"Last Day" in Althorp / HCPA ward

It's been such a long while since I've last written on the blog. Unfortunately, it's not at all because we have been away travelling this summer. In fact, it has been a miserable summer. It is probably THE WORST summer I've ever had in the 11 years I've been in this country. For the past 3 weeks or so, it's been raining almost every day and that has pretty much quelled any desire I have for travelling, writing, photography or being creative.

Enough of that rant, on to the story.

Today was supposed to be our last day in my current ward and our last day as a team together. It was meant to be a sad day indeed. We officially finish our endocrinology post at the end of this month but due to several circumstances (read: poor planning) they (read: the monkeys) are closing our endocrinology ward, and distributing the team to other wards to help out. Don't even get me started on the politics or the logic behind this, because it appears to us there is none.

Anyway, it was meant to be our last day together as a team and it was meant to be a sad day. Looking back, on these few months it's a real pity I didn't blog more about my fun days at work as almost every single day has been such a pleasure with my friends and colleagues in the team. In retrospect, I should have written more on the various things we were up to, stuff we talk about, all the jokes we shared and mischievous activities. Ah, mischievous activities .... :)

So to celebrate our last day together, as usual we all bought food and drinks to share after the ward round. It was wonderful - we had Thornton's chocolate cake, a rich variety of (rich tea) biscuits, chips, pretzels, jelly beans, tea, hot chocolate and coffee. It was a pity that two members of the team could not make it (Suboohi for being "slightly" under the weather and Anand for oncalls) to our epic journal club today.

The following are pictures of our supposed last day together, taken earlier today:


The Thorntons Chocolate Cake. The taste of this cake is beyond this world. I'll let you guys know on something about me: I'm not a very big fan of chocolate (yes, literally as well). So, to me the chocolate cake was a bit much - I had to have plenty of tea to wash down the sickly, hyper-sweet taste.

Dawn had the honours of cutting the cake. Pictured are the various goodies we shared today.

This was our team today - only 4 people including yours truly. I have just realised something as I downloaded the pictures onto the PC - I forgot to include myself in the pictures! Nooooooooooo! Oh well, there's still tomorrow.

Sarah and Abhishek


Sarah; she's one of our two registrars. I really look up to Sarah - she's extremely clinically sound, diplomatic and friendly.


Dawn is her usual happy, bubbly self.

I have always looked up to Abhishek too - he's another Senior SHO on our team, but several years my senior. Abhishek is very organised and responsible. Extremely intelligent and detailed too. I've learnt and copied so much from Abhishek.







In the end you know what? It turned out that last night's oncall was so packed with admissions that the hospital could not afford to close a medical ward. So, they alerted all of us that they are not closing the ward for another week! All the emotional turmoil we've been going through has been premature! Oh well, at least I have another few days with my lovely team:)

I'm looking forward already to go to work tomorrow!


------
Photography sidenotes (i.e read only if you are into photography, otherwise please ignore:)

Today, I took my 9999th and 10 000ths picture using my Canon 400D, or Taka Arashi as it's more affectionately called.

This is my 9999th picture:


This is my 10000th picture:


Now that I've owned Taka Arashi for around 9 months I've grown to really, really enjoy and like my Canon 400D Digital SLR camera. I remember when I first used Taka Arashi, I was extremely unhappy with the unsharpness and lack of detail especially when using the kit lens. I was also unhappy with the exposure, which to me tend to err towards producing dark photos. Having learned the nuances of the Canon system though - I've come to really enjoy using the camera and nowadays, I am usually very happy with the results. Here are the reasons I really enjoy using the Canon 400D:
1. It is relatively cheap; cheaper than Nikon's D80 or the Sony Alpha.
2. It has relatively more features than said Nikon.
3. I absolutely LOVE the professional grade L lenses. So far I only have the 24-105mm F4L IS lens and using it has been an absolute pleasure.
4. Picture quality, especially with the L lens is MAGNIFICENT.
5. The colours, provided with good lighting, are vivid and attractive.
6. If I stick with buying L lenses I have to option to upgrade to a full frame 5D or 1D mark III.
7. The 1D Mark III DSLR is ONE HELL of a camera. It costs around 4000 pounds and could take 10 frames of 10 megapixel, almost full frame pictures. The image quality is reported as one of the very best for a DSLR.
8. The 400D is small - perfect and as if custom made for my small hands. It's also relatively light.
9. The Canon range of accessories are extremely varied: wireless transmitters, various speedlight flash, batteries, battery grip and ooooooh the lenses. Especially the L lenses *drool* and the superwide EFS 10-22mm *DROOL!*

There are of course things I don't like about the Canon:
1. the pictures are still less-sharp. This is a "feature" of the Canon system. It features anti-aliasing to reduce moire artefacts. At the expense of a sharp picture. True, it could still be sharpened in Photoshop.
2. the exposure, to me, is still less than perfect. To me, they still err towards under-exposure but I've come to learn how to compensate.
3. the kit lens is rubbish.
4. contrast, under the default setting is way too high.

An extra note:
Lately I've migrated from using aperture priority mode to using manual mode. I am loving the manual mode, I tell you. I really like the extra control over exposure and consistent looking pictures. I am loving it, loving it!!

I do have qualms about using manual mode though, and that is - it's too slow to set up especially when you (a) want to capture fleeting moments (b) to change aperture or shutter speed on the run.

In other words, I really like the exposure I get from using Manual Mode and you can say I hate the inconsistent exposure using Aperture Priority, but for photographing moments, I still have to use Aperture Priority I'm afraid.

Thank you for reading. Until next time :)

Random Thoughts Post Barbeque

How I wish I could write down entries on the blog as soon as they occur to my mind. The one hour drive each morning to work is usually the time for bursts of inspiration but by the time I get home in the evening whatever impetus of idea I had would have disintegrated into fragments of incoherent thoughts.

Let me recall:

1. Post BBQ

The barbeque our team had had at Rutland Water has done wonders to our team's morale and congruity. We are now almost inseparable! As a friend most eloquently pointed out at our first lunch meet after the weekend: "It seems that after the BBQ we have stopped being colleagues - we are now officially friends".

I was oncall on the Tuesday we started work after the bank holiday weekend, and I was so surprised to find Abhishek there in the Medical Admissions Unit at tea time - he turned up just to invite me back to the ward for several minutes to join the rest of the team for our "journal club".

Aww - how nice.

At lunch, even though we were all working in different places due to oncalls, the whole Althorp team met up in the canteen to eat together. We are already planning our next outing ;) hopefully soon in the future.

2. The oncall

There's also something I wanted to share about my recent oncall. Partway through the day, we suddenly heard the dreaded sound of a cardiac arrest call. I ran to the surgical ward to find that the medical registrar was not present, and thus I had to lead the arrest call. Whenever I am called to a cardiac arrest, a sort-of "work flow" or algorithm would run through my head and it went like this at that time:

• Arrived. Patient is unconscious but breathing spontaneously and has a pulse.
• Blood pressure present: 120/60, heart rate 150.
• I asked the nurse for the patient's history
  
• Nurse: "80 year old, background of atrial fibrillation, hypertension and that's it. Found collapsed with a high pulse"
• I tried to rouse the patient - no response but still breathing and confirmed pulse.
• Asked for an ECG. ECG shows rate of 150, atrial fibrillation. No ST elevation to indicate MI.
• Delegate task of taking full bloods and arterial blood gas to juniors.
• Ask nurses to take blood glucose reading: blood glucose = 11 (darn, not hypoglycaemia!)
• At that time I considered to slow the heart rate with IV digoxin or amiodarone.
• IV access present
  
• I asked the nurse to repeat BP: BP fell to 90/40.
• Start IV colloid: (gelofusin) then recheck BP.
  
• As soon as the gelofusin ran through, the BP immediately picked up to 120 systolic, and the pulse slowed down to 90.
• I examined the patient: chest clear, heart sounds normal, abdomen ?!
• ... abdomen was board rigid, with a pulsatile and expansile 6cm mass
• Diagnosis: Query ruptured abdominal aortic aneurysm!!!
• Surgeons oncall bleeped and arrived - agreed with diagnosis of AAA and patient was arranged to be transported to theatres.
  
• Patient's blood pressure and pulse continued to improve with the IV gelofusin and fluids and the patient is starting to rouse.
• Checklist (I said this all out loud): "IV access, IV fluids, ECG, bloods, arterial blood gasses, pulse, blood pressure, surgeons - all check. We've done all we can, I think".
  

A friend of mine said, "Yes, we've done all we can - that was a well led cardiac arrest." And then, suddenly everyone in the arrest team - nurses, anaesthetists, the medical doctors, surgeons - nodded in agreement and gave me a clap! A nurse even said, "you're a natural born leader" but my brain was too short-circuited at that time for me to come up with a reply and I just smiled meekly and gave a wave of dismissal (which in human language should be translated as "nah, it was really nothing").

I have to say though, the event did make me feel slightly proud and happy - even till today :)

3. My friends do not get me

Courtesy: Stay Green

Back on the wards the next day, I found out that a friend was oncall. So after work, I went to the Medical Assessment Unit to meet up with him before I went home. The timing was excellent, as he was starting a tea break with the rest of the oncall team, and I was invited to join in.

A (male) friend of mine was complaining of chest pain. Everyone else in the room was giving their diagnoses - the most popular and likely being musculoskeletal chest pain, of course. Trying to be cheeky & funny I said I thought it was breast cancer, "any discharge?", I asked - cheekily. To my surprise, my friend - not the one in pain - felt so strongly against the joke, that I felt slightly silly for making it in the first place.

It was at that time when for the first time I realised, "Even though I have been working with this guy for YEARS, he still doesn't get my jokes!"

I don't know whether this is true or not, but in Malaysia, especially when working amongst male colleagues, it's quite common-place to make (urm, how should I say it) off-colour jokes, right? By "off-colour" I mean jokes that are shifted towards the ultraviolet end of the colour spectrum, get what I mean?

After 3 years or so working here, I finally realised - jokes like that are not acceptable in this country! D'oh!

So from now on, my joke algorithms has to be squeaky clean. That reduces my joke repertoire by at least 50%!

4. Thoughts on Althorp team

Moving to less cheeky matters now, I just have to say - I am working with a great team in Althorp at the moment. I dare say, we are probably one of the most cohesive group in the whole hospital - emphasis on "probably". One friend from our team said, "Going to Althorp ward every day feels not like going to work, it feels more like going to Nursery to play." What he means by that statement is that because we have such great teamwork and friendship in Althorp ward, coming to work is such a pleasure that it doesn't feel like a chore and I feel so fortunate to be part of this wonderful crew. Here's hoping for more great times ahead.

Fotopages

Latest picture on my Fotopages. Taken at Longford park over the weekend, it was excellent. We went out for an outdoors picnic with D and her kids & Dina. Arep's presence was sorely missed. It was D's birthday - and even though the celebration was moderate, it was brimming with fun - especially for the kids. More pictures to follow over here I think - soon.

Icecreams by the Pond

Spring is such a wonderful season. After the cold winter, spring is like the finish line after a long marathon, or the breath of fresh air after a long dive. We are all just so happy to welcome this wonderful season.

The Thursday just past, after a particularly efficient and productive afternoon, the team decided to hold an picnic "audit discussion" in the hospital's pocket park. We even brought (my favourite icecream) Soleros, coffee and food to share outdoors. The team's morale was increased several hundredfold while we were gazing at the tadpoles and the water-snake in the pond, absorbing the sun and enjoying our icecreams and coffee, exchanging stories, jokes & anecdotes.

It was certainly a day to remember for years ahead!

PS

1. This picture is from last year, at the time we had the "audit discussion" I was so wishing I had my camera to capture the moment.
2. It was only when I got home that I remembered - I did have a camera; my mobile phone! D'oh.
3. Our code word for tea break is "journal club", and from now onwards our code word for "enjoying the sun outside" would be "audit discussion".
   

Althorp Ward

Before you guys read any further, I'd be honoured if you guys wouldn't mind jumping over to my fotopages to see the edited version of these photos. Thank you. They are much better than these Picasa processed ones.

I haven't updated for a while, so let me reveal that I am currently working in endocrinology, now as a senior senior house officer (SSHO).

Yup, it seems that the hospital I work in has seen it fit to promote me to a more senior level despite in my opinion that there are so many other superior candidates there. I've heard the rumours several days before I was actually officially informed - and I was quick to the rumours as impossible. I was EXTREMELY shocked when the clinical director stopped me along the ward corridor to offer the promotion. I humbly accepted. I've now worked as a senior for around 2 months. Initially I didn't post about it on this blog as I myself couldn't believe everything and it has taken all this while for it to sink in.

Honestly, being a senior does change many things. There are slightly more responsibilities, and there are many more opportunities to do the "fun things" during oncalls (my first night oncalls as a senior SHO we had to insert a cardiac pacemaker - a process that took 6 hours! It was darn exciting).


That's the explanation why my return to Malaysia has been slightly delayed - but just for several months. I am definitely, absolutely, positively going back to Malaysia very, very soon - frighteningly soon, in fact. My parents seemed to encourage me to gain experience training in a more senior post.


Anyway, I am so happy to be working in my current ward. My colleagues are absolutely amazing to work with - the nurses and doctors are all hardworking and friendly. The ward is extremely efficient and our consultants are cool & very supportive. It really is a great team - it probably is one of the best wards I've worked in so far.


All the pictures above were taken today in my ward. The first few pictures are the doctors having what we call "journal club", which is a code we utilise to indicate "having a break for tea or coffee while occasionally discussing medical matters".

The first four pictures are of the other doctors in my team, the second last picture is of some of the nurses. The last picture is of the ward, my favourite ward Sister and our House Officer.

PS
Remember, better pictures on my Fotopages.

24-105mm F4L IS USM

Urgh, It's been a while hasn't it? I'm so sorry but I'm afraid it's another photography post, despite I normally post stuff like this on my Fotopages. Sorry!

Anyway, I've been looking into replacing my retarded "kit" lens for ages. The kit lens is really terrible in terms of poor resolution, relatively slow speed & distortion. I was considering getting the Sigma 18-200mm F3.5-6.3 with Optical Stabilisation - yet to be released, unfortunately.

Lately, Puan Mama Sarah has been asking if it's okay for her to get a Nikon D40 for herself. She's been into photography too - especially taking pictures of the children & of food. I was seriously considering to get Puan Mama Sarah the Nikon D40 (around 250 pounds) and the 18-200mm VR (around 500 pounds) and the Nikon 50mm 1.8 prime (around 60 pounds) totalling to around 800 pounds.

At first, to me buying a new DSLR is okay especially to support Puan Mama Sarah's hobbies. Talking to most of my friends though, they all say that it's a waste of money to buy another DSLR, but of a different brand. We might as well buy a new lens. You could get a nice L lens for less than 800 pounds.

Well, the rest is history. For Puan Mama Sarah, I present the Canon EF 24-105mm F4L IS USM. It arrived today, only a 3 day wait. We tested the lens in Jessops and were both so impressed with it that I felt I just had to get it (word of warning Arep & Rosli, DON'T test this lens!)

The lens came supplied with a carrying pouch, a petal type lens hood and the instruction manual.

This is the new L lens compared to my old 18-55mm kit lens. Notice that the 24-105mm L is significantly bigger, wider and heavier...

... but, it is also way better constructed with weather resistance, metal mounts, metal body etc2. My kit lens is not yet obsolete though, as I still need it for the wide 18-23mm lengths.

Let's put the new lens to the test:


The 24-105mm L is sharp and has good resolution.

Colours are very nicely conveyed.

I finally have longer reach with 105 mm but I found that even at that length, it is not long enough to take good close ups of wild life. The range of 100-400mm would be better.

At 105mm F4, the background is rendered nicely blurry (also called bokeh). Having Image Stabilisation really helps as well - especially in my unsteady, caffeine perfused, hands. I find that at 105mm, a speed of 1/13 would be sufficient for sharp pictures - not bad eh?

Am I happy to have this lens? Yeah, I'm kind of happy.

I'm happy to finally get a sharp lens, with quite good zoom range from 24-105mm and with Image Stabilisation. However, I cannot help but feel the best money-to-performance ratio would be the Sigma 24-70mm F2.8:

The Sigma 24-70mm F2.8 (example image above) has excellent resolution and quite fast at F2.8. It's branded as a macro lens as well and the picture above was taken at the closest focusing distance.

Compare with a shot using the 50mm F1.8 prime lens, below:


and finally the 18-55mm kit:




Anyway, can't wait to further experiment with the new lens.

Please visit my Fotopages too

Many people have approached me asking why I haven't updated my blog more regularly. To be honest, lately I've been shifting my attention to other matters: work, playing with the kids and my various other interests. However, I am still active on the net especially on my Fotopages:

http://ichi-mynn.fotopages.com

My intention was to post my less bad photographs and boring, photography related writings over there while posting everything else over here in Blogger - like journals and stuff. Unfortunately, due to the bad winter weather there has not been much of the "everything else" lately and thus the blog has been left barren.

Of course it is my intention to continue blogging, and there are half written posts in my drafts folder - just waiting for them to cook a bit longer. I've learnt the importance of blogging - the meetings with other bloggers recently - like Momad, Arep, Alynn, D - has made me realise how nice it is to finally meet friends we make on the net. Hopefully more of these in the future.

Also, now that the weather (and the car - loooooong story!) have improved, we are already planning future excursions with Auntie & Uncle De and Rosli & family. Can't wait!!!

Remember - check my fotopages too for updates.

Joyful Presents

I am way behind with updating my posts, I know. The pictures above were taken a few days after Safiya (quiteeeee a few days after Safiya's) and Puan Mama Sarah's birthday while we were visiting Kak Sawiyah in Wales. The above pictures were of Puan Mama Sarah & Safiya receiving their presents, just look at the lit up faces :) Thank you for a wonderful evening Kak Sawiyah!

Conclusion to Azim's Story?

Remember my brother Azim? Well, it has been around 2 weeks now since he was released from hospital after the accident. In the two weeks, Azim has been followed-up twice by his surgeon and the surgeon is happy with Azim's progress. Azim has also had several sessions of physiotherapy to mobilise his hand.

This is what his hand looks like two weeks after the operation. The graft has mostly healed well, with a few areas of breaks (which Insya Allah, will heal by itself after several days-weeks). To me, the wound seems to be nicely progressing. However, Azim says that his hand is very stiff - he is unable to move his fingers more than around 3 degrees - and that the hand is slightly swollen. He will need extensive physiotherapy to mobilise his digits in order to regain normal functions.


Now that all is well, Azim has been booked his flight back to Malaysia for this weekend. Everything was nicely planned, I was supposed to fly to Ireland tonight to help him with his bags and we were supposed to fly to Heathrow tomorrow.

However, bad luck seems to be following Azim like a shadow - this time in the form of fog.

(Picture: http://www.guardian.co.uk)
For the past 3 days, England has been blinded by fog. Driving back from my oncalls last week at night, the visibility was limited to only 10-20 metres. To make matters worse, the weather was cold and the roads slippery with ice.

In response to the fog, Heathrow has grounded most, if not all, domestic (mainly British Airways) flights. Most other flights are either delayed or cancelled. Meaning that our flight to Heathrow had a high chance of being grounded too, diminishing the chances of Azim flying back to Malaysia! The weather was reportedly going to remain terrible until after Christmas - affecting tens of thousands of people intending to fly from Heathrow.

Thank goodness however, we responded quickly. We had Azim book another flight to Birmingham (where the flights are not grounded, as visibility there is probably better) at the earliest possible opportunity. Alhamdulillah, we managed to book a flight for Azim for this morning and now Azim has arrived safely with us.

It is still far from over though; Azim is supposed to fly from Heathrow tomorrow - and I hope there wouldn't be utter chaos. We have already booked the bus tickets to arrive at least 8 hours before the flight, to include delays. It normally would be a horrible day to travel tomorrow, as it is the Christmas Weekend, but I'm hoping that would not be the case.

Wish us luck.

PS

1. For larger fog images, do visit my Fotopages :)
2. Oncalls has forced me to neglect my blog - I'm terribly sorry. Many updates planned for this Christmas holiday though :D