of the affected limb. Her left leg was not in good condition, whereby it was swollen and there was already gangrene of the small toe.

She was initially counselled for below knee amputation, in which she repeatedly refused.

Thus, we offered her a less than optimum intervention which was wound debridement

Even with the extensive debridement that has been done, the prognosis for the limb was poor.

I was scared that she might be going into sepsis as clinically she was becoming febrile and the white blood counts were already raised.

That afternoon after the ward round, i encountered the family members.

" Puan..tentang mak puan ni..semalam kita dah buang tisu-tisu yang dah mati, tapi disebabkan luka nya sangat besar, kami tak mampu nak kesemuanya. Untuk kes sebegini, sebaiknya adalah untuk potong bahagian yang affected tu. Kalau puan tengok, sememangnya otot-ototnya dan juga sebahagian tulang pun dah mati. Saya risau sekiranya jangkita ni merebak keseluruhan badannnya. Sekarang pun dia dah mula demam."i tried to explain to them the seriousness of the issue.

" Tapi doktor..apa akan jadi kalau dibiarkan begitu sahaja?"

" Jangkitan sebegini boleh merebak ke seluruh badan - menyebabkan sepsis, di mana , keadaan ini boleh menyebabkan kematian" I continued

" Oh..hm..tapi mak saya sendiri yang tak nak..kami tak boleh buat apa-apa" The daughter answered.

# How to counsel patients in this kind of situation?

*************************************************************************************

DEFINITION:

GANGRENE:
Gangrene is a complication of necrosis (i.e., cell death) characterized by the decay of body tissues, which become black (and/or green) and malodorous. It is caused by infection or ischemia, such as from thrombosis (blocked blood vessel). It is usually the result of critically insufficient blood supply (e.g., peripheral vascular disease) and is often associated with diabetes and long-term smoking.

WOUND DEBRIDEMENT

Debridement is the process of removing dead (necrotic) tissue or foreign material from and around a wound to expose healthy tissue.

Purpose of wound debridement:
An open wound or ulcer can not be properly evaluated until the dead tissue or foreign matter is removed. Wounds that contain necrotic and ischemic (low oxygen content) tissue take longer to close and heal. This is because necrotic tissue provides an ideal growth medium for bacteria, especially for Bacteroides spp. and Clostridium perfringens that causes the gas gangrene so feared in military medical practice. Though a wound may not necessarily be infected, the bacteria can cause inflammation and strain the body's ability to fight infection. Debridement is also used to treat pockets of pus called abscesses. Abscesses can develop into a general infection that may invade the bloodstream (sepsis) and lead to amputation and even death

NECROTIZING FASCIITIS

necrotizing fascitits is any necrotizing soft tissue infection spreading along fascial planes, with or without overlying cellulitis; - also called Meleney ulcer, NF is severe manifestation of lymphangitis that progresses in a frightening manner within a few hours; - tissue necrosis develops rapidly behind advancing wall of inflammation that limits penetration by antibiotics;

Below knee amputation
Amputation is the removal of a body extremity by trauma or surgery. As a surgical measure, it is used to control pain or a disease process in the affected limb, such as malignancy or gangrene

MOney..money..money

THE FORTUNE 500

Big Oil knocks Wal-Mart out of first place.
Exxon Mobil shoved aside Wal-Mart Stores to retake the top place on the Fortune 500, proving that Big Oil was king of the economy last year.
Exxon Mobil was the top selling-company in 2008, with nearly $443 billion in revenue, a jump of almost 19% from the prior year. The Irving, Texas-based oil giant was also the most profitable, with earnings of $45.2 billion.

Wal-Mart, which reigned as No. 1 on the Fortune 500 the past two years, slipped to second place. The recession was a boon for Wal-Mart: As cash-strapped customers crowded its discount stores, the retailer's sales grew 7% to more than $406 billion. But that wasn't enough to keep up with oil-rich Exxon.

The Fortune 500 ranks America's largest corporations by their annual revenue. The list was announced by Fortune magazine Sunday.

Other oil companies took high ranking spots in the Fortune 500.

Chevron held its place at third, its revenues growing nearly 25%, while ConocoPhillips moved up one notch to fourth, its sales jumping more than 29%. But the company lost almost $17 billion owing to its high exposure to refineries, which got squeezed by rising oil prices and slowing consumption. That gave ConocoPhillips a more dubious distinction -- placing seventh on the list of worst money losers on the Fortune 500.

Meanwhile, General Electric moved up one slot to fifth place, with sales of $183 billion. General Motors and Ford Motor were close behind, despite plunging revenues as customers steered clear of car lots.

It was a rough year for the Fortune 500 overall. All told, America's 500 biggest companies earned $98.9 billion in 2008, down 85 percent from $645.2 billion in profits the previous year.

And 128 companies on the list had losses, totaling $519.3 billion. The previous year, just 57 Fortune 500 companies lost money, for a total of $116.7 billion.

The bailed-out insurance giant American International Group topped the list as worst money loser of all.
As President Obama said in a recent speech, "I promise you, nobody is more frustrated than me with AIG."
Rounding out the five worst money losers are Fannie Mae, Freddie Mac, General Motors and Citigroup.

Investors in Fortune 500 stocks mostly saw their portfolios take a hit last year: Only 24 of the 500 companies generated a positive return last year. Dollar Tree, a retailer of $1 items, was the No. 1 stock performer, returning a whopping 60% to investors in 2008. Yet it just barely made the Fortune 500, appearing at No. 499. Investors must have had dollar signs in their eyes, because Family Dollar Stores was the second-best stock performer, gaining about 39% on the NYSE.

There's some good news for women in this year's Fortune 500, as more female executives crack the glass ceiling. Fifteen Fortune 500 companies are now led by women, compared to 12 the prior year. Archer Daniels Midland, whose chief executive is Patricia Woertz, is largest of them all, at No. 27 on the list. Other high-ranking women include Angela Braly, CEO of No. 32 WellPoint; Lynn Elsenhans, CEO of No. 41 Sunoco; Indra Nooyi, head of No. 52 PepsiCo; and Irene Rosenfeld, chief of No. 53 Kraft Foods.

THE TOP 10 COMPANIES IN THE U.S.:

1. Exxon Mobil
6. General Motors
2. Wal-Mart Stores
7. Ford Motor
3. Chevron
8. AT&T
4. ConocoPhillips
9. Hewlett-Packard
5. General Electric
10. Valero Energy

Agaknya daripada semua itu, ada tak di kalangan mereka yang menyumbang pada ekonomi israel?

Kisah isteri seorang Pejuang

Kegigihan Isteri As Syahid Dr. Abdul Aziz Ar Rantisi

April 12, 2009
Kiriman ini adalah dari kawan yang bersama dalam program Puan Rasya Al Adlouni (Ummu Muhammad) yang merupakan isteri kepada As Syahid Dr Abdul Aziz Ar Rantisi di Masjid Negeri Shah Alam pada 24 Mac 2009, Selasa lalu.
Assalamualaikum,
Alhamdulillah malam semalam, Selasa 24.3.09 saya dapat mendengar penyampaian dari Puan Rasya Al Adlouni (Ummu Muhammad) yang merupakan isteri kepada As Syahid Dr Abdul Aziz Ar Rantisi di Masjid Negeri Shah Alam.
Melihat kepada kekuatan ucapannya dengan suaranya yang begitu bersemangat sambil berdiri terasa seolah-olah yang berucap itu adalah As Syahid Dr Abdul Aziz Ar Rantisi sendiri. Itulah tarbiyah yang telah dilaksanakan oleh Dr Abdul Aziz kepada isterinya yang akan meneruskan usaha-usaha dakwah dan jihad di Palestin walaupun beliau telah pergi menemui Allah swt dalam keadaan “Hidup Dan Mendapat Rezeki DariNYA”.
Puan Rasya Al Adlouni adalah simbol kegigihan wanita Gaza yang telah membuktikan bahwa semangat dan kekuatan wanita yang beriman benar-benar boleh kita jadikan contoh tauladan bagi kaum wanita di negara-negara umat Islam lain. Walaupun umurnya sudah 55 tahun dan kini mempunyai 20 orang cucu, beliau masih mampu berdakwah dan menyampaikan kebenaran tanpa ditimpa oleh perasaan lemah dan gentar. Marilah kita menelusuri jejak dan kekuatan wanita-wanita di Gaza yang sentiasa melahirkan pejuang-pejuang dan mujahid-mujahid yang akan membebaskan bumi Palestin dari penjajahan Israel.
Inilah kisah sebuah bangsa di atas sejengkal Tanah Suci. Penduduk Syam yang merangkumi Palestin, Lebanon, Syria dan Jordan memang penduduk yang mempunyai sifat keteguhan. Banyak peristiwa yang pernah berlaku di sana dan akan banyak lagi yang kelak akan berlaku di sana di akhir zaman ini. Semua kita harus belajar dari peristiwa ini terutama umat Islam. Semua segi harus menjadi pelajaran termasuk dari sisi kemanusiaan sebagai wanita.Tahun baru 2009 dimulai dengan kisah duka bagi umat Islam iaitu peperangan di Gaza. Pemandangan yang sangat memilukan. Namun Allah swt menjadikan peristiwa Gaza bukan sekadar untuk menjadi tontonan televisyen dan bualan para wartawan untuk bulan tersebut.
Apa yang kita dengar dari berita:
1. Seorang ibu dari keluarga Samouni di Gaza melahirkan anaknya di tengah-tengah suasana pengeboman.
2. Seorang wanita mengatakan: “Tidak, tanah ini milik kami, apapun yang mereka lakukan tanah ini milik kami, kami akan tetap menentang mereka (Yahudi).”
3. Seorang wanita muda pergi ke kedai roti untuk membeli roti dan terpaksa beratur berjam-jam di tengah-tengah ledakan bom di Gaza. Ketika ditanya oleh wartawan mengapa ia tetap pergi ke kedai roti padahal ia dalam keadaan tidak selamat, ia menjawab: “Tinggal di rumahpun kami dibom sedangkan saya perlu membeli roti untuk keluarga di rumah, jadi saya perlu laluinya juga. kita hanya mati sekali.”
4. Selama 22 hari perang, Israel berjaya membunuh 600 orang anak-anak Gaza dari lebih 1,300 mangsa yang meninggal, tapi selama masa itu pula lahirnya 3,500 bayi baru. Ramai wanita Gaza yang melahirkan kembar samada kembar dua atau kembar tiga.
Sungguh luar biasa, hanya sehari sesudah kedua pihak menyatakan gencatan senjatanya masing-masing, polis lalu lintas sudah bertugas di jalan-jalan di Gaza, bahkan sekolah dibuka kembali kurang dari seminggu sesudah itu. Para murid saling menyapa ketika pertama kali berjumpa: “Hai kamu masih hidup ya?”
Wilayah ini sudah tidak mempunyai bangunan parlimen, tidak mempunyai balai polis (walaupun anggota polisnya bertugas) dan seluruh bangunan pemerintah sudah hancur dibom bahkan masjid-masjid dan hospital serta sekolah tidak luput dari pengeboman.
Infrastrukturnya boleh dikatakan sudah hancur tetapi ternyata struktur masyarakatnya tidak hancur, sistem sosialnya tidak terhapus bersama bangunan-bangunanny a. Solat berjamaah tetap dilaksanakan di tengah-tengah hujan bom di antara runtuhan bangunan dan masjid. Bahkan masjid mengumpulkan dana dari sebahagian jama’ah yang masih mempunyai sesuatu untuk disumbangkan kepada jiran tetangganya yang lebih memerlukan. Inilah sebuah bangsa yang mempunyai daya tahan yang amat tinggi.
Jangan lupa, sebelum peperangan, Israel sudah mencekik Gaza dengan sekatan selama hampir 2 tahun dan itu menyebabkan semua penduduk Gaza mengalami kekurangan makanan kerana sukarnya untuk mendapatkan bahan makanan di samping harganya yang melambung tinggi.
Dengan berita-berita seperti di atas kita telah mendapatkan gambaran betapa anak-anak Palestin dari generasi ke generasi telah ditempa oleh ujian berat dengan pelindung mereka yang tetap teguh yang terdiri dari para ibubapa terutama para ibu yang tetap menggenggam prinsip kesabaran di tengah-tengah ujian yang amat berat itu.
Kita boleh meninjau beberapa kriteria yang menambah kesabaran mereka iaitu:
1. Tidak lemah mental mereka2. Tidak lemah penampilan mereka3. Tidak lemah aktiviti mereka
Dari berita-berita yang diterima, para wanita Gaza tidak lemah mental mereka dan tidak akan mengalah kepada penjajah Israel, di mana kebanyakan mereka berpandangan bahwa perjuangan menentang penjajahan tetap akan diteruskan. Tidak ada yang gementar ketakutan ketika mendengar deruan pesawat pengebom di atas kepala mereka. Jika ditanya, mereka berkata dengan nada tegas bahwa mereka tidak takut kepada tentera Israel dan akan melawan dengan senjata alat dapur, jika berhadapan secara terus. Inilah di antara tanda tidak wujudnya kelemahan mental di kalangan mereka.
Selain itu mereka tidak lemah penampilan di mana nampak jelas bahawa mereka tetap tegak ketika diwawancara oleh para wartawan, bahkan mereka masih boleh menyuarakan kekecewaan mereka kepada para pemimpin Arab yang tidak membantu mereka. Bahkan ada yang menunjukkan tangan ke arah kamera. Sikap tubuh mereka jelas menunjukkan bahwa mereka tidak lemah penampilan walaupun sesetengahnya dalam keadaan cedera dan menanggung kesakitan.
Mereka juga tidak lemah dalam aktiviti mereka di mana walaupun tersisa sedikit kesempatan, mereka terus menjalankan aktiviti mereka samada ke pasar berjual beli, memakamkan ahli keluarga dan kerabat sehingga sempat pula bersilaturahim sesama saudara mereka di pasar. Di tengah-tengah aksi pengeboman, mereka sanggup beratur untuk membeli roti dengan mempertaruhkan nyawa mereka. Bahkan ada seorang ibu yang melahirkan anak di tengah-tengah pengeboman dengan hanya dibantu oleh ibunya dengan menggunakan lilin di malam hari.
Berikut adalah beberapa kesimpulan yang dapat dibuat:
1. Wanita Gaza adalah wanita yang sabar, ujian apapun yang menimpa tidak membuatkan mereka gentar ketakutan berbeza dengan wanita Yahudi di Selatan Israel yang sehingga perlu dibawa ke hospital kerana “stress” atau tekanan mental menghadapi roket2 Hamas.
2. Ketabahan mereka ternyata didasari oleh iman dan ketaqwaan kepada Allah swt. Kita melihat mereka mengekang perasaan kesedihan mereka dengan berdoa mengangkat tangan kepada Allah swt mengutuk kekejaman Israel ketika menghadapi keadaan di mana rumah mereka hancur dan ahli keluarga yang terkorban.
3. Kuatnya keganasan dan permusuhan Yahudi justeru membuatkan mereka tetap tegak, teguh dan menentang. Penentangan wanita Gaza bukan dengan mengangkat senjata, tetapi dengan menunjukkan keteladanan dalam sikap berani menghadapi kenyataan peperangan yang keras dan kejam ini di hadapan anak-anak mereka.
Nampak dari raut wajah mereka yang meskipun terurai dengan airmata tapi tetap berwajah tegar manakala anak-anak mereka menatap setiap bentuk bahasa badan ibu-ibu mereka.
Pendidikan apa lagi yang terbaik dan paling efektif selain dari pendidikan menzahirkan keteladanan dalam kesabaran?.
Cubalah kita amati bahasa tubuh mereka ketika diwawancara oleh para wartawan, baik semasa perang mahupun sesudahnya di mana keadaan mereka cukup tenang ketika menceritakan pengalaman mereka.
Kaum wanita di Gaza tidak sesekali menyukai peperangan, namun jika peperangan merupakan takdir bagi bangsanya, kaum wanitalah yang memikul beban berat sebagai mangsa korban. Merekalah yang pertama sekali merasakan sukarnya hidup seharian di tengah-tengah suasana perang bermula dari persoalan mencari keperluan sehari-hari hingga kepada usaha menenangkan anak-anak mereka yang ketakutan.
Belum lagi ditambah dengan jumlah mangsa korban utama sebagaimana di Gaza ini kerana senjata perang Israel sentiasa mengejar wanita dan anak-anak walaupun di tempat-tempat penginapan mereka..
Bagi bangsa yang terjajah dan dizalimi seperti ini, masa depan bangsanya terletak di bahu mereka. Kaum wanita Gaza tidak seharusnya menunjukkan kelemahan mental, ketakutan yang menimbulkan perasaan menyerah kepada musuh atau kelemahan aktiviti yang menyebabkan mereka tidak lagi dapat bergerak menjalani kehidupan mereka.
Jika sikap-sikap kelemahan tersebut yang dilihat oleh anak-anak mereka pada hari ini, maka kita dapat bayangkan bahwa dalam masa 10 tahun ke hadapan, wilayah yang sekarang ini bernama Gaza mungkin akan berdirinya bandar-bandar pelancongan Israel dengan nama Yahudi sebagaimana nama Ashdod, Ashkelon, Sderot, Kiryat Shimona dan lain-lain.
Ini kerana jika mereka (kaum wanita Gaza hari ini) lemah, maka anak-anak mereka akan tumbuh menjadi penakut dan mempunyai sikap mudah menyerah tetapi Alhamdulillah sekarang mereka tetap teguh dan InsyaAllah sampai hari Qiamat pun bangsa Yahudi tidak akan dapat merasa tenang dengan kezalimannya kerana akan sentiasa ada yang menentang mereka dari satu generasi ke generasi Palestin yangbaru.
Inilah yang seharusnya kita belajar daripada mereka.
Ditulis Oleh razali · dalam Kategori Iktibar, Sejarah & Fakta

http://haluanpalestin.haluan.org.my

When the Heart Fails..

" Come down to resus now!" Dr Irina ordered

Oh no..Resus room?i've never been there before.
Resus room is in the emergency department, whereby all the unstable patient is placed and being resuscitated.

I quickly ran to the lift and frantically pushed the button to the 2nd floor.

Within few minutes, i had arrived at the Emergency department.(ED)

ED is a haphazard place to say the least. There are number of patients of all disciplines awaiting further management.

There is a sense of adrenaline rush entering ED, pumping through the vein.

....
" Sorry..mm.. I'm from ortho dept..where's the resus room" I asked with my eyes searching the room.

" Resus..I just came from that room just now..go straight and then to your left" The Dr in charge of ED assisted.

"thanks..i've never been there before' i grinned, thanking her and quickly found my way..

...........
" Azhani, room 4"..Called out by a familiar voice. Dr Irina.

"coming.."..I reached the room and there stood a number a staff attending to what seemed to be a young gentleman, strapped onto a bed.

I froze..The upper arm of the young man, was cut off..It was hanging by a thread, I suppose..Bleeding was profuse. He was on blood transfusion.

Everyone was looking at me, since i had just arrived. There was a specialist from hand and microsurgery department , several medical assistnt and my medical officer. They were struggling to stop the bleeding.

I didn't know what to do at the time. I tried to stand as near to the patient and to see what was the other problems that he might have sustained.

I reached for the glove and tried to get ahold of the other limb.

" Azhani, you take the Full blood count, coagulatoin screen, renal profile and crossmatch. We need another 6 pints for this patient"

I nodded and grappled the needle, syringe and cotton swab.

The rest of the staff left me after they had bandaged the wound.

"Kak..i'm so thirsty..just get me some water..please"..the gentleman pleaded.

" I'm sorry..but you can't. we're going to have an opeartion soon. You have to be fasted".. I struggled to get the vein. I tourniqued the right upper arm and managed to get the brachial artery. Alhamdulillah, it was easy and I quickly filled in all the test tubes.

.................

" Azhani, make sure that the bloods are ready stat,okay. He's bleeding terribly.."

"okay..i'll call the blood bank "

"Hello, this is dr azhani from orthopedics.. I have ordered 6 pints for this patinet...and need it stat . He's profusely bleeding and his vital signs are deteriorating"..

-------------------
I dashed back to ED, and trying to find the PPK to send the bloods. Unfortunately, the PPK could not be seen.

I ran to the blood bank myself and ordered the staff to prepare the bloods as soon as possible. I went back to Resus room and met up with the patient's family members.

" Doctor, how is he?" the father asked with pure agony

" Currently, he has lost massive amount of blood, but it should be okay. He's still a young person. We're trying our best, but if the bleeding still persist, then his condition could still deteriorate." I explained." But what happened ? How did he get this injury?"

They explained that the son was involvedin a fight and he was attacked using a parang. The offender had hit him on the head and subsequently tried to chop off the limb with parang.

I shuddered at the story ..
Astaghfirullah..how can a person be so callous as to do such a thing? I thought to myself. How can a person's heart be so hard?
" Then , after that, your hearts were hardened and became as stones or even worse in hardness. And indeed, there are some stones out of which rivers gush forth , and indeed, there are of them ( stones) which split asunder so that water flows from them, and indeed, there are of them ( stones) which fall down for fear of Allah. And Allah is not unaware of what you do". (Al - Baqarah: 74)
----------------------------
" Go call your MO now! " all of a sudden, a voice from room 4 called out.
I went to the room and found that the gentleman was unarousable.

Pulse rate was dropping. 64 beat per minute. blood pressure was dipping. Oxygen saturation was down to 38 %.

Astaghfirullah..what has happened?

" Tell your MO to talk to the patient's family. I dont know whether he's going to make it. We're going to intubate him." the ED MO voiced out.

" Dr Irina, the patient is deteriorating, vital signs are unstable" I cracked out.
---------------------
Within minutes of arrival, the patient was already attended by numerous staff. CPR was performed as the patient was going asystole.

30 minutes of resuscitation had failed to revive him.

pupils already dilated and he was soon pronounced dead.
To Allah We Will Return..
-------------------

Indeed, if a person do not realize that he will be returned in the land of Akhirah..and he does not realize that he is only a mere slave in this world..he will be able to do whatever he wishes in this world. His action will be acted upon his desires.
Nay! verily, man does transgress( in disbelief and evil deed). Because he considers himself self - sufficient ( Al - 'ALAQ:3)

Due to the feeling of pride, man tend to have the feeling of supremacy above others. He does not fear the day of the Ressurection. He does not fear his creator. He then dare to go beyond the limits that Allah has set upon mankind
, even to the extend of taking the life of another human being.

The He showed him what is wrong for him and what is right for him ( As-Shams:8)

------------------------------------
What is CPR?

Cardiopulmonary resuscitation (CPR) is an emergency medical procedure for a victim of cardiac arrest or, in some circumstances, respiratory arrest.^[1] CPR is performed in hospitals, or in the community by laypersons or by emergency response professionals.^[2]

For 50 years CPR has consisted of the combination of artificial blood circulation with artificial respiration^[1] i.e., chest compressions and lung ventilation.^[3] However, in March 2008 the American Heart Association and the European Resuscitation Council, in a reversal of policy, endorsed the effectiveness of chest compressions alone--without artificial respiration--for adult victims who collapse suddenly in cardiac arrest (see Cardiocerebral Resuscitation below).^[4][5] CPR is generally continued, usually in the presence of advanced life support (such as from a medical team or paramedics), until the patient regains a heart beat (called "return of spontaneous circulation" or "ROSC") or is declared dead.

CPR is unlikely to restart the heart, but rather its purpose is to maintain a flow of oxygenated blood to the brain and the heart, thereby delaying tissue death and extending the brief window of opportunity for a successful resuscitation without permanent brain damage.

WHat to do ?

In short, the procedure for "hands-only" CPR is simple. An untrained bystander who sees an adult suddenly collapse (after verifying that the person is unresponsive and is not breathing) should do just two things:

1) Call 911 (or send someone else to do this if you are not alone), and if others are present, send someone to find an AED (automated external defibrillator).

and

2) Push hard and fast in the center of the chest. The rate should be fast, about 100 presses per minute, but it's not necessary to count. Just initiate deep, rapid, continuous presses on the center of the chest and continue until the victim awakens, an AED is found, or emergency personnel arrive.

Hands-only CPR eliminates the mouth-to-mouth breathing of conventional CPR (alternating 30 chest presses and two quick breaths). Although hands-only CPR is very effective, it is not as beneficial as conventional CPR in a patient who is not breathing.

In all children, and in adults who collapse after a near-drowning, drug overdose, or carbon monoxide poisoning, mouth-to-mouth breathing should still be included to get air into the lungs.

Studies have shown that hands-only CPR can be as effective as conventional CPR and may save lives. Those who have been trained in conventional CPR may still opt to use conventional CPR instead of the hands-only technique.

***NOTE: This reference is only intended to serve as a guideline for learning about CPR. It is not intended to be a replacement for a formal CPR course.

( if any of you have the chance to undergo CPR course, it is very useful to do so)

references:
http://www.emedicinehealth.com/cardiopulmonary_resuscitation_cpr/article_em.htm

Boleh ke tak?

"Okey..wad 6C - ada tak x-ray yang perlu ditengok ?..tak nak pulak nanti tiba-tiba ada yang kena review x-ray"

"Hmm..setakat ni takde lagi dr. Kem..ada sorang je yang baru pergi ke kat x-ray department. Esok sajalah kita review"

"then..semua orang , rounds to your own wards. Dr Fir akan rounds kat 6C..okey..cepat - cepat..go back to your own wards" jerit Dr Kem

Kami bergegas kembali ke wad masing-masing selepas arahan diberi.

"Staff nurse!..Ward round sekarang..Dr Fir akan buat rounds kat sini"

"kita start dengan Makcik Nira ..bilik 10"

"This is madam Nira, post right knee replacement, day 5. She has ambulated with walking frame already. However, we're still keeping her since there is an erythema surrounding the wound." Dr Sekinah presented

"Hmm..she's on what antibiotics right now?"

"IV rocephine , day 4 already. The erythema isn't progressing, same like yesterday, thus we plan her to keep her still and continue the iv antibiotics."

"okay..observe the wound first. Make sure she's ambulating."

.....................................................................

" Madam XI LI, post skin graft, day 6, yesterday already inspected the wound. The uptake is good, no necrotic tissue"

" Madam Maria,..she has multiple medical problems. Her ortho problem is right intertrochanteric fracture. She is on skin traction currently. She is able to flex and extend the ankle joint and the toes. " reported Dr helina

..."Hmm...i think she'll probably be managed conservatively..with her condition, i don't know whether she's a suitable candidate to undergo an operation. ..Okay..we'll discuss with the specialist first..make sure she's on anticoagulants..one of you need to discuss regarding which anticoagulant she wants.." Dr fir gave us the usual orders...


.......................................

" Syukur kali ni ward round dengan dr fir..tak de lah kena marah" Helina tersenyum

" Betul..dah lah cepat kali ni habis rounds..yay! boleh balik awal.." balas Julia

Aku meneruskan kerja aku..cuba menaip secepat mungkin progress patients selepas rounds..

Alamak..kena counselling patient regarding anticoagulant pulak..getus hatiku..

........................

Apakah itu anticoagulant..

An anticoagulant is a substance that prevents coagulation; that is, it stops blood from clotting

Untuk patients yang akan bedridden for a long time - maksudnya , dia tidak akan berjalan sangat dan most of the time akan berada atas katil..ada risk of Deep vein thrombosis dan ia merupakan keadaan yang serius dimana boleh menyebabkan pulmonary embolism. Keadaan ini sangat membahayakan dan menyebabkan pesakit tu boleh meninggal dengan keadaan mengejut.

Sebagai pencegah kepada keadaan ini, kita menggunakan sejenis ubat yang dipanggil anticoagulant.

Yang menjadi isu nya ialah, anticoagulant yang di offer di hospital ialah samada heparin atau clexane.

Secara saintifiknya dua bahan ini berbeza dari segi molekular level. Tapi,untuk pesakit, yang menjadi isunya ialah sumber ubat-ubatan ini.

1) Clexane:

Enoxaparin is a low molecular weight heparin marketed as Lovenox or Clexane. It is used to prevent and treat deep vein thrombosis or pulmonary embolism, and is given as a subcutaneous injection (by a health care provider or the patient). Its use is evolving in acute coronary syndromes (ACS).

Enoxaparin is manufactured by Sanofi-Aventis and is derived from the intestinal mucosa of pigs.

Enoxaparin binds to and accelerates the activity of antithrombin III. By activating antithrombin III, enoxaparin preferentially potentiates the inhibition of coagulation factors Xa and IIa. The anticoagulant effect of enoxaparin can be directly correlated to its ability to inhibit factor Xa. Factor Xa catalyzes the conversion of prothrombin to thrombin, so enoxaparin’s inhibition of this process results in decreased thrombin and ultimately the prevention of fibrin clot formation.

2)heparin

Heparin binds to the enzyme inhibitor antithrombin (AT) causing a conformational change that results in its activation through an increase in the flexibility of its reactive site loop.^[15] The activated AT then inactivates thrombin and other proteases involved in blood clotting, most notably factor Xa. The rate of inactivation of these proteases by AT can increase by up to 1000-fold due to the binding of heparin.^[16]

-----------------------------------

" Assalamualaikum makcik..saya dr azhani..ni anak makcik ke?" aku menoleh ke arah seorang gadis di sebelah makcik tu. Dia mengangguk

" Makcik, keadaan makcik sekarang tidak mengizinkan untuk kita teruskan dengan operation, mungkin makcik kena pakai "skin traction" ini untuk beberapa waktu" aku menunjukkan ke arah skin traction yang terbalut pada kaki kanannya.

" Tapi, bila memakai skin traction ni, makcik akan berada atas katil saja untuk sementara waktu ni. tak boleh berjalan..makcik faham ke?"

Makcik Maria terdiam. Dia menghela nafas panjang. "ya..makcik faham"

aku menjelaskan komplikasi apabila patients terbaring lama atas katil dan keadaan Deep vein thrombosis. Dan akhirnya aku masuk pada isu anticoagulant.

"Tapi doktor rasa macamana..doktor pun muslim jugak..doktor syorkan ke guna yang dari bahan yang haram tu?"

.........................................

Hmm...apakah fatwa terhadap ubatan2 sebegini?

IDOLA KU...

Abdullah Azzam

Rantisi

Tok Guru

Sheik bin Baz

Sheikh Ahmad yassin

Dr yusuf al qaradawi

Hassan Al Banna

Aku inginkan suasana itu...

suasana yang begitu menenangkan..

di mana hanya tentang perjuangan yang diperkatakan..

hanya redha Allah yang menjadi buruan...

ku ingin menjadi seperti mereka..

akan tetapi..

hanya kelemahan yang ada pada diri..

apakah layak aku akan berdamping di kalangan mereka kelak?

apatah lagi untuk bersama dengan Rasulullah nanti?

yang dikelilingi para sahabat..

para mujahidin..

apakah suatu hari nanti aku akan terpilih?

another day at ORTHO

From Donor site

Mesh

It has been one month in orthopaedics...And still I feel as if i possess little knowledge of the subject. Numerous operations that I have attended,yet i still feel inadequate as to proceed with any large stitchings as of yet.

2 days ago one of my patient had to undergone split skin grafting to cover an extensive wound on the anterior aspect of her right leg. Most of the skin and part of the superficial layer of that part had been debrided and she had been on daily dressings.

I went in to assist the operation and it has been my first one to see skin grafting. Subhanallah! It was an amazing thing to see. The skin graft had to be taken from her thigh. The anterior aspect of her thigh. They had razor off the superficial layer of the thigh and make the layer gotten into a mesh.

The layer was made into a mesh using this machine - in which it sorts of grind and voila!.. There appears many different sheets of mesh. These mesh layers are then incorporated by way of applying into the extensive wound.

These mesh layers are then sutured into place. My job was to make sure that the layers are well applied and basically cut the sutures whenever asked by my medical officers.

It lasted for more than one hour and with the help of 3 medical officers, and one scrub nurse.

One thing that i realize is that teamwork is a must to create a harmonious and happy working environment. this will inevitably lead to good outcome of work in which both the doctors,staff and patients will be satisfied.

After a while working in orthopaedics, i have also discovered that i am actually getting a liking towards becoming a doctor. Before this, i had abhorred to be in the hospital, but since recently, i have found that the ward has not been such a nuisance to work in .

I have to work daily, with no holidays for this 4 months. It was something quite unbearable to work in, initially. It still is sometiems..but the stress level is not as daunting as it has been in obstetrics and gynaecology. Thus, i feel that i can focus more on my patients.

Aaah..my pateints..i feel so much at ease with my patients. I do like to see the smiles of my patients. It feels so much pleasure as to see their faces lighting and and getting better.

i have so many old patients...so many grandmothers in my ward that just tug my heart.

"makcik...makcik..apa khabar hari ni?" ..i would greet them with a big grin.

"makcik, makan dah elok ke?" ..i would definitely get a warm feeling inside whenever they nod with a grin that just shows off their false teeth.. :)

Hamba Pilihan

"sungguh beruntung orang-orang yang beriman, iaitu orang yang khusyuk dalam shalatnya, dan orang yang menjauhkan diri dari (perbuatan dan perkataan) yang tidak berguna, dan orang yang memelihara kemaluannya, kecuali terhadap istri-istri mereka atau hamba sahaya yang mereka miliki, maka sesungguhnya mereka tidak tercela.
Tetapi barangsiapa mencari di balik itu (zina , dan sebagainya), maka mereka itulah orang-orang yang melampaui batas. Dan (sungguh beruntung) orang yang memelihara salatnya. Mereka itulah orang yang akan mewarisi, (yakni) yang akan mewarisi (surga) Firdaus.Mereka kekal di dalamnya" ( Al - Mu'minun : 1 - 11)

Seringkali kita terlupa bagaimana seharusnya kita mengendalikan kehidupan kita..Dek terbawa dengan sekitar, kita terbuai dengan arus deras yang mengalir..membawa kita jauh dari syariat Agung.

Dalam mengharung kehidupan seharian kita, bukan sentiasa kita diingatkan akan hukum-hukum Allah yang tercinta. Bahkan, yang sentiasa dilaungkan di luar sana adalah untuk menentangnya...dengan cara yang halus.

Bermula dengan di pagi hari lagi..iman di hati mengetuk supaya terjaga awal untuk bermunajat dengan Allah - tapi ada dendangan merdu untuk terus memejam mata..

Kerja sebagai ibadah - seharusnya itu menjadi pegangan setiap mukmin. Kerja yang dilakukan setiap hari - itulah sepatutnya menjadi suatu wasilah ubudiyyah kita terhadap Allah. Namun, apakah ia terlaksana? Adakah tersemat di dalam hati kita bahawasanya timbunan kerja di hadapan itu merupakan kesinambungan ubudiyyah kita, usai saja solat dan sebagainya. Jangan lah kita menganggap bahawa ibadah khusus itu saja adalah wasilah ubudiyah kita.

Kerja harus dilakukan dengan penuh teliti dan komitmen.
Sebagai seorang doktor, pada pandangan saya, seharusnya ia perlu untuk mengambil berat terhadap pesakit dari semua segi..fizikal , spiritual dan emotional. Contohnya, apabila bertanya tentang keadaan dia sekarang - guna lah peluang itu untuk memasukkan sedikit ' kata-kata tarbawi' untuk menaikkan sedikit perasaan rohaninya.
"Puan..apa khabar hari ni? macam mana hari ni?sakit nya makin kurang ke? ..Alhamdulillah...Insya Allah, nampaknya luka makcik hari baik..Doalah agar Allah permudahkn..."...

Kalau dari solatnya bagaimana? Adakah pesakit itu menganggap bAHawa setelah dimasukkan ke hospital, solatnya boleh di qada'?...inilah yang menjadi dilema utama ...dan ini merupakan suatu masalah yang berleluasa. Sehingga kan jarang sekali kelihatan pesakit2 untuk menunaikan solat...

dan orang yang menjauhkan diri dari (perbuatan dan perkataan) yang tidak berguna,

Astaghfirullah..sesungguhnya perbuatan dan perkataan yang tidak berguna seringkali dibuat oleh kita semua...dan terasa seolah-oleh tidak dapat untuk mengelakkannya.

"Eh..eh...ko tau tak..dia tu tak habis- habis lagi nak cerita tentang si polan...aku tak larat dah nak dengar..macam dia tu bagus sangat"..kata cik jenab

"memang..aku pun dah tak larat. mentang- mentang bos puji dia..ala, mana tak nya, ...pot pet..pot pet" balas cik minah..

kalau di pejabat/wad - sememangnya perbualan adalah suatu kemestian. Tapi, jenis perbualan bagaimanakah yang dikehendaki ..dan jenis mana yang perlu dielakkan?..

Itu belum lagi menamakan perbuatan-perbuatan yang tidak soleh...terutamanya dari segi pergaulan di antara rakan setugas.. yang berlainan jantina

"Jom kita makan kat luar..aku dah lapar dah ni.." ..Hassan memandang ke arah Hasnah..Tangannya mencuit bahu Hasnah.. "nak makan kat mane? fast food ke warong?.."

fenomena-fenomena ini menjadi suatu kebiasaan..sehinggakan sekiranya kita tidak memandangnya dengan perasaan tarbawi - kita akan menganggap seolah-olah ia adalah perkara yang tidak salah.

Malah jawapan setengah orang ialah"..aku tak leh kluar dengan orang lelaki lain..pakwe aku ngamuk karang...". nilaian dan neraca nya adalah disebabkn oleh seorang insan lain.. bukannya dari segi syariat...

Apabila memikirkan semua ini..bukannya senang untuk digelarkan sebagai seoarng mukmin...dan sekiranya Allah tidak memberi petunjuk , sesungguhnya amat senang sekali untuk terkeluar dari jalan yang diredhaiNya...

Sungguh indahnya sekiranya dipilih Allah untuk menjadi salah seorang hamba yang diredhaiNya dan menjadi hamba pilihanNya ---untuk mendiami Syurga Firdaus...

Subhanallah!!

For the 3rd week in a row, i'm stuck assisting in the operation theater (OT). It seems that most of my time spent so far for this posting is inside the OT. yesterday, my medical officer had allowed me to suture the fascia and muscle. Since i was a bit slow, i had not the opportunity to continue with the subcutaneous and tissue. it felt somewhat exciting getting to stitch, as opposed to just retract the muscle all the time. What is required for the Houseman to do during major operation is mostly, retract the muscles, suck the oozing blood and pass the instrument. And, of course, hold the limb..it's not much of a work, but it's just the beginning. There were 2 operations that had lasted more than 4 hours that i had assisted in the last 3 weeks. One was spine operation and the other one was of arthroscopy of the knee.

One of the most amazing thing that i discovered is that the human body is such an intricate design. Subhanallah!

"Wahai manusia! Telah dibuat suatu perumpamaan. Maka dengarkanlah! Sesungguhnya segala yang kamu seru selain Allah tidak dapat menciptakan seekor lalat pun, walaupun mereka bersatu untuk menciptakannya. Dan jika lalat itu merampas sesuatu dari mereka, mereka tidak akan dapat merebutnya kambli dari lalat itu. Sama lemahnya yang menyembah dan yang disembah" ( Al- Hajj :73)

Sesungguhnya Allah Itu Maha berkuasa. Can you imagine, even if there was only a malleolus fracture which extends into the joint line, we are still ridden with pain and swelling. thus, we are left with agony and bounded to the bed due to pain.

We are weak indeed, and we must put that inside our heart and be reminded that we are bound here with syariah that Allah has imposed upon us...Our life is for the sake of ibadah..

Health talk!!

RICKETS

As humble servants of Allah, we must bear in mind as to take good care of our spiritual,mental and also physical health. It may seem rather trivial as to ensure that our health is at its optimum level. However, once this nikmah is taken away from you, it is rather grievous indeed.

Have you ever wondered how it is like to feel pain most of the time?or having shortness of breath? or to be bedridden?

And the need to be admitted to the hospital ? to be poked at ?

It is no pleasure indeed, I must tell you.

Good health is one of the blessings by Allah, thus it is with this reason that we must take this into consideration and it is our duty as Muslims to take care of the gift given by the Almighty:h

From Albukhari - (from his sahih) -
Dua nikmat, yang kerananya banyak orang yang tertipu : kesihatan dan waktu kosong

...Thus, i would like to start this session with getting to know one of the nutrients that's important in our body:

Vitamin D: (calciferols, fat soluble)
- Available mainly from animal sources, fungi and yeast.
mainly manufactured in the body when the skin is exposed to sunlight.

So, you may wonder, why is this important for us?
--> This is required for the absorption of calcium and potassium; the use of calcium and phosphorus by the body.
Think of it this way, it's important for your growth and strength of bones, cartilage and teeth; stronger muscles nd nerves

What happens when there's not enough of vitamin D?
- dental caries, insomnia, muscle cramps, nose bleed
in children, it causes rickets and adults - osteomalacia

What are the symptoms of deficiency:
- anaemia, less bone growth, weaker muscles, respiratory infectoins..

-- Vegetables for health and living, by Prof Dr Ong Hean Chooi,institute of biological sciences,UM