Odysseys of George

Have we heard of Minimal Access Surgery? Well it is quite self explanatory actually, a surgical procedure performed via a small access. However in such diversified community, explaining the procedure actually can be quite comical. “Itu guna laserkah?”, ” teropong punya potongka”, “luka kecik-kecik potongka” or even ” guna camera potong ka” are some of the ways patients ask us about the above procedure. Patients, most of them, have actually heard quite a lot about this procedure and knows that this is advances in medicine and surgery and has its benefits.

Then I have older and even young surgeons asking what is so interesting in such a procedure. Isn’t the conventional open chop-chop more surgically interesting? More “fast & furious”? My answer ” True and False”.

Well, conventional surgery is what most or all of us are used to. Therefore, it becomes easier and safer but actually that too after some learning curve.So now it becomes exciting.

MAS is the way of the future. Benefits clearly outweighs the complications when a procedure becomes a norm such as laparoscopic appendectomy and laparoscopic cholecystectomy.
Yes, for the surgeon it can be tedious and frustrating in the begining but when the challenge and preserverance are conquered, and the patient recovers with a definite difference from conventional surgery — satisfaction guaranteed. Surgery is art.

A beginner in lapaoscopic surgery, should not have any restriction to convert to open method when he or she is having difficulty.

So what are the benefits:
1.Reduced post operative pain
2.Easier / Better recovery with shorter hospital stay
3.Early back to work
4. Good cosmesis
5. minimal adhesions and wound infections

And the disadvantages:
1.increased short term complications usually due to technical errors

Minimal access surgery requires totally different skills than conventional surgery. For instance, surgeons need to learn different hand-eye coordination (‘psychomotor’) skills in order to manipulate the imaging and surgical equipment; tissue appears significantly different when
viewed from inside the body; care must be taken to avoid accidental damage.

So why not laparoscopic surgery?

20 days ago while operating, I was informed by my anaesthetist that a mishap occured. An ambulance from Seremban Hospital on its way to Selayang Hospital had one of its tyre burst sending the ambulance with its 6 occupants into a ravine. 3 newspaper reported the incident in a small column mentioning that all 6 occpants were treated as outpatients and discharged. The truth - The driver was admitted for observation suffering from cerebral concussion. The patient arrived to Selayang Hospital and an elective surgery was set for him (urgency?). The nurse had some cerebral injury with liver and spleen injuries for which she was inubated and treated conservatively in ICU and later recovered. The worst,a lady doctor, houseman 2 months into her service, married was brought in with GCS 3/15 with severe head injury and bilateral multiple rib fractures and bilateral haemopneumothorax. She was also found to have a lax anus which suggested that she probably had cervical spine injury. If not mistaken, she was later found to be a primid in her early pregnancy. The other 2 occupants - not known.

Guess what? It took the newspaper 4 days to publish the accident. The doctor passed away recently and again the papers took another 4 - 5 days to publish the outcome. In between, the Minister and DG promised compensation and presence of insurance coverage for doctors accompanying patients in any transport. An inquiry was promised. A compensation was also promised.

Outcome? Well the lady housman passed away on day 19 post trauma in Serdang Hospital. No compensation was given as she is not confirmed in service. MMA gave a cheque for RM10 000/=
as a form of sympathy. Many unresolved issue, nobody seems to question and address these issues.

Problem: to be confirmed one will have to work for at least a year and have successfully completed their kursus induksi. Therefore, most of them who are not confirmed are all houseman and some junior MO. These are the people who will end up accompanying patients. And they are not covered. It is different for the nurses and MA or attentdents, as most of them are already confirmed in service thus the ex-gratia scheme comes into act if anything do happen to them.

Other issues: 1.maintenance of the ambulance and credibility of the drivers.
2. When does a doctor accompany a patient — this case was totally unnecessary for any doctors to accompany.
3. Can a doctor exercise his right to refuse to accompany patient since he is not covered? Or does he do it for the patient and country even if the government could not care less for their doctors!
4. When a police officer goes down in the line of duty or when two paratroopers collide among themselves, their fate and condition is alerted in the news for public knowledge. But when a doctor goes done in “the service of mankind”, why hush it and do we condone it?

Many senior doctors feel sad for her and many junior doctors are worried about their safety. Immediate family members and spouse and children are all worried and sympathetic. But where is our voice? What has the government and MMA have to say? What do our fellow doctors say?

As for me I have brought my disgust and opinions up directly to the President of MMA but wonder whether it fell on deaf ears.

My condolences to the spouse and parents of Dr Nor Baizura.

Why dive? The ocean holds the largest area in the world. If the earth (land) can be so beautiful what more the untouched oceans — the deep secrets filled with stories just waiting for one to learn and understand the complexity of life. Its the best destressor and a healthy recreational activity. It suits all ages.

Alone

It can be dangerous and not everybody can dive thus the need for a license. However, once one has experienced the sensations and the peacefulness, there is no turning back.Then there is more to do than just diving. The specialities present makes diving not just challenging but fascinating. To name some are like deep diving, wreck and cavern diving, technical diving, underwater photography and videopgraphy, underwater naturalist and night diver. You can even make a living out of diving by becoming instructors or divemasters.

The world of geometry

You also begin to meet people from different walks of life. Is it expensive? Well, again one can tailor it to their finance. Don’t invest into the gears so early because you may not be suitable to dive or you may not know what to choose from the many brands available. Well, at the end of the day, most are one off buys which can last for a long time and the cost for the gears can reach an estimate of RM1000 (booties/fins/mask/wetsuit) to about RM 6000 (fins/ mask/snorkel/BCD/Regulator/wetsuit/booties/dive watch with minimal important accessories). If you buy over a period of time you would not only buy the better set and the cost will not kill you. Even then, the beauty and the peace of the underwater world is worth every cent.

Sweet Lips

Did you know more and more people are taking up diving even the celebrities? Well, that maybe for the next time…