My Artwork the 2nd

I have to say that I enjoy making posters for Palestin issues, and even the last time, it came out quite good

I came up with an idea to do a countdown... This is Ramadhan special

Of course we have iftar, always have n always will...

Ah-ha... this is d first KBM-Special poster... don't forget to check out the "story" behind this poster...

go to link: http://keindahanbersamamu-ppukm.blogspot.com/2010/11/lepaskan-diri-dari-penjara-dosa.html

this was made for Fahmi's entry, his very first entry.. Go to Link:

http://keindahanbersamamu-ppukm.blogspot.com/2010/10/gara-gara-hiburan.html

I really like the book : Super Health... Its very medic n scientific! I hope to do more posters like these

I really like this poster.... :D

Go to link: http://keindahanbersamamu-ppukm.blogspot.com/2010/11/ziarah-sahabat-nursing.html

Ha-ha... this is a special father's day poster i guess... This is d first time i have my family member as a model for my poster... Me dad~~~ but there's a sad n touching story to be shared here... Go to link:

http://keindahanbersamamu-ppukm.blogspot.com/2009/06/cerita-tentang-ayah-bukan-sekadar_22.html

and the award for the most popular post goes to~~~Prof Har's talk!!Yeay! congrats to prof har... I guess she have quite an influence :D... Go to link:

http://keindahanbersamamu-ppukm.blogspot.com/2010/11/perkongsianour-role-in-sex-related.html

and the 2nd most popular post goes tooooo.... DERU!!Oh yeah! im so happy for DERU!!

go to link: http://keindahanbersamamu-ppukm.blogspot.com/2010/11/post-deru.html

kisah raja n ikan: 

http://keindahanbersamamu-ppukm.blogspot.com/2010/11/kisah-raja-dan-ikan.html

we have a monthly "ta'lim by ustaz emran.. there will be a third one, n yes, still on shahadah.. shahadatain is very very important people....

more Surau's program...

this poster was made after i met a psychiatric patient who have suicidal ideation... she make me think a lot that i came up with this:

http://doctorimanrozali.blogspot.com/2010/12/what-makes-you-live-life.html

this one is on Hijrah : http://zatelimanrozali.blogspot.com/2010/12/mari-berhijrah.html

this is a perkongsian on PERINTIS's forum: http://keindahanbersamamu-ppukm.blogspot.com/2010/12/pada-7-disember-2010-bersamaan-1.html

this is actually an artwork i made specially for the book PERSIAP is making, the inter-language book?

i think that was it.. huhu...

The Doctors We Are Becoming

This article was written by Leana S. Wen, MD where she talks about her experience and feelings during her internship (which I assume the housemanship, as we called)... Its a very good article, unlike other "immature" stories of people sufferings during housemenship, I find this article very helpful in its own way. The best way to learn to survive is learning from someone passionate enough to actually survive at the same time still stand strong to what they believe to be the right thing to do

DO ENJOY READING IT (^_^)

"Excuse me… um… how exactly do I order the Tylenol?"

I look up. In front of me is a young man wearing a pressed shirt and striped tie. "I'm Ben," he says, introducing himself to me as an intern on his very first day of residency. It's not really a statement that needed to be said; none of us would have mistaken him for anything but. How to order Tylenol is a seemingly self-explanatory action, but last year it was me asking that question. As I lead him through the order entry system, I reflect on the past year. How have I grown in this notoriously grueling yet life-changing internship year? What advice would I impart to the new cohort about to impart on this same journey?

Clinically, I am stronger than I was a year ago. Clinical training in a supervised setting is indeed the purpose of residency and why tens of thousands of young people in the prime of our lives devote many long hours to our hospitals. Internship is all about becoming more comfortable with management of everything from routine urgent care presentations to medical resuscitation of very sick patients. Throughout the past year, I've seen my classmates and I progress from asking "What next?" to thinking through and acting on most treatment decisions ourselves. Part of that clinical development is knowing how much more there is to learn, and it remains daunting and inspiring to see that, as much knowledge and skills as we have gained, there is still a long way to go.

Professionally, I feel more comfortable in my role as clinician and resident physician. I remember on my first day of internship practicing my introduction in the mirror. "Hello, I'm Dr. Wen, your doctor," didn't seem quite right. Too curt, yet oddly redundant. "Hi, I'm Leana, your doctor." Not right either. Too informal. "Nice to meet you, I'm Leana Wen, one of the doctors." OK, but who are the other doctors? The struggle with something as basic as introducing myself is symbolic of my biggest challenge in intern year: feeling at home as a resident. My training occurs at two main hospitals and two other affiliated sites. Not only were there dozens of residents and attendings and literally hundreds of ED nurses to meet, each month was a different rotation with more new people and new ways of doing things. It took me until the end of intern year to feel at ease with my colleagues. Being part of AAEM/RSA has been instrumental for me to feel at home in my specialty. Now, not only do I know my 60 co-residents, I am connected with thousands of residents across the country.

Intellectually, this has been a year of alternating disappointment and growth. So much of medical school was about memorization and pattern recognition; I was afraid that residency would teach more of the same. I did not want to be an automaton who did nothing more than input data and run algorithms like a "Choose Your Own Adventure" book. EM, perhaps more so than other fields, has the potential to turn into an algorithmic exercise. However, there are plenty in our field who believe that EM is far more than figuring out a disposition. As my mentor, Dr. Josh Kosowsky, likes to say, "EM is the modern home of diagnosis." What other field presents so many diagnostic puzzles in any given day? Checklists have their place, but algorithms should never replace the art of healing. One of my most valuable lessons this year, one that has kept me intellectually challenged and emotionally engaged, is to make sure to hear each patient's story as their narrative, not just as a chief complaint followed by yes/no answers.

Personally, one of the battles each of my classmates has struggled with is finding balance. Internship is pretty far from a "normal" life: it throws off anyone to work under fluorescent lights for six days a week, to eat nothing but hospital food for three meals a day, and to not see family and friends for a day and a half. Our days are so long that by the end of a shift, it's often hard to find energy to do the things that used to make us happy. Yet, as busy and as tired as we get, we shouldn't make residency just about working, sleeping and eating. I've watched each of our classmates emerge from survival mode to making time for the things that matter to us, from training for triathlons to watching sci-fi flicks to getting a scuba-diving certificate. As for me, I'm ballroom dancing and playing the piano again, and a much happier person for it.

Despite finding better personal balance, one of my classmates said during our end-of-the-year intern retreat that he wasn't sure he liked the person he was becoming. This resonated with all of us. In intern year, each of us can recall instances when we've become more abrupt with family, short with sales clerks, perhaps impatient or even disdainful with patients. However, as difficult as our lives may be at times, as grueling as it may be to work night shift after night shift, we cannot lose track of our fundamental purpose of being healers and advocates for our patients. It's a profound privilege that we have to take care of patients in the time of their greatest need. It's a profound honor that families place care of their loved ones in our hands.

"That was an awesome day. Thanks for showing me around!"

I smile. It's the end of Ben's first shift. His hair, impeccably groomed ten hours ago, sticks out in the back and strands point towards the ceiling. His face bears the telltale imprints of mask and eyeshield. His blue tie is flecked with blood. (I feel sure that from now on, his attire will consist of scrubs.) I wonder what Ben's reflections after intern year will be. I know that he, too, will develop clinically and grow into his professional role. I hope that he finds his intellectual pursuits rewarding and his personal balance satisfying. Above all, I hope he retains his humanism, his ideals for why he chose to enter this healing profession of medicine.

Forensic Post: Asphyxial Death; Hanging

As a continuation to my previous forensic post, today im gonna talk about the second asphyxia death, hanging. I never seen autopsy on hanging also, another “cis…!” for that…Honestly, writing this post itself feels a bit creepy, but that's me, I'm not sure why I'm kinda attracted to these creepy stuff. But let this post be a lesson to us all, SUICIDE IS PAINFUL, NEVER TAKE YOUR OWN LIFE 

Death by Hanging

Is also a form of asphyxia death, where the body is wholly or partially suspended by a ligature around the neck. Simple eh? But you see, even thou someone might hang themselves; it’s not necessarily for them to actually die due to asphyxia. For all you know, it might be death due to cerebral congestion from the external jugular vein compression (4.4 lbs), cerebral anoxia from common carotid artery compression (11 lbs), vagal inhibition from vagus/carotid body compression causing cardiac arrest, fracture or dislocation of cervical vertebra or it could be a combination of both coma and asphyxia. Well, all of that sounds painful enough!

Of course, we should also think about the manner of death, in this case, natural can be rule out because it’s not likely someone found to be hanged would be dead naturally ( but if someone were to die naturally but then was hanged after their death to make it look like suicide, then it is possible right? But who would do such a thing? That would be so twisted, why am I thinking as such? Heh!). So the focus should be on suicidal, murder and well, accidental is also possible but would be quite rare.

What are the signs?

Externally you can see a ligature mark and it is the ONLY specific sign. This ligature mark depends on the nature if the ligature use and the types of knots.

A fixed knot is when we “ikat mati awal-awal”, so once the person is hanged, the knot won’t move. Because usually the knot will be loose, the ligature mark seen will be in V shape since the upper and “knot” part of the ligature is not in contact with the skin.

A running noose is the adjustable knot. Once pressure is exerted on the ligature, usually by the weight of the person, the knot adjusted to the neck and chokes the person to death. Thou it sounds terrible, some believe that it’s less painful compare to the fixed knot (but how can they know right? Hehe…). Due to the nature of the knot, a running noose ligature mark will be complete, circular and more horizontal and we may even see the knot impression mark.

That’s the first thing about ligatures, there are more things to observe at the ligature mark:

• Where is the point of suspension?
• What would the duration of suspension be? Longer duration even prominent ligature mark
• What is the constriction force, complete or partial, complete hang? Or maybe just kneeling or sitting position
• What is the texture of the ligature, diameter, single or double, shape and pattern? Help knowing the type of ligature used
• Are there any scratch marks at the neck near the ligatures? This indicates struggling to be free, thou this does not rule out suicidal since hanging could be painful

Other important feature of hanging that can be observed is

• the head, normally it would inclined to the opposite site of suspension,
• the face will be congested, the tip of the tongue can be protruded and bitten,
• the saliva might be dribbling from the mouth and see the eyes, it might be close, partially open or might have a serene look
• the penis would be turgid, congested and semi erected
• the nail is cyanosed
• and the postmortem staining will depend on the parts of the suspended bodies. Since those who dies due to hanging normally is not lying on the ground, the usual post mortem staining at the back would be absent. Instead it may confined to the feet, if its full hanging, or at the legs, buttocks, hands and arm if the bodies were found to be in sitting position. Interesting isn’t it?

back to Allah, the One and Only True God

We always think of hanging as suicidal, and most of the time it is. Taking life with our own hands is consider as “major sin” and you don’t get to heaven if you do that. No matter what happen in our life, there is always a way to solve it. God don’t create problems for us so that we will be stuck for the rest of our life, thou sometime it may seem that way, but largely it depends on our own effort to actually do the right thing. To all problems from any aspects of life, the right thing to do is ALWAYS and ALWAYS to return to your beliefs. Seek the right way by diverting ourselves to the right path. After all the main reason for God to send a “big test” to us is to make us divert ourselves back to Him, beside testing our belief. So suicide is NEVER the way to get out from any sort of problems! There’s a lesson to be learn here kids! Till next time, thank you for reading! :D

Forensic Post: Asphyxial Death; Drowning

Not like my everyday post, today I like to talk about…. DEATH… More specifically, asphyxial death. Why? Because it’s a big and important topic, with many medico legal and interesting aspect and also because I never get the chance to actually observe one yet (cis..!).

Asphyxia is the condition of lack of oxygen arising from an obstruction to the air passage from within or out. Generally, those who died due to asphyxia might have cyanosis, general visceral congestion, venous congestion, increase venous back pressure, stasis of the blood, pulmonary edema, serous effusion, post mortem fluidity of blood, petechial hemorrhage, cardiac dilation, biochemical changes and pseudo-Rouleaux formation due to heamoconcentration in the blood.

Under asphyxia we have drowning, hanging, sexual asphyxia, strangulation, manual strangulation (or throttling) and last but not least, suffocation. Well they all sounds the same, but there are not actually. Since there are too many of it, maybe I talk about the others in my other post, today, we talk about, drowning. Death due to drowning…

Drowning

Is when the air entry is prevented from entering the lungs by water or any form of fluid matter into which the head had fallen and remained in. Get it? You know, head in water, air prevented in, and cannot breath. Note here, it is the head that remained in, so if someone were to be push in a small bucket containing water (or even pasta sauce) just enough to immerse the head, and the person dies because of it,  it is already consider as drowning. (and I learn that from watching detective conan haha)

Before jumping to any conclusion, there are a few aspects of drowning to think about

Was death really due to drowning? What was the motive? I mean they might have died due to natural disease before falling in the water or suffer a natural disease while they are in the water. It could also be an injury before they fell or be thrown in the water or died from other effect of immersion other than drowning… so how can we tell? Before starting the autopsy, we have to answer a few questions where we go back to the basics, the 4 manner of death, accidental, suicidal, homicidal or natural… So the purpose is to rule out what’s not and rule in what it is. So lets go through…

Signs of Drowning

What are the post mortem signs of drowning? The signs could be further divided to external and internal signs which can further be subdivided to presumptive and specific. Basically, the presumptive external signs are bodies which are wet, covered in seaweeds, cyanosis, congested eyes, presence of “washerwoman’s skin”, “goose skin” or cutis anserine, and retraction of scrotum and penis. But more importantly are the specific external signs which are fine white, tenacious, lathery froth or foam like soap with blood oozing from the mouth and nostrils. This can be reproduced by exerting pressure to the chest. Another important sign is the cadaveric spasm, which is the clasping or grasping of objects found in the water. For the internal signs, the white tenacious foam can also be found in the air passages to the terminal bronchiole. There can also be logging and ballooning of the lungs.

Laboratory test

When there are drowning bodies, laboratory test of the pulmonary and blood is important to determine the possible cause of death and the actual place the drowning took place. An important key point in the lab test is the diatoms. These are microscopic unicellular algae that can be found in certain water. Since it is indestructible, we can determine whether the victim was alive or not before they were immersed in the water by looking for these diatoms in the lungs, blood, brain, liver, kidneys and bone marrow. If they are alive, these diatoms have time to circulate around throughout the body. By comparing the diatoms too, we can determine whether the alleged crime scene (locus of crime) was true or not.

Don’t forget about the blood! Since the bodies died in the water, we can also determine whether the water was salty or fresh water by looking at the blood. Is it crenated or are there burst spherocytes?

What about the pulmonary tissue? There will be two aquosum. The first one is emphysema aquosum, where the alveoli is filled with water, mucous and also air, the inter alvelolar septa is also ruptures. Another one is oedema aquosum where the inter-alveolar space is filled with water, the interalveolar membrane is widened due to edema and it may also rupture.

We should also do biochemical test to check the chloride content, magnesium and specific gravity of the blood.

Of course there are other things regarding drowning I didn’t cover here, but basically that’s about it. So, thank you for reading! See you again in the other forensic post! (^_^)

This is Me

This is me

This is real

This is who I am suppose to be

If I’m not me u will never see

That this is who I’m supposed to be

I am me

If you see it dark

I may see it differently

If you find it amusing

I might look the other way

You might think I’m not free

When being drown by the rain heavily

But it’s the rainbow I want to see

That’s why I still waited for the sun to smile at me

I might cry harder

I might laugh louder

But this is me

It’s who I always want to be

I’m not pretending

I don’t want to be who you want me to be

Because this is how I’m supposed to be

I am me

My world is a better place when I am me

Because when I am me

Every color has different stories

And every art have different meaning

This life is a lesson for me

No matter what you say

You can never change

What’s inside of me

I am a person who I want to be

This is me

Datuk Sosilawati's death...Or not?

The murder case of the millionaire Sosilawati shocks the country, not excluding my family. The story became the main issue during this Raya season. Me, the one longing to become a pathologist is more than excited. I keep wondering wether the case was taken to HUKM or not. Even if it was, I didn’t have the chance to talk about the case from Dr. Swarhib or Prof Shahrom. Yep, they’re the best when it comes to the whole question and answer session.

Basically we know that they were murdered and then the body was burned and thrown into the river. The story is the same one every time in the newspaper, but still sells like hot goring pisang. What’s up with that? I can’t imagine what its like for the family; it must be really hard for them… anyway, all this commotion makes me think of something, DYING MESSAGE

If you watch a lot of detective conan you’ll know exactly what’s a dying message is, and its totally different from a suicide note. Of course a suicide note could also be a dying message too, I learn that from watching too many detective conan too. I’m not sure what’s the true meaning of dying message because I couldn’t find it (on the internet). But base on my personal opinion (correct me if I’m wrong) it’s the last message made in any form by the victim just before their death to tell something about their death, and usually the culprit. And if you watch detective conan you’ll know how twisted a dying message could be, its so twisted that you keep saying “are kidding me?” Maybe the reason I couldn’t find the definition of this dying message is because in real life, do people really make a dying message? Who in the right mind would be so clever think of a twisted way to tell others about the culprit when they know they have no chance to live in this world. I mean when you’re about to die, you couldn’t care less about whatever that will still go on in this world, or you may think of a way to escape or stay alive.

Anyway, I’m way off track… I was wondering you know, what if there is still a chance that some of the victim are still alive? I mean hey, in a murder case where the victims are burn to the ground, you can blind a lot of people, the police, the pathologist, even the detectives. Placing DNAs to a murder scene is not really that difficult… I learn that from watching too many CSI. Me? Honestly, I can think of a way to put the DNA to the murders scene (as if…). if only there was a dying message you know, or some kind of clue to point to whether she really was killed or is still alive. But when I think again, why would anyone want to fake her death in this case? Usually people would want to fake other people’s death (or maybe their own) if there are a lot of benefit. There may still be a possibility you know… so to say that I am 100% convinced that Sosilawati had died, I would say no. but then again, its not like this is my case or anything, hehe…

Making a Difference

you can make a difference

all you have to do is choose

there is always a way to be the kind of person you want to be....

you see what you want

you wish everyday that the day will come

wishing

hoping

hurting....

because every moment that passes by,

you feel that you are not getting closer

to what you want to be

stop

just stop

why is this happening?

close your eyes...

think deep

"why am i not making a difference?"

"why am i still here"

still hoping?

still dreaming?

while the blanket still covers your body,and its warmth is still so soothing

inside that little room

that shell that covers your dream

still in it, hoping and dreaming

have you been fooled?

the time you wasted to entertain you dreams

while the devils whisper lies to your heart

"its not the time yet, you are not ready yet"

when will you be ready then?

what does it take to be ready?

courage

are you scared?

about the consequences?

but is it not true, that Allah knows best?

you are not pushing destiny, you are not creating it...

all you are doing is just opening up your heart and letting it happen

if you want to blossoms

then there is always the obstacles that will stand in your way

but that's what it will always be

obstacles

nothing more than just obstacles

of all the things Allah created for His faithful servants

why are you not being thankful?

is it not the obstacles that will make you strong?

that will add up to your heart a sense of dependence for The One True God

what else do i have to say

to make you see...

that when you follow what's in the holy Quran

Allah is always by your side

do it

make a difference

and live the life you always wanted to live....