Salam Aidil Fitri : Eid Mubarak!

Salam..

Hello again.. It has been more than a week since my last entry.. I tried to write something up, but unfortunately I was not able to load the writing up to this blog page for some reason.. Hence, the long delay between the last entry and today.. In fact, the entry I intended to post was an entry about my recent encounter of people asking me about Ramadhan and my respond (in writing, as an article) to the questions.. I was actually relieved that I wrote the piece.. It felt like I had done a small effort on dakwah..

Anyhow, this entry will be short, sweet and concise.. We would like to take this lovely moment to wish our beloved families, our closest of companions and dearest of colleagues, a very wonderful Eid.. We both would also like to take this opportunity to ask for your kindest of forgiveness of our wrongdoings and errors towards all of you.. May we all have a blessed Eid and may we all be granted the opportunity to meet with Ramadhan again next year..

SALAM AIDIL FITRI
MAAF ZAHIR & BATIN

EID MUBARAK
1 Syawal 1429 Hijriah

From :
Dr Mohd Shazrul
Dr Shahrina Karimah
(Limerick, Ireland)

The joy of baking!!

Salam..

Hi everyone.. I'm back.. as my husband has wrote earlier,I was busy baking!! I loveeee baking.. I baked nearly everyday.. Hmm.. Honestly,I'm surprised myself.. Never thought I would enjoy baking this much..

As Eid is approaching,I've made a few cookies.. started with makmur (my favourite!!), sarang semut (very tasty yet hard to make.. as my husband always said 'banyak cekadak" hehe..), mama caries (another yummy cookies but need to improve the look..),choc coconut biscuit (not very nice coz I accidentally over fry the coconut.. huhu) & dahlia cookies (just finished baking..) overall I'm happy with all the cookies I've made.. Still more to come:)

My cookies...

Nowadays,I'm craving for chocolates.. This is not unusual for me.. when the chocolate-craving mood comes,I can finish the entire big choc bar to myself!! (and then I'll feel fat!! hehe..) but i don't feel like eating choc bars so I make a choc cake & choc brownies instead!

Yummy.. Choc brownies with almond..

Apart from cookies & cakes,I made some kuih as well.. made lopes & buah melaka.. I even tried to make cucur badak but it turned to be a total failure.. huhu.. the inti was nice but the outer layer was like a rock (if I'd throw it to the wall,it wouldn't bounce back.. it would actually break the wall!! hahaha).. I don't know what went wrong.. I'd search all the recipes,they all the same.. but I'm not giving up.. will try again sometime.. wish me luck!!

I'll write again soon.. not in the mood of writing a long entry..:)

My 2nd choc cake..

Hadron Hacked!

Salam..

Day in day out, I'm back again, dominating this blog ferociously, until Ina has had little or nothing to say.. Ideally, it is supposed to be a shared blog, about us.. Evidently, I'm currently in the driving seat and pressing on the gas! It is not that Ina has lost interest in blogging, but much to my delight, she has been busy baking! Yes, people - BAKING! Some cookie-preparation for the upcoming Hari Raya.. Why am I not in the kitchen? Well, baking has never been my strong point, so I guess rather than messing the biscuits and cakes, why not stay away from the oven and do some other chores..

This entry would probably be a fairly brief one.. I have nothing new or major to discuss, by the way.. So, I will probably update a little bit about my most recent entry - The Large Hadron Collider (LHC)..

Setback After Setback

As we all know by now, the supercollider was launched last week.. Much has been said and the media coverage has been enormous.. In fact, the people involved with the mega project have started a blog about the events too..

Unfortunately, there have been two big, if not major, setbacks during the past week.. I shall pen this down and, maybe, we could learn something from the recent dramas..

Greek Hadron Hackers

On Monday the 15th September, news broke to the world that the LHC computers were hacked.. Fortunately for the 10,000 scientists who depend their work (and maybe their lifetime ambition and aspiration) on this machine, the damage was only to one network of the computers which their main function is to process data on the Compact Muon Selenoid Experiment (CMS).. And, fortunately again, they are not directly connected or linked to the collider system itself..

Nothing is known up to now on what actually hit them.. The message was "We are 2600 - Don't mess with us".. It was sent by a group of hackers calling themselves the Greek Security Team.. Yes, the message was sent in Greek..

"It was not a malicious hack and it was quickly detected.. But this sort of things keep you on your toes.."
(James Gillies, CERN spokesperson)

Ouch! Hot Magnet!

On Friday 19th September, CERN's LHC hit another low point.. About 100 magnets which are designed to work at a temperature near to absolute zero were struck by a system failure termed a quench, which resulted these magnets to heat up up to 100 degrees Celsius.. Also, it was thought that a total volume of one tonne of helium had leaked into the underground tunnel.. The fire brigade was called to assess the safety of the tunnel, then.. It was thought a faulty electrical connection between two magnets caused the magnets to melt, further leading to mechanical failure..

As a result of this damage, that part of the dinosaur machine has to be switched off, warmed up to a temperature well above zero, only then it could be repaired, and then re-cooled down to experiment environment condition before it can play home for the re-enactment of the Big Bang.. Initial report indicated that the whole process may take up to two months.. Yes, the project will be on hold for two months! That is only the time part down.. No official statement has been issued about the estimated cost of the repair as yet..

What Can We Learn?
A mega project consisting a huge number of manpower and state-of-the-art technological equipment is bound to have a glitch in the system, be it human error, computer breakdown or system failure.. However, despite these seemingly major setbacks very close together, so close at the kick-off of the project, there are many that can be learned.. Maybe at this early stage, we can learn a few things..

1. The need to have a computer security system as state-as-the-art as the machine.. If the computer-system part was overlooked by the authority, then this event should open CERN's eyes..
   
2. A mega system requires a mega-meticulous check-up before any switch on button is clicked.. Could it be that because of the high-tech equipment on board, there was a slight perception that it was a zero-defect failure-free system? Even in our daily lives, being complacent is common yet self-destructive..
   
3. Was media-attention-induced popularity somehow backfired to the project resulting the project a target of hackers, rather than inducing the minds of the world population towards the greatness of science?

Simple questions asked, hard to be answered.. But, as scientists, we should not be defamed by a fall, deterred by failure or disheartened by disaster.. We learn and learn and learn again until we find the answer to achieve greatness and possibly creating and writing history.. I close this entry with some sayings from a great scientist himself, Mr Thomas Alva Edison..

"I have not failed.. I have just found 10,000 ways that won't work.."

"I am not discouraged, because every wrong attempt discarded is another step forward.."

"Many of life's failures are men who did not realise how close they were to success when they gave up.."

Till next time, salam..

Tidy, Tidier, Tidiest Town

Salam..

I'm back again, spending a little bit more time blogging.. Yes, yesterday's entry was a little to heavy for the light-readers.. But, fear not, today I will be jotting a few mumbles from my head from a recent event in Ireland.. I am hoping this entry will not be lengthy and will only be a point to ponder, to compare and contrast between home and hometown.. I will be discussing a bit about the popular Tidy Towns competition in Ireland and how we fare back home..

Tidy Towns - In The Beginning

Between 1953 and 1957, Bord Failte (Irish Tourist Board, now Failte Ireland) launched a National Spring Cleaning Campaign, with the main objective was to encourage communities to improve their local environment and make their area a better place to work, live and visit.. Rather than the competition a quest for a gold medal, it was the friendly rivalry that mattered to heightened the standard of town cleanliness across the board..

Later in 1958, Tidy Towns was introduced.. Initially, there were only 52 towns took part, but the popularity increased rapidly until now we are looking at around 700 entrants per annum.. Glenties, a town in County Donegal, took the first gold medal for Tidy Towns.. In fact, Glenties maintained their excellent portfolio for a consecutive three years, 1958 to 1960, before Rathvilly (Co. Carlow) put a halt to their run in 1961, only to see Glenties re-claimed their throne the year after.. This rivalry has somewhat posessed the whole nation day by day until the local authorities are doing their best to ensure the gold medal comes home to town.. This year, Westport (Co. Mayo) emerged victorious as the overall winner for the competition..

With the re-structuring of Bord Failte in 1995, the Department of Environment, Heritage and Local Government assumed responsibility to manage Tidy Towns.. Today, the department leads the yearly competition with generous sponsorships including from SuperValu as the main sponsor.. Even after 50 years, the competition still maintains its core principle : Make Your Place A Better Place..

Today, Tidy Towns has expanded considerably to attract more competition among the towns, with the introductions of several categories, including Architectural Award, Chew It Bin It Award, Biodiversity Notice Nature Award and Can It Award.. Of course, these different categories are sponsored by different authorities or commercial companies, for example the Architectural Award is sponsored by The Royal Institute of Architects of Ireland to recognise the role of modern architecture in maintaining and enhancing the beautiful fabric of Irish towns, villages and urban areas..

Tidy Towns : Is There A Malaysian Version?

Over the years, I have come realise the differences that makes these two countries themselves.. Of course, you may be thinking I am talking rubbish as all countries would be very individual and unique in its own way.. What I am trying to relay is the differences that Malaysia can potentially learn from Ireland (and vice versa).. However, it may seem that my pointers would be leaning more towards Malaysia learning from Ireland.. I would not mind you think that at all, most basically because I believe I can change something when I go back home eventually.. It would be harder for me to change things around here, being here more as a professional and less as an active local community member..

Nevertheless, I have made some plans and ideas and I am hopeful that I can kick-start them when I go home as a community member and a professional..

The Malaysia-equivalent of the Tidy Towns is not as massively accepted as it is here.. The Ministry of Rural and Regional Development had an almost similar competition, however I could only find a local (rather than national) level competition.. In fact, the most recent I found it to be in 1999, almost 10 years ago! Hence, to answer my initial question : No, we don't have a Tidy Towns equivalent.. I might be wrong (and I hope I am) in saying this..

The idea of the spirit of cleanliness is more prominent in school level nationally than it is compared to towns or cities.. The Pertandingan Kebersihan, Keceriaan dan Keselamatan (Cleanliness, Radiance and Safety Competition) is not a vague idea not known to any schoolchildren.. In fact, school authorities spend a good amount of their budget to ace in the national competition, striving through the district and state level before going national.. Unfortunately, the spirit ends with the award ceremony, to much of my concern..

Hopes

I do believe Malaysia is more than capable in organising an equivalent competition to Tidy Towns.. Whether it would go national from day one or concentrating on the spirit and idea on cleanliness is up for discussion by authorities.. Having in mind the diverse cultural uniqueness and historical heritages even at state level, maybe this idea can be a stepping stone towards achieving a tidy Malaysia.. Maybe someday we will be able to see 'Pertandingan Kebersihan Kampung Peringkat Kebangsaan ditaja oleh The Store Supermarket' (ie National Tidy Village Competition sponsored by The Store Supermarket)..

It is still at idea and suggestion level, but however unlikely, not impossible.. Malaysia Boleh!

Big Bang : Between Science And Faith

Salam..

Today I will attempt to serve you a dish that even I have never feasted upon.. Recent news have highlighted the advancement of scientific achievements - namely the emergence of of the Large Hadron Collider (LHC).. Many of us may scratch our heads until the follicles of our hair begin to fall, and we still ponder on what is this thing.. For the laymen (like me), the news on this achievement may somewhat mean nothing unless we sit down and try to read a line or two about it.. Well, I did some reading on it and maybe I could write a small bit about what I understand from my reading - does not necessarily mean what it actually is!

Big Bang Theory

In 1927, Georges Lemaitre proposed a model of the universe's birth.. He proposed that 13.7 billion years ago, a cosmic explosion occurred and subsequently resulted in 'time' and 'space'.. It is true that this theory is simpler said that understood.. Lemaitre initially named this Hypothesis of the Primeval Atom, but the nickname the Big Bang Theory was the one widely used.. I will not even try to dwell any further into this.. We could maybe ask one of our physics teachers if we want to know more..

The Big Bang theory is one of the ideas that have transformed the Mathematics and Physics world.. Several others include Albert Einstein's General Theory of Relativity (1921) with the famous E=mc2, the Quantum theory, the String theory and Sir Isaac Newton's theory of universal gravitation and the laws of motion (1687) of which he described in his seminal book Philosophiae Naturalis Principia Mathematica.. Since then, scientists have attempted to unlock the mysteries of the universe, trying bit by bit, from multiple of angles, proposing hundreds of hypothesis and ideas - but, for what? - to simplify all of these observations into one theory (if possible) : the theory of 'everything', the Theory of Supersymmetry!

This is a lot of information to process! Yes, but scientists being scientists, as do 'normal' people do, we seek answers for almost everything! ANSWERS - that's what we all want, one answer to all questions! But what does these theories and hypotheses and ideas have to do with us today? Why is the question only raised (publicly) now?

Is It A Bird? Is It A Plane? No! It's A Supercollider! A What?!

Once the LHC is switched on, it demarcates the launch of scientific excellence and, possibly, superiority of the Europeans on top of the United States.. LHC is a superconducting magnet that operates close to absolute zero (the temperature at which all atoms cease all movement) and then accelerates these particles to energy 99.999% of light speed and this instrument also has the capability to detect even the faintest of whispers of particles much smaller than atoms.. The European Organisation of Nuclear Research (CERN) spent roughly $8 billion digging a 27-kilometre tunnel near the Swiss-France border.. It is also, to some people, known as the Geneva Machine.. There are about 9,000 scientists on the project, from the four corners of the world including India, Russia, Japan, Turkey and Israel, not to mention from the more modern countries like the United States, France, Great Britain and Germany..

Where did the $8 billion come from? The US chipped in a massive $500 million, but this is barely 5% of the tab.. Germany tossed in 20% of the price tag, the British 17% and French 14%.. As stated above, this is more than just physics and mathematics in play, but psychologically puts the US behind the Europeans in the race of scientific excellency..

However, we need to remember that in the recent decades, the US has been the one leading the world in particle physics.. In fact, before the LHC, there was another supercollider and it was in the US.. A 30-km tunnel was dug in Texas to house the Superconducting Supercollider.. At the time, Ronald Regan was the premier.. Yes, it was bigger than the LHC and more expensive.. The US spent $8.4 billion and without the help of international partners.. This was a project described by Ronald Regan as 'the doorway to a new world'.. The project was the news in late 1980's and early 1990's.. Waxahachie town was put on the map.. However, in 1993 the cost estimates had swollen to a gigantic $11 billion, the US congress had to pull the plug.. The attempts to 'down-grade yet capitalise' on the site to become a counter-terrorism training facility and site for a prison all collapsed.. It is now abandoned, home of weed at best.. There are others, too.. Fermilab has a collider in Chicago called Tevatron and CERN has a e+e- collider before LHC..

What does this LHC do, anyway? This machine is a particle accelerator.. It is 4.3km in radius and the superconducting magnets steer the protons around a ring until it accelerates at a peak of 7 trillion electron volts (eV).. The technology in the LHC enables itself to produce 100 times the number of collisions per second of any other collider in the world.. The machine will then detect the energy and the computers will then process the data to enable the scientists to have a peek on the world of small, to find the answers about the universe.. Maybe then, the quest for a unifying theory will come closer to achievement.. Maybe there is a simpler explanation for the ideas behind the force-carrying particle Higgs boson, the intertwining complexity between gravity-electromagnetism-weak force-strong force, the muons and neutrinos, and the similarity and differences between quarks and leptons!

Yes, this machine sounded doing an experiment very vague indeed.. It is important that we realise this is not a once-off experiment but the machine will become the dream hotel for the world's scientists for the next few years, if not more.. Not to worry, despite recent scare in the media about the LHC producing a black hole that could potentially swallow the earth and its contents, scientists have reassured that this would not happen..

Faith and Science : Balancing Belief and The Quest For Answers

The ever-growing science field and technology supporting the need to provide tools to gain answers have somewhat, in general, tipped the balance between faith and knowledge..

Science have opened our eyes all these years to the once-mystical area.. Years ago, people were hunted if they believed that the earth is round and not flat.. And the breakthrough of the idea that the earth was not flat only came about in the 6th century BC by Greek philosopher Phythagoras.. Though very hard on the cultural and theological belief of the people at that time, he defied the odds and worked (possibly, in the name of knowledge or science, spearheaded by curiosity) on his theory through until it is accepted today.. Yet, he proposed the idea without the technological advantage of a Hubble telescope! Since then, as far as science is concerned, developments after developments have emerged to satisfy the thirst for knowledge and answers among scientists.. And science develop alongside the questions asked.. From Galileo's telescope to the Hubble to the Sputnik and now to the supercolliders, we witness the growth of scientific technology to feed on the hunger for scientists' answer!

However, what does this thirst and hunger do to us, scientists? As we can see, the development of science have shifted the world's mind from previously believing in the mystical and divine magical towards fact-based, scientific-explanation line of thinking.. People now tend to find a logical explanation of things rather than leaving that to belief merely.. Men used to believe that storms are the wrath of God, but now storms are the interactions of particles of different charges.. The dragon swallowed the sun and night came, but scientifically it is the rotation of the earth on its axis and the rotation of the moon around the earth that makes the shifts between night and day.. Men seek logical explanation all the time.. What this phenomenon does to society is people began to question the work of God..

It is not unusual to find atheists among scientists nowadays.. And this is not new.. Galileo and Einstein were both atheists! Where do we draw the line when to stop searching for answers? Is it the curiosity and strive for answers that produce magnificent minds at the cost of crumbling belief in faith and God? This is the worrying question I have in the setting of the media-driven scientific explorations.. Faith and theological beliefs now are somewhat confined to mosques, churches and temples, whereas science is 'life'.. It should be the other way round!

"Who believe in the Ghaib and perform As-salat and spend out of what We have provided for them (ie give zakat)" [Surah Al-Baqarah : 3]

The word Ghaib is mentioned to signify that Allah (or God) has His area that no human mind could ever achieve to understand - heaven, hell, death, life.. This sentence in the Holy Quran should be enough to hold all muslims' hearts to know when to say stop looking for answers.. When we start questioning the unseeable, we are standing on a thin ice!

Big Bang And Me

The scientific world has somewhat engulfed me with answerable questions, yet many more to learn and find out.. Being in the medical profession, maybe I am standing on an ice so thin if I am not careful.. I see people die and much are done to these people.. I wake up every morning and remind myself that my purpose of being a doctor is not about curing a disease, even further from about prolonging life, but to help these people.. And leave the outcome to God..

This is indeed a very lengthy entry.. I might just close this one with questions, rather than my opinion of things.. I have debated my statements quite so thoroughly, enough for you readers to ponder and evaluate yourself, and hopefully able to answer these questions..

1. How does this scientific world affect your belief in religion and God?
2. Do we strive for answers so much to feed on our thirst for knowledge?
3. Have you ever said 'stop' to yourself in the quest for answers?
4. Are you being careful in your quest for these answers as not to cross the boundary?
5. Do you reflect in yourself and return to Allah (or God) at the end of the day?
6. Are you grateful that Allah has given you the knowledge that you have now?
7. What is your next step in the quest for life? Is it answers or belief?

I hope I have shed some light to enable us to answer these questions.. Till then, until we meet again..

Harvest Festival..

Salam..

Thank you for dropping by again.. It has been more than a week since my last entry.. Gladly for me, I received some good responses from multiple people.. To cut the long story short, I had a discussion about the specialty while I was working last week, and I mentioned what my views are about the field.. I got the article printed (thanks to Mary McAllister, side A ward clerk) and some nurses read and relayed their views.. I thank the people who responded to me..

"I'm glad the doctors feel the same way.."
"I liked it.. It's so modest yet so true.."
"I think it's very good.. I couldn't explain it better myself.."

Those were some of the replies I received.. It makes me feel good to have some comments (fortunately for me, this time they were good ones..) about my blog.. As for you readers, do not hesitate to drop by and jot a word or two..

Milford Harvest Festival

This is a festival I never actually knew about, not until last Sunday.. I am not sure of how far back this annual festival has taken place.. However, I did find out that this is one of the events held by Milford Care Centre, spearheaded by Milford Hospice Friends Association (MHFA).. This association was founded in 1983.. As for general information, Milford Care Centre is actually a voluntary organisation.. It is run mainly from funding through charity.. This festival is one of the events to raise funds for the hospice.. Also, as far as I was informed, only the doctors are employed by the Health Service Executive (HSE), but all other employees are employed by the hospice itself..

Now, moving on from some background to the event.. This year's event took place on 14th September.. However, this year, the event was not held in the hospice grounds itself as the weather had not been great lately.. It was decided by the organisers that they would take a ground outside the hospice.. The venue was just about 5-minutes drive away, and with full tarmac ground, all the mud and muck were avoided.. I took a small bit of my time over the weekend to see what was it about..

Generally, it is a festival of trade and display.. Locals sell goods including home-made bread, scones and jams, used clothes and home utensils, cutleries, books, home decoratives and toys.. These were segmented in different tents for convenience.. We had a walk around and bought only a spread cloth for serving food.. There were also barbecues, despite the drizzle.. More interestingly, there was a Harley-Davidson motorbike lot and a Goldwing lot, too.. Also a collection of retro cars and old farming machineries.. We got to take some snapshots of the events..

Ina with a Goldwing motorbike..

Three love bugs..

Barbecue in the drizzle..

Ina with an antique retro van..

Retro sports car..

I seriously do not know what this is - possibly a pump of some kind..

A collection of old Irish punts..

Old oil pump - sponsored by Esso!

Unfortunately, we didn't have the leisure of time to stay long at the fest.. On the way home, I had to stop by at the hospice to drop some things for work, mainly because I am away on annual leave this week, hence I don't really plan to be at my workplace, but also I didn't intend to leave the work left for a week..

And, in the rain, Ina got some pictures with a horse..

Well, I think I'll cut this one short.. I know, this entry is probably more pics than discussion, unlike my usual entries.. No matter, I still have few more up my sleeves.. I'll come back later for a slightly heavier entry - the Big Bang Experiment, Trust Me I'm A Doctor, Tidy Town - to (provisionally) name a few..

As for this one, enjoy the pics.. I congratulate Milford Hospice for holding a wonderful event.. I hope this would boost the funding for the running of the hospice..

Till then, see you later..

The Art And Science Of Palliative Medicine

Salam..

A very good day to all of you.. I suppose this is one of my entries that would probably go under a different heading compared to my other previous ones.. I know, usually I would write about the present happenings or the unforgettable past, but this is a little bit different.. I would be honoured should you take a small piece of your time to take a small peek on what I would very much like to share.. It may not seem significant to our life at the moment, but I can assure you, a lot of reflections can be made and, maybe, some of us could see a bit of room for this..

What Is This Palliative Medicine?

Palliative Medicine is probably one of the youngest of specialties in medicine family.. As a matter of fact, it has only been recognised as a medical specialty by WHO in the recent years, not more than 30 years.. But the history of palliative care tracks back to the early fourth century.. In the beginning, these hospices are places for travellers to rest.. It was not until sometime in the 19th century that a religious order established hospices for the dying mainly in Ireland and London.. It is possible that at that time, Palliative Care was born..

The term Palliative itself comes from a Latin word 'Palliare', meaning 'to cloak'.. Unfortunately, many of us have some reservations with the specialty and services provided by palliative care team.. It is not uncommon to hear people associating the word Palliative Care or Hospice with Cancer or even Death.. Even in Ireland itself, where palliative care possibly first began, the locals still see hospices as a place where 'you can check-in but can never check-out'! As a matter of fact, even among general medical physicians, palliative care is still vague and more of a concept than an actual practice.. It is all about how much we know, how much we understand what palliative care entails and what can they offer.. It would be of no harm for me to share a small bit from my experience working in the area..

WHO defines Palliative Care as :

An approach that improve the quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosicial and spiritual

It is imperative to understand the few basic concepts in palliative medicine.. As from the definition, the main aim is to improve quality of life.. It does sound straight-forward enough but in fact, the aim of improving the quality of life is more of a practicality and support rather than just throwing suggestions.. Many of these patients suffer from terminal disease (mainly cancer) which is or has become unresponsive to treatment.. An easy example would be widespread disease.. Some may have had chemotherapy treatment but disease still progress, or some other may already have widespread disease at time of diagnosis.. Either way, no further (radical) chemotherapy or radiotherapy can be used to 'cure' the disease.. This is when the call to concentrate on the quality of life becomes a must..

Prevention and relief of suffering is another aspect in the definition that may well need a little explanation to clarify.. It is again important to note that the word 'cure' is not being used.. Alas, palliative care is not about curing.. A large proportion of patients under palliative care suffer from intractable pain, or nausea and vomiting.. And these symptoms, more often than not, are clinical presentations of the progression of the underlying disease.. Believe me, they are not pleasant at the least.. By focusing on prevention and relieving these symptoms, the palliative care team hence are focusing on the quality of life.. Many of these patients require morphine to alleviate their pain.. Of note, morphine is the strongest natural analgesia (pain medication) known to man today.. By relieving pain, these patients can potentially spend more quality time with their family members and loved ones.. This is just an example of many..

These all sounded very scientific.. Do not be alarmed.. Palliative care is still medicine, and medicine is science.. The science of medicine is still very much the basis of management.. Palliative care doctors still prescribe medications to the patients.. In fact, I would say, among the physicians, palliative care doctors are among the best to deal with symptoms like pain, comparable to anaesthesiologists! They prescribe large doses of morphine, yet the attention to detail on the calculation of requirement of each patient is meticulously forwarded..

The Art Bit Is Crucial Too

Special to palliative care is the art of it, as do other specialties have for themselves.. The hard part in understanding palliative medicine lies in the question : When do you stop all measure? This is very difficult to understand until we take a while and sit down to evaluate the theme.. When a person is dying, when does the doctor say "no more IV fluid drips" or "stop all other medications"? This next sentence may sound incredibly disturbing, but I will try to explain at my best effort.. Active treatment is stopped when the probability of having a significant response that can improve quality of life is low.. I emphasize the sentence in bold as one read may sound like "washing their own hands".. I give an example of a frail gentleman with widespread lung cancer and currently having a chest infection.. The decision to NOT treat with antibiotics would be made if the general condition of the man himself would not improve despite having antibiotic treatment.. However, if the man was otherwise mobile and relatively well before the infection, then antibiotic treatment may well be tried to give him a chance of fighting the infection.. This is a hard one to call - as a matter of fact, this would be very common in palliative care setting.. The judgment call to treat or not to treat is the art in palliative medicine..

There are many other examples that would call the doctors up to make a decision as hard as - or even harder than - this.. Dealing with family members is another example.. How do you tell that you feel the patient is dying? What would you say when family members ask about the length of time their relative has? Suffice to just throw samples, just for us to ponder.. Many can debate siding on 'to treat' as many as on the 'not to treat' side.. It is still evidence-based, but taking into account the experience of the doctor and the setting of the situation.. The decision-making call is the art as much as it is science..

Palliative Care And Me : Reflection And Ambition

Alhamdulillah, I have been given the short spell of experience working in palliative medicine in Limerick.. At almost six months, I am fairly happy to prescribe morphine intelligently.. I have the opportunity to work with two very experienced consultants in Milford Care Centre.. Dr Sinead Donnelly is the chairperson of Irish Palliative Care Consultant Association currently and has thought me a lot about the person approach of palliatve medicine.. The art and basic manners in dealing with patient in palliative care.. Dr Marion Conroy is my current consultant, who has taught me a lot on managing the medications in palliative care.. In fact, both have taught me so much in different ways that I am truly grateful to have this experience..

Recently, too, I recieved an email from Dr Ednin Hamzah (CEO and Medical Director of Hospis Malaysia) thanking my interest in palliative medicine in Malaysia.. I sure will consider having palliative care as an interest in my medical career, if not as full time.. Palliative medicine in Malaysia is even younger than in Ireland, only coming to the scene around 1991..

Reflecting on my personal experience as a family member, I realise how magnificent this small moment in providing palliative care service is to me.. My grandmother died a few years back and it is that moment that I keep reflecting on to motivate me to learn as much as I can about caring for the dying.. Had I the knowledge and experience of palliative care at that time, maybe I would have done a little more to the situation.. I could still remember the gloomy air of the situation and the sorrow of the moment..

Dedication

Before I end this entry, I dedicate this writing to my late grandmother, Hjh Zabedah bt Abu Samah, and to my two consultants Dr Sinead Donnelly and Dr Marion Conroy.. I thank my late grandmother who opened my eyes to see the strength required to care for the dying, and I thank my consultants who reminded me that being a doctor is not about curing a disease but caring for a person..

* Art Trivia : In case you haven't noticed, I managed to write this whole entry without using the word drugs, instead I used medicine / medication ~ the linguistic art in palliative care..

* Feel free to visit Hospis Malaysia at www.hospismalaysia.org

Exam Is Over and I Got A Nintendo DS Lite!

Salam..

I'm back again! But by no means back due to popular demand.. I'm just available to scribble a few words.. Ina is on-call tonight, so she will not be home until late tomorrow.. I will be on-call tomorrow, but fortunately enough for me, I don't have to stay over the hospice during the call.. But I will be on-call for the whole weekend, off-site, but as close as a mobile-phone-call away.. Hopefully, it will be quiet like the last time..

Exam Is Finally Over (For Now)

It was not the most pleasant of experience having to take the MRCP exam.. For the lay person, the MRCP exam is a general professional exam.. MRCP stands for Membership of Royal College of Physicians.. I took the Irish exam, hence MRCPI.. There are three massive parts of the exam.. Part 1 consists of 100 mutiple choice questions on basic medical science - may sound easy, but believe me, it is far from it! I know a few people (in fact, a large number of people) who are still stuck at the first part.. Part 2 consists of another written exam, even harder, but I was told the questions are more clinical in nature.. And the last part (the second part of Part 2), is the actual clinical examination..

The exam took place in Dublin last Tuesday.. Ina took two days of holidays to accompany me down to Dublin.. We stayed in Abberley Court Hotel, about 10 minutes drive from the exam hall.. Of course, I went to the exam alone and I left Ina in Tallaght Square Shopping Centre in the meantime..

Anyway, I am in a way glad that this exam is over - for now.. If I pass this exam, alhamdulillah.. If not, I'll have to attempt the paper again sometime next year.. Maybe I'll consider sitting for the MRCPUK exam too.. I don't really know how I did.. It felt ok-ish.. But I have to admit, I didn't really give myself the best preparation.. I did study and did quite some questions, but maybe I could have done a lot more.. But I really didn't want to stress myself too much as I know from before that I perform worse when under stress.. So I tried to keep a manageable level of stress just enough to push me with the studies but just under the 'cracking' point..

Well, no point wondering how I did in the exam.. I will just wait patiently and calmly for the results.. I will update through this blog.. Do pray for me..

Train This Lazy Old Brain!

Yes, it was a MAJOR SURPRISE! Ina bought me a Nintendo DS Lite.. It was never on my wishlist.. Of course, I did dream of having one before, but that was long gone.. So, to be greeted with brand new Nintendo DS Lite with Dr Kawashima Brain Training was just so out of the blue and surprising.. Ina bought that and gave it to me when I met her at the Square.. She went shopping there while I was squeezing every glucose molecule in my body to stimulate my brain during the exam..

Oh, in case you didn't know, our brain does regress over time.. Some studies have suggested that we are actually using at most 5% of our brain capacity.. And that 5% was thought to be achieved by El Primero de Brainiac Albert Einstein himself! So, the general population are using even less of that.. Hundreds of thousands of our brain cells die everyday, hence the quite common appearance of general cerebral atrophy in the elderly population on CT imaging.. It is not a disease-related condition, but largely a natural process.. It is then very important to remember that the more we use our brain (or what remains of it), the more active the cells are.. In very easy term, the more we use, the more the cells need their fuel, ie. glucose, hence the more healthy they are.. Some researches have shown that people with higher education level have is less associated with dementia later in life..

I have now spent some time with Dr Kawashima.. A little bit of loud reading, a little bit of maths and a little bit of sudoku.. Badly for me, my brain age is currently at 70 years! I have to do something about this.. Maybe I'll improve over time.. I might get Ina to join me in this strive for brain youth too.. Honestly, I have my reservations on how this might effectively improve my brain, but I'm doing it for the fun.. And it is FUN! So, even if my brain continues to age, I will still have fun at the very least.. Maybe I will add several other games in my collection too, just to spice up the gadget a little bit more than just the brain training.. Hey, why not, right? I just don't intend to be a forever-geek, but nor would I like to be a Homer-brainer!

It is then a matter of balancing the work for the brain and the rest for the brain.. For those who watch a lot of television, that's too much rest.. For those who squeeze every last bit of their brain reserves, that's too much work.. Find the balance for yourself.. As for me, I am still trying to find the right amount of both to put on my plate..

Well, I guess I have scribbled too much for the night.. I thank Ina for the nice DS gift.. And I hope you folks enjoyed this entry.. I will drop in again sometime soon and write a little bit more on some other thoughts I have.. Watch out for my next (hopefully) exciting entry.. Till then..