Raison d'etre

Coming Soon!


Thursday, July 31, 2008

I? need? help?

I dunno whats missing!

I have the ability to befriend ... but no longer have the ability to maintain close frienships... and its not because of a lack of effort...

I dunno how to make things better... Some switch went "click" sometime ago and things aren't flippable back again...

Am I too serious? I don't know... I don't think I am but is it the practical years taking a toll?

hai what do I do?

personality wise? I dunno le? I used to be loner before... I don't have a gang.. ex housemates seem to be the gang I have.... but now with ruru in tow ppl probably see me as a pair? I really don't know? I.... Just don't know whats wrong...

being in the wards... I sometimes wander alone... it kinda feels weird... I am friends with everyone of course but then there's no strong connection there... No one to go to lunch with... coz ppl assume I'll have it with ruru? I'm not sure... bit lately this problem has been bothering me......

is it something I did?
something written on my forehead that I am not aware of?
that I somehow delineate myself from the others?

With hometown friends... Usually having topics to chat... Its now come to "how are you"... I am always the one to initiate drinks/ tea/ gatherings... however I am not invited... is it because my holidays always do not coincide with my other friends?

I feel so funny.... Its been bothering me quite some time la... and I dunno what to do with it...

if you have answer... let me know... I need to know whether its me and if its something that I can change... and I will change if i am the cause of the problem.

have a nice day!

Sunday, July 27, 2008


This be my new bikey! Actually its my first bike as the rest Were hand me downs... So I'm pretty proud of it...although pretty sad looking at my wallet Hemoptysis... hehe

{--Click on the images to see the full size view--}

- Alloy body - 21speed - Front suspension - unique body design- unique welding -

Bike = (price lost in haggling)..

Miscellaneous (unhaggled price )
Lock 1 = RM 26

Lock 2 = RM 24

Basket and rear tray = RM 40
Bell = RM 5

Pillion rider Stand = RM 7

Grand total = RM 553!

Thursday, July 17, 2008


Going through one of the most stressful and tiring phases of my life...
I know those who are close have noticed that I have changed... This time for the worse.

Well, I'm the sort who used to take everything in my stride, hardly being affected by situations and conditions where I can remain happy go lucky no matter what...

Then I realised that I may be bottling up a lot of unexpressed feelings all this while...so much so that when I reach the boiling point I pop the cap off sky high. I think, I actually enjoyed being angry at one point. The reason, (on hindsight) is no longer having to keep everything inside feels so refreshing. I can lash out at someone at will instead of you know...-Being taken advantage of, seething inside whilst putting on a smiling face outside-... Not having to restrain my emotions feels really good.

That is... until I realise how much it affects the people around me.
They don't say it out loud but then I can see how their image of me has changed. I know I don't need to be a crowd pleaser but then knowing that people restrain themselves around you isn't exactly enjoyable.

So... what next?
I'm not exactly sure but I know I must strike a balance between being a punchbag and a crown of thorns...
Starting with
1) Learning how to breathe
2) Relax, take a step back and think before uttering anything to prevent the foot-in-
mouth syndrome
3) Time management, stress management,
4) prioritization
5) reestablish my circle of friends...my safety net
6) Mingle with my housemates into a dough!


I can't help it.. I curi from some people's friendster profile.. Too cute to resist!!!Expecially the one in the centre...ARGGGGHHHH Tolong!!!!

Tuesday, July 15, 2008

What are you doing? Saving the jerk who dumped me

“What are you doing?”

-“Saving the jerk who dumped me!” (Straight face included)

Yup that’s one dialogue that really caught me off guard the first time and brought lotsa chuckles to me the second time around.

Then came the –uh- “betrayal” by Mae and Tai lee that totally caught Azula off guard… and I’m pretty sure all the audiences! I mean, you always get shows where the good guy gets betrayed by his closest friends… but in Azula’s case I never saw that coming.

“I never expected this from you. The only thing I don’t understand is why? Why would you do it?”

“I guess you just don’t know people as well as you think you do. You miscalculated. I love Zuko... more than I fear you!”

And the holy cow grazes!


Well that’s the most up to date episode of Avatar: The legend of Aang- Book 3 Fire: Chapter 15-the boiling rock part 2. And I really can’t wait for the next episode due this Thursday!!!!!!!!!!!!!

Yeah… and if you don’t get the hint- I love AVATAR!
Its simply one of the best shows around, and the quality is maintained throughout all three seasons! I’ve pretty much shied away from 21st century cartoons- Anime, the justice league, spiderman,TMNT and *shy* pingu notwithstanding- but Avatar is on a league of its own.

Oh well, I can sing praises the whole day but that isn’t the point of this blog.

The point of this blog is.

I owe an apology to everyone –

1)Mao mao coz I neglected you since March I think? Not really neglect lah but I wasn’t exactly message-happy like I used to be. Part of it because I have a new distraction, part of it because of the exams in March, part of it because of the O&G posting but I’m guilty all the same…

2) Lao ru coz I sorta tuned out of life midway through O&G and only recently do I finally start to get the frequency right. I was super irritable and out of sync and moody and depressed and in the whatchamacallit-“me against the world” syndrome. You tried a lot to cheer me up and I’m most of your efforts were in vain. But now I’m back again and I promise to be a better “liver” this time around. I’ll try me best. I’ll act on your complaints ASAP k? Sayang…

3) All my O&G posting mates especially my teammates- Mas Edi, Aisyah and Jia ying- I’m sorry I screwed up at the start of the posting because I didn’t know what was expected of me. I’m sorry I didn’t get the most up to date info (sometimes I just don’t know it exists!!!1) and caused you all to lose out on the Drug formulary. I’m sorry for my sullen look and half-hearted replies, my impatience, my some-might-say-haughty replies and my exasperation at times.
Give me a chance to explain myself?

- The lecturers don’t inform me of anything that crops up. I try my best to confirm with them beforehand but they just snap their fingers at the very last minute and hey presto everythings cancelled. Information transfer leaves a lot to be desired because they never attempt to reach me. And when information does reach me it stagnates at the ketua ward or ketua kumpulan level. I dunno how to remedy this part. I try to write it on the board directly so that it circumvents the information tiers but then it isn’t exactly accessible… woe is me.

- As you all know I “kena” all the time. That plus the fact that I miss out everytime on ward rounds, OT, clinics etc because I need to set up the hall and tidy up afterwards, and not being appreciated makes me feel so downright clownish.

- As some of you know I “kena” secara tiba-tiba tanpa syak wasangka atau usul-periksa dan lain lain peribahasa…case in point…

I sent a msg telling Doctor I at the start of the posting we under her supervision would like to meet her. I didn’t call because she was busy with the Repeat Final Years O&G examination for a whole three days…. So when I managed to see her I asked her when as she didn’t reply all through the 3rd day…

“doctor doctor!...
:Who messaged me that day?
“Me me! (hoping to earn brownie points for enthusiasm, I think)

And somehow rather I managed to get into her bad books and stayed there throughout the posting… and I don’t know how to remedy things… oh well at least its over..

And of students snatching new cases in the clinic and Those who don’t abide to the on-call roster I did inform the students in question at least once but after that I can’t really do much. We’re adults and I don’t see the point of me playing the role of mother hen… Sorry if you all expected me to do something further… I don’t know what I can do.

All of this plus many other incidents in the labour room, made me edgy and agitated and I will retaliate at the slightest provocation.(JK you felt the brunt of it and I guess I owe you no apologies as you should understand by know speaking without consulting Wernicke will piss people off. Your girl friends have accepted the way that you are and raise no complaints but I’m sorry the rest of us aren’t so accommodating.) Inane requests that used to be attended to were turned down outright… as I have no residual energies left to respond..

At the end of the day if you feel my explanations don’t cut it, I can only Apologise once again for things that I do/ things I didn’t do and hope Surgery will be more forgiving for us all.

Thank you for your cooperation and attention and support (if there’s any left…)

And happy holidays!!!!!!!!!!!!!!!!!

4)To anyone whom I've neglected or let down or anything at all... I'm sorry
And to you you and you who complains that my blog should be what I write and not what I baca elsewhere and then tampal here and there I hope to say that I just wanna share and I just don't have the time (or when I do have the time, the energy) to write.. but I'll try to be more proactive..

5)To my fishies... I'm back to see you and clean your house so don't despair!!! :-)


p/s-Wei kiat's ultimate cute pic

Thursday, July 10, 2008

Surviving Med School

Written by Jeff Wonoprabowo --

Throughout the year, one question loomed over me, haunting me like a bad dream: "Do I really want to go through all of this to become a doctor?" It's a question I think is harder to answer now than when I was in college, especially now that I’ve started to see what I am getting myself into.

One day while I was in high school, I was sitting on the couch in front of the television. I’m not sure what I was watching. I do remember my mom calling me away from the tv set. She called me into the living room because she wanted to talk. I found it rather odd; it seemed totally out of the blue. But, I suppose, this shouldn’t have come as a surprise. Conversations with mom sometimes seem, at least to me, to come right out of left field. That evening my mom defied the stereotype that all Asian parents want their children to become a doctor or a lawyer. She sat me down to tell me she didn’t want me to become a doctor. That conversation was in high school.

The thing is, I was never the child who grew up with dreams of becoming a doctor. When my mom found out she was pregnant, she decided that in order to stay at home with me she would have to start her own business. She started a data entry business. As a result, I grew up around computers and decided that one day I wanted a career that involved computers.

But here I am, now a medical student. Although I have only completed the first year, I’m on my way towards earning the right to add the initials M.D. behind my name. Not that I need any more letters; my last name is long enough.

It’s scary, though. I have put myself on a path towards becoming a physician -– a path that is long and quite expensive. Should I continue down this path, I know I will find myself in a very rewarding career with enough money to keep a roof over my head and food on the table.

It's a frustrating journey. There's a ton of information that is force-fed during the pre-clinical years. At times it's a challenge to see how some of it is even relevant to patient care. More than once during my first year, I wondered if I really want to do this. It was almost a monthly cycle; it coincided with exams that came about every five weeks. I hated exam weeks. Actually, I still do. But those were the times when I wondered, considered, and longed for being somewhere else. I enviously think about friends who have finished school and are earning a good paycheck. Then I take a look at the numbers on the statements I receive from my lender. It is always a little shocking to see how quickly those numbers grow. Sadly, the balance of my checking account has the opposite trend.

Yet there are times where I am truly grateful for the chance to be where I am. And there are many more times where I am excited about the possibilities of where I’m headed. Because medicine -– being invited into the depths of patients’ lives –- is exciting. I wouldn’t blog about medical school if I thought it was boring, depressing, and monotonous. On second thought, I probably would. But if you're reading this site, you probably wouldn't be my target audience.

Sure, it can be hard and time-consuming. Obviously it can be very frustrating. But after having spent six weeks in the wards with attendings, residents, and medical students (2 at the beginning of the school year and 4 after), I think I have found a source of inspiration and motivation. It's not about the prestige; I don't think all the training is worth what prestige is left in the profession. It's not about the money; there are easier and shorter paths to earning a decent living. It’s not about being your own boss; the current medical system has made that terribly difficult. It's all about the patients.

And now I think I've found the answer to that looming question. I just hope my answer doesn't get lost in the deluge that will come in the form of my second year...

Notable Replies :

As a person who initially wanted to be a doctor (and went through all the pre-requisites, the MCAT, etc.) and who then decided instead to become a nurse, I have to say that in my practice, neither medicine nor nursing has much to do with the patients and has everything to do with insurance companies and attempting to manage patient care with inadequate and dwindling resources. I work in the ER and when we admit patients to the hospital and I speak to admitting doctors (who often don't even know the patient and are chosen to take care of them based on which insurance the patient has), it turns my stomach to think of being the MD on the other end of the phone having to come up with a plan of care for a complete stranger that he or she may or may not meet for another 24 hours depending on their schedules. It's sick and it's scary from a professional liability standpoint. Dealing with our aging population and their 10 chronic illnesses day in and day out is not fun, it's not mentally stimulating and it's not glamorous- it's work. The bottom line is that once you get through your learning curve, work is still just work as it would be in any other job. I had to ask myself how much I was willing to sacrifice in my personal life for something that ultimately would end up still being just a job at some point. Life is very short and at the end of your days, where do you want your memories to come from and where do you want your life to have been spent?

I hate to be the cynic, but is it about the patients? As you can see from the replies, the more time someone spends in health care the less it becomes about the patient. I keep thinking it is going to get better. It certainly isn't about patients in med school. In the first ridiculously painful year there was always second year to look forward to when I got to barely talk to a patient. Then there was third year when I got to touch a patient, however pointlessly in the learning like a leech phase. Finally, I'm a fourth year where my contribution is actually minimal and if I wasn't here then someone else would do it more efficiently and probably better. These thoughts don't go away once you "hit the wards" as some have suggested. Yet, I will keep hoping that eventually this medicine stuff actually allows me to be in service of people. But yes, I'm doing this blindly and with the faith that it will someday matter. I may never enjoy medicine (memorize stuff you don't care about and apply occasionally...it actually isn't challenging...who knew!), but the hope is that it will someday matter.

I've been waiting for this article for a very long time. Since my first year in med school 6 years ago actually :). In the Caribbean we have 5 years of Med school then we graduate as medical doctors with the MBBS (bachelor of medicine and bachelor of surgery). We have one year of internship afterwhich we go from provisional registration to fully registered medical doctors, unleashed to the public ;)

I just completed my internship year and have been recently unleashed :) Our days/months/years in med school are quite a lot different to those in the US and other 1st world countries. We have patient interaction and contact from as early as our 2nd semester in 1st year on the wards!! i remember in my 3rd year, i was very competent in basic procedures as iv cannunlation, incision and drainage of abscesses and removal of chest tubes. in 4th year my colleague and i, (under direct supervision) applied our first skull traction on our orthopaedic rotation....applying the Steimann pin was petty stuff for us then.
So, basically we had a lot of hands on experience and really got our hands dirty throughout our training. Having completed my first year as a Doctor and applied all that i learned as a student, repairing episiotomies, delivering countless babies and actually doing an above knee amputation (having scrubbed in countless times as the assistant), it became quite clear to me why doctors either make or break in their profession.

"there are some things in this life that money just cannot buy!!!"

...and the satisfaction, pride and overwhelming joy that the privelege of assisting another human being where they cannot assist themselves is most definitely one of them. Too many doctors focus on the money! hands down!!

Dont get me wrong, there were countless days and nights i'd cry because of stress....i was broke with, sleepless nights, lack of food, disappointing results after my greatest efforts, crticism, condemnation and harsh words from my seniors and most of my high school friends were buying their first cars or home and living "the life"....the list goes on. I now realise that this journey cannot ever be compensated in financial rewards/returns and that i must seek that elswhere. Hence, i started my own business and now have money coming in to me whether i'm there or not, whether i'm sleeping or awake and i have this peace of mind now when i go to "work" and have to deal with all the stress and the "heirarchy". Now, the moment when i truly opened my eyes was when i decided to volunteer my medical skills at a free health clinic in a rural community where access to health care and availabilty of doctors and medical services is dismal. But it was "that feeling" when the patients left all smiles because they got free advice, counseling, medications, ultrasounds, eye tests, you name it...it was that feeling that gave me inner peace and removed all doubt and panic that i'd chosen the wrong path. the money will come (esp if you diversify your income) but peace of mind must be earned and you will cherish it forever.

Thank you for your article and everyone's comments. No one or way is right or wrong yet each comment has so much emotion attached....why are some negative and others positive? because we all live the struggles day in and day out but some choose to face them and find ways to overcome whilst others choose to run for fear that they've made the worst mistake of their lives......what do you choose??

For me. The answer still isn't clear. I never wanted to be here and the stress is killing my relationships... is it worth it? I don't think so.
But what the hell. No turning back so I'll do what I can.

Tuesday, July 8, 2008

outdated--- Treading dangerously --

Barisan Nasional World Records!
Posted by labisman

Friday, 28 March 2008

THANK YOU BN. For giving us the World’s Healthiest Country. Even as the Elections Commission, your own agents, ooops ... I mean er... civil servants, admitted one week before the elections, Malaysia has more than 8,500 voters aged over 100! Dear BN, what’s your secret? Do these super-old voters drink ginseng? Tongkat Ali? Or indelible ink?
THANK YOU BN. For giving us the World’s Most Expensive Car Jack. As the Auditor General’s Report released last year showed, you used our money to buy car jacks at RM5,741 each when it costs only RM50 per piece in the hardware store. I understand that these fantastic tools can “jack up” not only cars but even Datuks all the way up to the Fourth Floor of Pak Lah’s Minister Mentor.

THANK YOU Umno. For the World’s Greatest U-Turn. Last November, when HINDRAF (HINDu Rights Action Force) Indians demonstrated in KL to protest their “marginalisation” by the Umno-controlled government, you condemned them as “ruffians” who would jeopardise social stability, tourism and foreign direct investment (FDI).

But one week after elections, Umno itself demonstrated in Penang, Ipoh and Shah Alam claiming that the new State Governments there will “marginalise” the Malays. And no doubt, they want to “promote” inter-racial harmony, social stability, tourism and FDI with slogans like: “Don’t play fire with Malay rights!” So dear Umno, why don’t you call yourselves MALRAF - MALay Rights Action Force!

THANK YOU Gerakan. For the World’s Smartest Economic Policy. As revealed by blogger (and now MP) Jeff Ooi, former Chief Minister Koh Tsu Koon used taxpayers’ money to give Motorola a RM1 billion (that’s RM1,000 million) contract, so that the American electronics company would announce (just before the elections) a RM350 million investment in Penang to “prove” that the state was still economically “competitive”. Wow, what a vote of “confidence” in Penang’s economy!

THANK YOU Umno for the World’s Greatest Irony. Last November, you accused HINDRAF of causing losses to businesses and traffic jams (when it was actually the massive police roadblocks/crackdown that caused the jams/chaos). You said such protests were “not our culture” and a “threat to national security” worthy of ISA detentions.

But now Umno’s MALRAF has shown that such protests are indeed part of Malaysian, or at least, Malay culture. And the best part was that they proved we could have peaceful demonstrations – as long as the police behave professionally. In other words, Umno’s demonstrations have truly “demonstrated” that 50 year old Malaysia is mature enough to allow people to “let off steam” by shouting and holding banners for an hour or two without incurring National Apocalypse.

And then after all that shouting and sweating, habis cerita! We Malaysians (who are so bored that we stop our cars to look at road accidents) finally get some street entertainment and after that all the crowds go for their teh tarik and roti canai. Hey, that’s good business for the mamak shops you know!

But if you ask me, the true MALRAF are the many Malays who protested against BN policies through their votes, especially in Kedah, Kelantan, Penang, Perak, Selangor and KL. Just as the majority of Chinese did an electoral CHINRAF.

So what shall we call those Umno demonstrators? How about MONEYRAF? A MONEY Rights Action Force to demand their “Malay rights” privileges to “buta gaji” contracts, projects, AP’s and share allocations so that they (and their Mak Datin wives) can continue to buy their BMW’s (and “ori-punya” Gucci handbags) while the real makciks struggle to make a living selling mee goreng at the roadside.

THANK YOU Selangor BN, for being the World’s Most Environment-Friendly Government. DAP Kampung Tunku State Assemblyman, Lau Weng San, has lodged a police report over alleged destruction of documents by the previous Selangor State Government. Pictures have appeared on the internet of files strewn all over office floors.

Perhaps they were shredding all that paper to recycle into tissue paper? To wipe away the s**t before it hits the fan when the new Menteri Besar takes over? Ah, what fragrant records they shall leave behind... how eco-friendly of them!

THANK YOU MCA. For giving us the World’s Best “Buy One Free One!” Special Offer. This means the voters can Buy Opposition and Still Get Free BN Service!

Despite Pak Lah threatening the Chinese that they would “lose representation” in the government if they voted for the Opposition, the MCA still got their four Minister’s posts in Pak Lah’s new Cabinet. Of course, these Minister-ships have little real power anyway.

For example, even though the MCA got a massive “mandate” in the 2004 elections, the MCA “Minister of Housing and Local Government” (H&LG) never had power over housing and local government. Why? Because these matters are actually (in the Constitution, no less) under the jurisdiction of State Governments! The Minister of H&LG could not appoint Majlis Perbandaran Councillors or give approvals for housing projects. In fact, he himself once complained that Local Councils were not implementing his proposals for more CCTV’s, street barriers and well-lighted pavements under the “Safe City Concept”.

As MCA president Datuk Seri Ong Ka Ting said himself on March 9, the party “accepted and respected the people’s decision” and would “continue to fight” for the rights of the community and country. As The Star reported, he also urged MCA candidates with good track records “not to be affected” by their defeat and to “carry on serving” the community. One example is the hardworking MP Lee Hwa Beng, who despite being defeated by the young man who filmed the VK Lingam video, has sportingly agreed: “I will keep my service centre open.” Well done sir.

In other words, the people get the BEST OF BOTH WORLDS. We get more of an Opposition voice in Parliament and we still get the BN reps to help us with complaints of blocked longkangs, blinking street-lights and bloody road potholes. Well, how else can they hope to win back our votes in 2013?

BUT what if the new State Governments transform the Majlis Perbandaran’s to become more efficient? To do the bloody blinking jobs they were paid to do in the first place? What will happen to the MCA’s Majlis Perbandaran Liaison Officer and Petition Writer roles? Oh oh... looks like the MCA reps have to urgently reinvent and rebrand themselves.

THANK YOU Elections Commission (EC). For giving Malaysia the World’s Most Advanced Technology. Before this, we’ve only seen “tele-portation” on Star Trek – you know, like when Captain Kirk or Dr. Spock says “beam me up” and they are instantly “tele-transported” in a sort of large laser beam from some strange planet back to the mother spaceship.

But BERSIH, the elections reform group, says that you, the EC, have managed to transfer voters (possibly thousands) from Selangor to places like Kelantan and Terengganu without even their knowledge. How many of these people could actually drive five to eight hours all the way there to vote? PAS claims that at least 200 buses of “phantom voters” were brought into Terengganu and its President, Hadi Awang says police “escorted them like VIP’s”.

No wonder the cartoonist Zunar calls you, the EC, a “component party” of the Barisan Nasional. Come on... don’t so like dat-lah. I mean, congratulations on such marvellous technology and all that. But dear EC, at least you should have the basic courtesy to “tele-transport” voters only after they say “beam me up”. Not before, OK?

What’s next EC? Al Jazeera TV reported on March 9 that you could stuff 560 “registered voters” into one street of small terrace houses in Cheras, Selangor. You even had the sense of humour to stuff 26 of them into the same 1,400 sq ft house (perhaps to share the bathroom?) as the brother of Jenice Lee (now elected as DAP State Assemblywoman for Teratai, Selangor).

Now, we all know that great progress is being made in “data compression” technology. For example, we used to need two or three pieces of VCD’s for one movie whereas nowadays, you can stuff five or even more movies into just one piece of DVD. So... for 2013, I am looking forward to the EC’s “best-punya” world-class technology – to stuff 30 “registered voters” into the dog kennel behind my house!

THANK YOU MIC. For the World’s Best SMS jokes! Allow me to jazz them up.

“Hi. My friend is looking for a job. Construction background. His education not that strong. But can “kau tim” things. Any buildings collapse, he will say Act of God. He was with Malaysian Govt past 30 years. Last job: Works Minister. His name is Samy Vellu. Please help him to get at least toll gate collector job. Thanks.”

And you probably also heard the “latest news” that Samy Vellu is now a film producer in Bolehwood? His first movie will be Kuch Kuch Kalah Hai starring Mydin Khan, Sharizat Rai, Kayveas Kapoor, Koh Tsu Khan and Khir Tempe Blachan. Special guest appearances by Khairy Kumar and Bobby Badawi.

And lastly, there was this: Breaking news! Samy Vellu is very angry and will leave MIC to form a new political party for Indians called Parti Untuk Kaum India MAlaysia - PUKIMA.

By Teh Tarik


Article by Thomas Robey

I have to admit: my complexion has adopted a green hue after living in the Emerald City (Seattle) for 6 years. I’m not referring to gardening skill, increased nausea, or skin mildew, nor am I a Ralph Nader supporter. The green in me is due to being bitten by the environmentalism bug. I didn’t realize how bad it was until I found myself in a country where my habits clashed with everyone else’s. For example, when returning from a clinical rotation in Eastern Washington, I hauled eight bags of aluminum, plastic and paper home because it was not apparent that those items could or would be recycled in Spokane. Yes, I know this qualifies me as over the deep end. Your follow-up thought is “what has this to do with a medical blog?”

The differences in recycling between cities can be played out on a much smaller scale. Do your school or workplace recycling habits resemble your behavior at home? More and more of us know by heart the recycling rules in the kitchen: “#5 plastic is okay, but the lid goes in the trash,” or “save that deli container for my next art project.” Does this behavior get checked at the clinic door? Does your medical center recycle? If so, I bet that all attempts to reduce waste go by the wayside in the hospital’s operating room. There’s good reason for OR’s to make extra waste (namely, sterility!), but it’s hard to believe that all of that stuff needs to be disposable!

Change is always hard – how many of your patients quit smoking with their first try? As with other behavior modification, improvement is easiest on a small scale. Here are some small examples of correctable material waste that I’ve noticed in health care:

* recyclable cardboard glove boxes in the trash

* single use metal suture kits (forceps, scissors, needle drivers)

* no beverage container recycling

* disposable sterile or contact precaution gowns

* no white paper recycling

* only styrofoam plates and plastic utensils are available in the cafeteria

* shredded patient information sent to the regular waste stream

* plastic water bottles at every conference

And these are just the obvious ones. I hope you could hear the incredulous tone of voice as I listed these off! What waste do you see where you are learning/doing medicine?

International readers might wonder why hospitals allow steel instrument sets to be thrown away. The answer is expense. It costs more to collect, clean, package and sterilize the instruments than to buy lower quality ‘one-use’ tools. Even these cheap instruments last a while - I salvaged and sterilized one of the sets I used in an ER and practiced suturing at home before discovering how helpful they were for projects around the house requiring fine manipulations.

Presenting ideas to a large institution or making suggestions as the new guy who’s just here for 6 weeks is intimidating. But there are a number of little solutions to reduce waste that you can do as a student (i.e. as the lowest rung on the ladder). The surgeons in one red state thought I was a nut for putting out a box to collect aluminum, but a week later it was full. I take home papers without patient information on them for the bin. Even just inquiring about a clinic’s recycling policy could result in a system change.

As fuel and plastic prices increase and more people become aware of resource limitations, it will become more important to reduce, reuse and recycle, not just to save the planet, but to reduce the bottom line. And it may just be those energetic new students or house staff who help translate ideas into actions. What will you do?


Great Blog, I find it hard to believe that so many physicians don't care at all about the environment. You're right to make the point about how much money they could be saving by re-using and reducing their waste. Another great point is that environmental degradation has serious health implications like allergies, asthmas and increasing cancers. As a physician who cares about a patient's health, it just makes sense to care about the environment they are living in as well.

Posted by: Christine | May 28, 2008 11:05:29 AM

Very interesting post. As for paper which contains private data, there are vendors who perform secure recycling services. We use them at our bank, and it is the same process for our note-taking during support calls as it is for destroying other sensitive bank records and even checks. The disposal services offer locked bins for us to drop the paper in, then they pick them up and pulp the paper without any human eyes seeing the contents. It's far more secure than shredding documents.

I can understand why surgical instruments are single use on patients, but I have always wondered why they can't be sterilized and used for medical school work on cadavers. It would save the medical schools a great deal of money.

Posted by: Mike Haubrich, FCD | May 29, 2008 4:36:40 AM

Good for you for being a recycler- I am too. Shame on you for not taking the extra five minutes online the Spokane Review's website or other Eastern Washington Counties webpages to discover that there are recycling drop off centers located in and around Spokane. I have lived in Spokane off and on for several years when staying with family as I have posted before. My most recent stint there corresponded with yours when I was studying for the boards - and while I found that the ease of recycling at the end of your driveway wasn't there. I did still find plenty of ways to have my plastics/can/paper into a recycling bin.

Posted by: Irene | May 29, 2008 6:06:26 PM

also - to follow up. AMSA did an indepth article regarding the issue of waste/recycling in the medical industry in its April 2008 issue. I belive it is available online or you can order print copies of the magazine. www.amsa.com

Posted by: Irene | May 29, 2008 6:09:18 PM

Beverage container recycling? You mean using non-disposable and just washing them, right?

P.S. Elegant usage of recycled electrons ;)

Posted by: Jared | May 30, 2008 4:01:27 AM

Just a few responses:

Irene: I did find places in Spokane to recycle some items. The drop-offs were open 8A to 8P, charged a fee for glass and mixed paper, paid out for aluminum and would not accept some plastics. My medicine and surgery hours plus call schedules made the special trips to the drop-off centers difficult.

Jared: You are right that reusing coffee mugs etc., is better even than recycling. What I was referring to was the glass, plastic and aluminum bottles and cans that soda, water and energy drinks come in. I have been challenged before on the carbon neutrality of blogging, but have not figured out quite how to measure it ; )

Another wrench in the sustainable OR movement is liability. If every patient gets a new (disposable) sterile drape instead of a laundered and sterilized cloth cover, I bet the hospital is better protected against infection liability. A quick search netted no AMSA article. I did find that one of AMSA's issues is open access. Perhaps that does not include 'convenient access.'

Posted by: thomas robey | May 30, 2008 3:16:50 PM

Great post! I admire your thinking so much about the environment and taking pains to ensure recycling your waste... I attended medical school in India and as a visiting student at a big university hospital in US, I noticed the huge amount of waste that such a big hospital generates.... quite a lot of which can potentially be avoided.... I think minimising paper-based patient notes and switching off lights and computers when not in use should be a good start.

Posted by: Anuja | Jun 3, 2008 9:59:30 PM

Good post. I live in England and work at the a major psychiatric research centre. I was appalled when I started work there and found out how little recycling went on. I was also shocked by how little sense of social responsibility many of the scientists/psychiatrists had. It seemed that this was also inversely related to peoples pay packets. We have however, managed to get a recycling scheme in place and are in the process of challenging our throw away culture. Next campaign may be to stop departments from getting drinking water shipped in by truck (which has to be the about the most obscene of all our excesses). It's hard, but worthwhile.

As for surgical equipment, it would be interesting to revisit sterility. I wonder how much of this argument is really just an excuse to take the easy option and throw away. Does it really cost more to sterilize that to throw away, or is this just myth?

Posted by: Fergus | Jun 8, 2008 4:09:54 AM

I really enjoyed reading your post - you're quite the trooper to take on this shared responsibility! I also understand the delicate nature of not rocking the boat when you're the new kid on the block. Is there a discreet (or anonymous) way to send a signal that greater recycling is needed at Eastern Washington?

My colleague and I recently published a paper that showed a 34% increase in recycling simply by using specialized recycling lids. I wonder if there was a way for you to sneak this paper onto someone's desk? Maybe it could motivate the janitorial staff to adopt systematic recycling practices (as opposed to you doing all the work).


Posted by: Michelle | Jun 9, 2008 2:58:40 PM

This is a great article. This aritcle brings about a couple of important American cultural ideas; convenience and ignorance (advertent and inadvertent). These ideas do not always persist in other countries. As the population of the earth rises, what price is going to paid for using "one-time use" convenience items? Stepping out of the physician personality to examine the world in different shoes is important. It is critical that we 'self-examine' ourselves and do it honestly. Even though I am studying to be a surgeon, I am still a biologist in love with out-of-doors, not just human biology.

I think a critical link for not only physicians, but other people, is to understand that environment controls health! Researchers spend a lot of time and money trying to find links in human health and the environment.

If physicians cared more about the environment, do you think others (non-physicians) might follow?

Posted by: Amanda | Jun 9, 2008 3:17:24 PM

Monday, July 7, 2008

Devolution- O&G inspired


Some would recall how I once said I will not be the same me anymore and I'll become evil.. where I decided not to be nice anymore...

somehow... I actually managed to do just that.

It all started mid may. With so much to do and so little time-- the mounting pressure, expectations and responsibility got to me.. my senses became denervated initially, I began to lose passion for life bit by bit...subsequently, my moods deteriorated and there was just no telling when my emotions will take a nosedive... then came the hypersensitivity stage where provocation meant asking me to re-send a message...

I became easily depressed, irritable with a short fuse... Where once I tolerated and returned insults with a smile... now I no longer put up with nonsense. For those who knew me as the easy-going, simple and happy-go-lucky guy... i'm sorry to say that part of me is kinda buried...awaiting exhumation someday.

My impatience made me turn down many simple requests, I flare up easily and I'm in a constant bad mood...For those of you who have been unfortunate enough to cross my path when I'm in one of those moods, I sincerely apologize, Just today I think I managed to shock 3 ppl by my response towards an unkind comment. Well I've always wanted to put that person in her place... making her realise that spewing words without the thought process ever going through Wernicke's area is gonna backfire someday and this time she really got it from me... I am unapologetic for my outburst because she deserved it but I am extremely displeased with myself because I rebutted her statement equally as fast, without considering whether I'm acting out-of character etc...but these days I really couldn't care less.

Whats happening to me? I...


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