Dropping Your Brain On The Paperwork

I’ve heard many times people say that they have the best job in the world. To tell you the truth I’ve never really been able to relate mine to that kind of statement, not until today. In fact, today was supposed to be like any other days I’d lived before. I was one of three physicians in charge at the emergency unit this morning. I came an hour late for work because I felt like somewhat sleep-deprived by the time I woke up to the alert ring from my cell phone I set up regularly at 4.45 a.m. Besides I decided to go on foot to the hospital this morning since I realized I had been in my second week of physical inactivity. I missed my 60-minute Sunday morning jogging cos I spent a couple of weekend back at my parents’ home in Surabaya. 


By the time I arrived at the ER around 8 a.m. there were already four or five patients awating in the ward. There I went doing my job, taking history, doing necessary physical examinatons, then going back to my seat ready to rearrange the stories the patients told me on their medical record. This is inarguably my favourite part of the job, trying to rule out some differential diagnosis, thinking of all the possibilities to pave the path for establishing the most accurate diagnosis. I call it a creative process of dropping your brain on the paperwork. A process in which your academic capacities are put on test for real. A process uniquely by you that yields a result which sometimes leaves your signature, your flavor that makes you differ from your colleagues. Then, once the diagnosis is established, it’s not that difficult to administer the proper treatments to the patients. But truly this is among the most fulfilling part, it gives you a good feeling at the start and confidence along the recovery process of the patients. 

Marit Larsen’s Spark: Showcasing Quality of A Pop Queen

Marit Larsen by Ralph Gunthner

Akhirnya tiga tahun setelah album terakhirnya The Chase (2008), Marit Larsen kembali merilis album studio terbarunya 18 November lalu. Album yang diberi judul Spark tersebut berisi 10 buah lagu yang masih menceritakan semua pengalaman pribadinya. Khusus untuk penulisan album ke tiganya ini, Marit menghabiskan waktu selama delapan bulan di New York untuk menemukan lingkungan penulisan lagu yang lebih segar serta terisolasi. Tema mengenai perpisahan cukup mendominasi di album ini seperti yang dapat didengar dalam lagu “I Can’t Love You Anymore”. Lagu dengan iringan gitar dan drum yang terasa minimalis di bagian verse-verse awal dan refrain dengan permainan gitar listrik di bagian interlude dan diakhiri dengan cara yang indah. Liriknya yang ditulis bersama Teitur, seorang pemusik asal Kepulauan Faroe, cenderung sangat jujur dan mengena, “You had your chance, you lost my patience, I can’t love you anymore”. Besar kemungkinan dia terinspirasi oleh perpisahan dia dengan kekasihnya, Thom Hell, yang juga merupakan seorang pemusik, namun Marit selalu menyangkal hal ini. 

Sebagai single pertama dipilih lagu “Coming Home” yang bercerita tentang kebahagiannya saat menatap mata seseorang yang istimewa di hatinya, “The most magical thing that I’ve known, one look in your eyes and I’m sinking. And it feels like coming home”. Berbeda dengan single terdahulunya “If A Song Could Get Me You”, “Coming Home” terasa lebih lepas, lebih pop, dan lebih dominan permainan gitarnya sepanjang lagu. Asal tahu saja, selama menyepi di New York, Marit Larsen lebih banyak menciptakan karya baru dengan gitar dan jika ingin bermain piano dia harus ke rumah teman atau pergi ke toko alat musik. Salah satu lagu yang didominasi piano adalah “Don’t Move” yang merupakan salah satu lagu terbaik di album ini. Dalam lagu ini selain piano, permainan string yang cantik juga dapat didengar. Marit Larsen cukup terobsesi dengan string agaknya termasuk dalam penggarapan album ini di mana dia memakai tujuhbelas buah string. Lagu berikutnya yang saya amat sukai adalah “What If” yang dibuka dengan hentakan drum yang ringan namun sungguh sangat menggoda. Permainan string dan permainan gitar listrik yang jenius pada bagian bridge solo instrumental sangat penuh intrik perlahan-lahan memuncak dan hilang tergantikan oleh permainan piano solo. Efek drama berhasil diraih begitu Marit mulai menyanyikan lirik provokatif “Now that I know who you are. I almost wish that I’d never met you. How incredibly sweet. This has proven to be. You put all your trust in me. I’M YOURS INDEFINITELY” sebelum akhirnya jeda sejenak untuk masuk bagian refrain lagi. 

Lagu lain yang layak didengarkan adalah dua lagu terakhir yaitu “Fine Line” dan “That Day”. Dalam lagu “Fine Line” permainan piano dan harmonika dan lagi-lagi string menyatu dan diakhiri dengan kolisi instrumen yang benar-benar indah dalam cara yang tak terpikirkan, “It’s a fine line, it’s a fine line” diulang sebanyak lima kali dalam melodi yang mencekam sebelum akhirnya lepas kembali ke nada awal “It’s a fine line between love and hate. You ran away with my favourite song” dan berakhir. Lagu “That Day” hadir dengan dominasi gitar akustik serta lirik yang bercerita tentang awal mula dimulainya sebuah kisah cinta sebelum akhirnya saat ini berakhir, “I wish I could go back to that day...”. Lagu yang sedih. Namun secara keseluruhan Marit Larsen dan produsernya Kåre Christoffer Vestrheim sekali lagi menyuguhkan musik pop yang original dengan balutan yang pararel dengan dua album terdahulunya, hanya saja kali ini lebih bersinar dalam hal penggarapan musik, variasi, serta penulisan lirik yang bagus. Semoga pemusik yang jenius ini dapat segera melebarkan sayap ke Amerika ataupun ke Asia Tenggara yang dulu merupakan kantong fans terbesar dari M2M. Apalagi Marit Larsen tahun ini dianugerahi 900000 kroner Norwegia untuk tiga tahun dari Musik Export Norway guna memuluskan ekspansinya ke luar Norwegia. (Depe)

My Very First Time Using Defibrillator

Chains of survival

The title may sound corny or rather sappy, but the first time of doing something particular is mostly so memorable. This was a real scene that took place at the ER when I and a friend of mine were on call one Tuesday morning. Really just a couple of days after my ACLS training. So it was a real test for me, though I already saw plenty of similar case prior to the ACLS. I wanted to perfom a more algorithm-based medical intervention for ACS case like what I had been trained to.

This is what ventricular fibrillation looks like

So there come a 50-year-old man with a chief complain of having chest discomfort or much like chest pain. The pain was dull as if there were weighty thing being put on his centre of sternum and on area to the left of it. But he was unable to point out precisely where the pain was originating from. He also felt that the pain was somewhat referred up to his back. There was neither nausea nor vomitting, but he was having cold sweat. He was fully awake with GCS score of 15. Blood pressure 140/90 mmHg, heart rate 80 times per minute, respiratory rate 22 times per minute, temperature 35,6oC. History of type-2 diabetes, chronic hypertension, and dyslipidemia were all denied (but I was skeptical, just like House says: Everybody lies!). Signs and symptoms suggested that he might be suffering from acute coronary syndrome, but since it conveys a wide range of causes, we needed some more detail examinations. We set IV line access, giving oxygen through nasal cannula (NC). We run ECG test on him (which laterly suggests STEMI with wide anterior infarction) while giving order to the nurses to administer aspirin (to be chewed), clopidogrel, plus sublingual ISDN. Unfortunately before those medications could even be administered, the patient collapsed (mostly caused by unbearable pain). We advised an injection of 3 mg morphine, but in short he fell into cardiac arrest. No carotid pulse was palpable. Such a nightmare for both the family and healthcare poviders. I shouted to start the chest compression before I ran quickly to get the defibrilator machine which had been in its absolute dormant period for too long since nobody knew how to operate it. But not again after my ACLS training. I was highly determined to come all out this time. Once the defib machine was set, I ran a quick look using the padles. The ECG suggested a pulseless ventricular tachycardia (VT) which was an absolute indication to perform the electric therapy of defibrillation (the other being ventricular fibrillation (VF) and polymorphic VT (Torsades de points)). I gave him a 360 joule shock (since it was a monophasic defib machine) followed by 2 minutes of CPR and an injection of 1 mg epinephrine (following the VF-pulseless VT algorithm). After 2 minutes I ran another quick look, the ECG suggested normal sinus rythm and palpable carotid pulse. We assumed he already came to ROSC (return of spontaneus circulation). We were ready for secondary survey. We fetched a deep breath. Thanks God. Did it end there? No. The patient is losing his carotid again in just five minutes. The ECG read sinus rythm, so it was a PEA (which was an absolute contraindication of defib, the other being asytole). The chest compression was soon started following the PEA-asystole algorithm. After a few cycles it turned into VF again, I did the defib. No amiodarone was available in the hospital. So adrenaline kept being in use. It’s a drug than can boost peripheral resistance and increase the contractility of heart muscles. Then it turned into asystole over and over again until we decided to cease the long series of CPR of 45-60 minutes. We did our best, but our patient wasn’t granted a second chance. It should always be reserved for God's privilege.

That Day

lyrics by Marit Larsen

I’m pacing the streets 

Where our story begins 

On a pale autumn day 

It was a day much like this

I’m back at the corner 

Where you used to wait for me 

Down by the place where we 

Made our first memories 

We smiled at each other 

Your skin was so cold 

And I swore I had never seen you more beautiful 

A few stolen glances 

We stayed out in the rain 

Could we just go back there again 

To that day, that day 

When I came to see 

It was our time, our beginning 

The end of the wait 

Oh I wish I could go back to where 

I was heading on 

That day 

I can’t help but wonder 

Every now and then 

If I hadn’t spoken 

Would we have kept going 

Your number is still here 

On my fingertips 

Like a forbidden secret 

That shouldn’t exist 

I know that I loved you 

I know that I tried 

But the kind that will keep you awake in the night 

It just doesn’t make sense 

And time after time I was trying to get back there again 

Marit Larsen Will Soon Come Back With New Album

Photo: maritlarsenfanclub.de

Mark the date, it's on November 18 this year. A brand new album called Spark!!! Here's the official press release from her Facebook page. While counting down to that most anticipated date, you'd better listen to her newest single "Coming Home"

Nasib Dokter Di Negeri Jiran

Hear our voice. We hardly speak, but will usually fade away from conflict (and fly to another place)
Posted by: MS Mohamad

I read an interesting article today about a few prominent figures addressing their concern over the increasing UKM and UM medical graduates who have left the country to continue their medical practice overseas. After reading the news for 3 times, I called a very close friend, an MD (UKM) graduate to ask his opinion on how the news might have affected him. He has been working in Singapore for more than a decade as a Consultant Surgeon with a certain sub-specialty "Why be a slave in your own country, when you are a king in another?" He replied. Indeed, if anybody would want to find a reason why all of us left, either after housemanship, after being a specialist, or even after sub specializing, and now, even prior to doing housemanship, they need not look at our payslip, or the wealth that we have gained overseas, but only to the Medical System that has been rotting in the ignorance and politic-based stupidity that Malaysia has been well-known for (in the medical field). I have served the system for nearly 2 decades of my career, waiting for it to improve for so long, and only finding myself in despair, quitting with a 24-hour notice and serving abroad. The system is, in my opinion, keeping doctors, since the beginning of their career as House Officers to the end of it, in the lowermost priority.