Wednesday, April 22, 2009

BOMOH - In All Strata Of The Society

Look at these 2 CT-scan films

The first was taken on 17/02/2009, and the second was taken on 20/04/2009 They are 2 months apart. Name deleted.

This CT-scan film belongs to is a 50 year old lady (not a commoner) who presented two month ago with lower abdominal pain. She was diagnosed to have ovarian cancer and was adviced (by the gynaecologist) for surgery and chemotherapy.

She went off AOR (at own risk), refused the treatment and opted for the bomoh 'therapy'.

Bomohs are usually more friendly than doctors, but their 'treatments' are cheaper. Wrong ! some charge much more than what I charge for a laparoscopic cholecystectomy for a single consultation.

Back to this lady, she came back to me 2 months later with intestinal obstruction. The intestine was blocked completely by the cancer. She could not eat or drink, vomitted her stomach out. She now agreed for anything, belahlah, colostomy pun tak apa !

But everything was too late. The tumour was not resectable; anyway I did I could do to help her. And she now is counting her days.

Kadang-kadang terfikir juga, apa salahku? Mungkinkah aku tak tahu nak explain apa dia kanser. Mungkinkah aku kena cakap ...Makcik, kalau tak rawat ini, makcik mati dua bulan lagi.

In Kelantan, this bomoh things are killing more people than what the Mat Rempits do on the road. Nak salahkan siapa ?

Ada orang kata ............ ini budaya kita.

Ada juga yang kata ..... ini mentaliti dunia ketiga

Janganlah kata.............. Melayu mudah lupa

I saw TV9's Tanyalah Ustaz 3 days ago. Ustaz Amran Kasimin answering questions, very interesting.

Tuesday, April 7, 2009

Radiologist blues


When I was a lecturer in the university, I got very irritated when my students demonstrated 'lack of common sense'.

Medical students are unique creatures; there are usually intelligent, capable of memmorising many things, giving 1001 rare differential diagnoses, but (now I begin to realise that) they are actually lack of common sense.

I used to think of that long time ago, but I kept pushing that idea to a deep corner of my head. Maklumlah, they are top scorers in their schools and colleges. But more often than not, when you asked them simple straight forward things, they could not give you the answer. They think that you simple questions are tricky, and give you around-the-corner answers. If I do post-grad teaching, it is usually highly 'technical' (or rather surgical), but if I take year IV medical students, it becomes philosophical. This is because I want to inculcate 'common sense' into their brains.
With teaching and training, they 'come back to their sense'. Many of them become good doctors after graduating, but some of them maintain this bad attitute in their professional life.
This is demostrated in this particular case.

This CT-scan film belongs to a 52 year old lady who came to me two days ago. She complained of a severe upper abdominal pain and a progressively enlarging mass in the area. Associated with that she had occasional fever, poor appetite and a weight loss of 16 kg in the past 6 weeks. The pain was so severe that it was only temporarily relieved by pethidine.
She was seen in three hospitals in the last 6 weeks, the last was on 26/03/09 on which a CT-scan was done. She was asked come back for the CT scan report on 26/05/2009 (The radiologist wrote TCA - 2 months, the nurse gave appointment on 26/05/09).
The scan above (taken in my hospital) shows a huge multicentric liver cancer, which is about to rupture (the severe pain is due to liver capsular stretching). I bet on 26/05/2009, she is already 6 feet underground. In the hospital her pain was only controlled with i/v Fentanyl PCA (patient control analgesia), Oxycontin and amytriptyline. Yet the 'good-thinking chap' requested 2 months to report a CT-scan of a terminally ill, dying mother of 5 children presented with an impending rupture of liver cancer.
Inilah yang dikatakan "ada akai tapi tak pakai" atau NO COMMON SENSE !