Going Bump at Night

"There is nothing more frightful than ignorance in action."

Johann Wolfgang von Goethe

"She's been having hallucinations and thought she's possessed," the medical officer on the other end told me. "We are admitting her for observation - in case it is really endometritis - but we would appreciate it if you can come and review her. She seems distressed though. Afraid. Especially after we told her that she would be admitted."

18 year old Malay woman. Just given birth to her first child a few days ago. Judging from the brief blurb my O&G colleague gave me, it might mean postpartum psychosis. It was 10 PM and I was not thrilled considering that I had to chase my last postpartum psychosis patient down a long hallway to stop her from "rescuing" her baby from the nursery.

I quickly found the ward and the patient's bed and I saw that both the patient's husband and mother was helping her to settle down. I know I should never make snap judgements from simple once-overs but the girl I was suppose to see appeared a lot saner than I thought she would be. Her name, for the purpose of this article, is Ruya.

After introducing myself, I interviewed everyone and this was the story I was given: When Ruya was twelve, her grandmother witnessed her rising from her bed after she had fallen asleep. She then tried to leave her room when her frightened grandmother gave her an urgent shake, jolting  her out of her blank, trance-like state. Ruya herself was surprised to find herself out of her bed and remembered none of her actions preceding her awakening. "It was like waking up from sleep," she told me.

Throughout the years, this odd nocturnal behaviour recurred alongside frequent nightmares. Ruya's baffled and terrified family then sought out the help of bomohs, shamans and medicine men who confirmed their worst suspicions - Ruya was being plagued by djinns and demons which possesses her to steal her away. However, nothing these witch doctors do could free Ruya from their clutches. "The spirits are too strong," they said in their failure.

Finally, they came into the care of a Muslim imam - a man they refer to simply as the Ustaz. The Ustaz gave them the same supernatural diagnosis and have told them that over the years, the spirits plaguing Ruya had multiplied in numbers due to the machinations of vengeful bomohs they have stopped patronising. And, with the help of this imam, the incidence of grand-theft-Ruya decreased as she grew older. Then it stopped altogether. Impressed by the spiritual mojo that this imam displayed, the family converted to Islam because clearly, it is the One True Religion™, is it not? Why else would Ruya's night visitors loosen their grips on her?

Keeping my face as straight as I could, I asked one very critical question: Did any of these "paranormal activities" occurred when Ruya is awake?

"No."

"My O&G colleague told me that you appeared very distressed and upset that you have to be admitted in this hospital. Why is that?" I asked further.

Ruya said that that's because she was afraid that she might have to stay in the hospital overnight alone. The Ustaz have apparently told her that she must never ever be alone or the spooks and djinns will take the opportunity to assault her again.

"Please tell O&G to discharge me tomorrow! Or my mother will have to sleep here with me for another night!"

At that moment, I felt very angry but since I'm a professional, I smiled instead. I started off by telling them that there are a lot of schools of knowledge and I happen to be from a school of medicine. I told them that what I know might bring Ruya some relief and proceeded to explain that Ruya is (or was) a somnambulist i.e. she walks in her sleep. Sleepwalking is very common in children and as a child grows older, the episodes will naturally decrease in frequency, as observed in Ruya's case.

After my brief lecture, Ruya's mother thanked me and mistakenly addressed me with the honorific of "Ustaz" (which I declined politely). Ruya's husband however incorporated the information I have given him into his worldview and agreed that the devious ghosts and ghoulies have been using sleepwalking to lure Ruya out of her bedroom. Holy crap, you can never win with these people!

Realising that this is a battle I don't want to fight so late in the evening, I politely excused myself, went down to the labour room and told the O&G team that they have just referred a case of sleepwalking to me. I gave Ruya an appointment, but not for her somnambulism.

Anyway, how did the imam "know" that it was evil spirits that's plaguing Ruya? Was he lying or did he fool himself into thinking he is able to detect supernatural entities just because he went to Qur'an school or something? And boy he must have considered it a great success to convert an entire family to his brand of magical thinking. Had Ruya's family consulted a Christian pastor or a Taoist priest just as her symptoms were abating, they would be following a very different god today.

I am frequently told that I should leave people's beliefs alone because, why take them away if it comforts them? Ruya is one of the reasons why. Thanks to pure superstitions peddled by the shamans and the imam, a young woman had become so afraid of the world around her that she must be accompanied by family members at all times. And this is not the first time I have one of my patients harmed by one of these charlatans.

This is the 21st fucking century, people. Stop being afraid of the dark.



He who bumps back,
k0k s3n w4i

Let There Be a Little Light

"The candle flame gutters. Its little pool of light trembles. Darkness gathers. The demons begin to stir."

The Demon-Haunted World:

Science as a Candle in the Dark (1995) by Carl Sagan

This story is a tad wordy and long, but it should be. It explains the reason why I do what I do, my raison d'être.

The Darkness.

It was more night than evening when my phone rang and the numbers flashing urgently on its screen were familiar ones. It was the hospital. I answered it and on the other end was a House Officer from the Emergency Department, and he had a referral for me. He told me that he currently had a 14-year-old girl in his care who, for the past one year, had been visited by the ghost of another girl who kept asking her to play. He believes that his patient is suffering from a psychotic illness with florid auditory and visual hallucinations.

"I'll be right there," I said. The story I got sounded clear-cut but I made a habit of taking medical history on my own in person regardless and far too often, I discover that referrals sound clear and cut because they had been filtered through the biases and inclinations of the patients, their family members and finally, through the referring medical personnel, who packaged it all neatly for my benefit. It is like a game of telephone or Chinese whispers: the final version of the tale that got to me tended to suffer from distortion and embellishment, and sometimes acquire a funny foreign accent along the way.

Anyway, I arrived at the Observation Ward in Casualty shortly and was introduced to a homely young Bidayuh teen girl sitting in bed with her mother. For the purpose of this story, I will call her Minnie. I beckoned to the mother to leave Minnie for a few minutes so I can interview her apart from her child. No surprises there. The mother's testimony mirrored the House Officer's: her daughter have been tormented by a ghostly girl ever since she started living at a boarding school.

"Leave Minnie alone with me for awhile. Go have a hot drink," I told the mother. "I have some questions for her."

That's an interview technique that I have adapted from the police's investigative protocol (or at least, what I understand about cop procedures from movies and TV) and in many ways, what I do is very similar to detective work except that instead of perps, I am looking to pin down a diagnosis. The human mind and its many malfunctions is an inexhaustible font of mysteries. I need to look for clues and evidence, establish motives and even check out alibis - and the less factors hanging around my interviewee that might influence her answers, the better.

After chatting with her for a few minutes, I nailed it. The House Officer was wrong, and he was wrong because he either didn't ask the right questions or didn't notice the evidence pirouetting right on his nose.

Minnie is a well-adjusted 14-year-old. She scored straight A's in her go at the UPSR. She enjoys writing stories as hobby and have an especial interest in romance lit. She told me that ever since she started attending a boarding school last year, she had been haunted by a girl's ghost who visits her two or three times every month. She described her visitor as having wavy hair and is dressed in a white nightgown. She couldn't tell me how the apparition's features look like because her face was covered in dirt - "grave soil" she elaborated colourfully. When the girl spoke to her, it was as if she was speaking directly to her mind. Come and play with me, come and play with me, was all she ever said. Minnie said that the visitations always occur as she was falling asleep or after she had been asleep for a couple of hours, in which case she would be woken up by the sudden presence - and that was the first clue I got which told me that I wasn't dealing with a psychotic illness (psychotic illnesses rarely oblige us by being predictable). Minnie then offered me the clincher: she claimed that she would find herself paralysed in these episodes, her limbs in rebellion against her will, and her scream frozen in her throat. "It is as if a great weight was holding me down," she explained quietly. Then, after a few seconds or a minute, the ghost would depart and free her body.

The Nightmare (1781) by Henry Fuseli.

"I tried looking online to look for an explanation, but I couldn't find anything helpful," she told me.

"You'll be glad to know that I can help then," I said, smiling. I was pleased with myself because I knew exactly what she had been experiencing. "Have you ever heard of sleep paralysis?"



The Light.

In explaining sleep paralysis to patients, I always start by explaining why people don't usually act out what they say or do in their dreams. It's because there is something called REM atonia that kicks in during REM sleep and it paralyses all of one's muscles during these dreams through motor neuron inhibition (the exact mechanism of which is still being debated). I told Minnie that what she experienced was caused by a person "waking up" before their REM atonia have completely washed off, while they are still stuck in a sort of limbo between waking and sleeping. I explained to her that it is a common phenomenon that affects as many as 6.2% of everybody in the world and it is commonly associated with a feeling of terror and the sensing of a menacing, malevolent presence in the room. Vivid visual and auditory hallucinations are also commonly reported during episodes of sleep paralysis which would explain the  grave-soil covered intruder and her creepy-ass invitation to play. Sleep paralysis is also associated with stress, poor sleep, shift work, and other factors that disturb normal sleep cycles - which also explains why she only gets these episodes when she's sleeping in her school hostel and not at home.

Side note: I have often heard the misconception that dreams only occur during REM sleep being bandied about even amongst doctors. That is not true. One can dream even during non-REM sleep, though they are less common, less intense and less memorable than REM dreams.

As a bonus, I also told Minnie about my own isolated sleep paralysis incident in 2003. It was right after my SPM exams and there was a blackout. I awoke suddenly and found that I was helplessly paralysed in bed. I don't know how but I sense that there was someone in the room with me. Sighing whispers were coming in from the window and I could hear the sound of tinkling bells approaching my inert body, getting ever closer with every passing second... and then all of it disappeared in an instant the moment I re-commandeered by muscles and bolted straight up in bed. I wasn't afraid then because I have already read about sleep paralysis. I knew what it was and knowledge is a potent ward against fear - that is why horror movies stop being scary right after the priest, exorcist, or demonologist character explain what they are dealing with and how they can defeat it.

Minnie was visibly relieved after hearing my explanation and it had piqued her curiousity about how regularly our massively clever brains can screw things up, leading to questions about optical illusions, the nature of dreams and memories, mental illnesses and near-death experiences - all of which I was happy to answer to the best of my ability. I like to think I have planted a seed of scepticism in her. Before meeting me, the only explanations that Minnie received from her friends, her teachers, her parents and her priests were all supernatural, that she was plagued by demons or ghosts. They told her to pray whenever that happens to her, to comfort her with the thought that God will protect her from this evil beyond the grave. I did better than all of them: I explained it using real scientific knowledge. Prayers only helped to arm her against her fear. The knowledge I gave showed her that there is actually nothing to fear in the first place.



On Lighting Candles.

And it is not their fault that her friends, teachers, parents and priests could offer nothing better than superstitions. My Chinese ancestors have called it 鬼压身 (pinyin: guǐ yā shēn) which literally meant "ghost pressing on body". Christo-European cultures have attributed it to sex demons like incubi and succubi. Arabic cultures think that shayṭān or an ‘ifrīt is responsible and that reading the Throne Verse of the Quran can supposedly prevent it. Just about every group of people in the world have their own take on what causes sleep paralysis. It struck me how everyone claims to have the answer but none can actually back their claims up - until science came along to establish the phenomena using electroencephalograms, fMRI scans and whatnot.

My meeting with Minnie is a microcosm of what I usually do in the Department of Psychiatry. I deal with people who experienced malfunctions of their brain, people who hear voices when there are none and see things that are not there, and rarely can I get away with just explaining to my patients what it is that afflicts them (like I did with Minnie) but the general idea is the same - I help to guide my patients back to reality either through my words or through medications. And very often, my patients only end up in my care after they have consulted priests, imams, shamans and witch-doctors exhaustively to no avail. Aside from the stigma associated with mental illness, I guess people just naturally gravitate towards the easy answers that we in Psychiatry do not give, and there is a lot in Psychiatry we do not yet fully understand. But hey, at least we are honest about it.

I suppose this field of medicine holds such a strong attraction to me because I already have a desire in me to "straighten the record on reality", so to speak. It is this desire that lead me to criticise all manners of pseudoscience, superstitions and religious beliefs when I am not at my day job. And speaking of religion...



On False Light.

How easy it is that the very architect of this universe revealed himself on our provincial planet and have all the answers we will ever need compiled in little books which form the foundations of his religions? He said "let there be light" and poof, all darkness went away. Or at least, that's what we are told. God is the answer to everything. So are ghosts. So are magic. They are answers we grasp for when we fail to think of any other. Why are there thunder and lightning? God is ticked off at gay people. Why do people go mad? They have been possessed by demons and evil spirits. What is sleep paralysis? Some ghost, devil, witch or goblin making a chair out of you. So, why should anyone have to suffer the inconvenience and ignominy of ignorance when we have such flexible, omni-explanatory answers in our hands?

Alas, I am a sceptic. I inhabit a far darker world than the one most people live in. No God have brought an all-illuminating light into mine - and however bright believers think that light is, it is false. It fooled the cleverest of men, convincing them that they are enlightened while in actuality, they stumble in the darkness, bumping into walls and one another. I believe that the real answers did not drop on our laps from the revelations of prophets and shamans who assure us that they have insider knowledge on the workings of our reality from the Creator himself. I believe that the answers are out there, hidden in the shadows at the edge of human knowledge, and we find them by lighting one candle at a time.

This time, I lit a candle which exorcised a ghost and made a young lady's world a little less haunted. Someone's got to do it. After all, who else do we have with us in the dark besides each other?



Candle-lighter,
k0k s3n w4i

Now We Have a Psychiatric Ward

"Several hours later I'm the only one awake

All these streets are empty it's just me and my mistake

One by one the stars go out this black sky turns to gray

One more blue sunny day"

Blue Sunny Day (2009) by Jonathan Coulton

Best song about an emo suicidal vampire ever.

Our Psychiatric Ward was officially open on Monday - 20th January 2014 - after languishing in development hell for most of last year. It was mostly due to poor planning and shoddy workmanship that delayed its readiness. It is still pretty rough around the edges but it is serviceable. My Head of Department is really progressive in his ideas regarding the treatment of the mentally ill and is very respectful of their rights. He believes that the insane asylums of old (which are basically leper colonies slash gaols intended to separate the crazy from the"normal" folks) belong to antiquity and in the pages of Batman comics, and have no place in the modern practice of Psychiatry. He insisted that the ward should be designed and run "like any other ward in the hospital". We do have two of those classical padded rooms though, but no word on straitjackets yet.

Yesterday, now that we actually have a room in the ward for the on-call officer, I had my first stay-in call since I joined this department. We only have one patient currently and she was amply tranquillised and posed no problem to me the entire night. And very fortunately for me, I received zero referrals in my entire 24-hour watch. I only received one call from my staff nurse at 8:00 PM asking me if our sole patient can keep her cellphone. Since we are running this ship "like any other ward in the hospital", I said "why not?"

The on-call room is situated on the first floor above the ward proper. It was so spartan that I seriously contemplated printing some of the landscapes I've photographed, frame them and hang them on the walls. One might start seeing things staring into so much white.

The captain's quarter.

There was a Sony Bravia flat-screen TV still in its box sitting in one of the corners of the room which got excited me for about 4 seconds. Then, realising that it wouldn't do me any good that night, I promptly lost all interest. After a cursory survey, I also noticed that some essential amenities were no where to be found. There was no chair so I went out and wrestled one in. There was no hot water so I had to jog vigorously in place while I showered to stave off hypothermia. There were no curtains, so I had to kill the lights before I change my clothes. I seriously didn't want to give the patients in the cancer ward opposite a striptease (unless they can pay me really well for it).

Looking out of the window, I saw that I had a splendid view of the mortuary...

So I'll be the first to find out when the first wave of the zombie apocalypse hits.

... and the posterior facade of the main hospital block.

Shot using a 15-second exposure time.

Now, one feature of the architecture I really liked was that I could look right down at the ward from upstairs and quickly take stock of the situation on the floor.

I am watching you.

I am not sure how having strange people surveying them from above behind a pane of glass would affect our patients afflicted with paranoid delusions, but hey - you win some, you lose some.

The other architectural quirk I liked was that the 1st floor where my room is located is accessed via a staircase on the outside of the building, so I could enter and leave the building without anyone knowing. I do so enjoy my privacy - which is why some curtains would be peachy. Also, I already look like I dress in the dark most of the time so I'd appreciate it if I don't have to actually dress in the dark. Of course, the outside staircase also meant that I could be murdered in my room and no one would find my corpse until it had already stiffened.

I'm going to enjoy working here.



Slept like a baby,
k0k s3n w4i

This is the Face of Someone Who Smokes in My Hospital

 "Isn’t making a smoking section in a restaurant like making a peeing section in a swimming pool?"

Unknown

The quote is attributed to the late George Carlin, but I cannot find any references for that.

The Psychiatry Clinic I serve at is situated right in front of the Emergency and Trauma Department (ETD) and everyday after work, I would have to walk past the ambulance bay on my way to my car. Of all the corners of the Sarawak General Hospital, the entrance to the ETD is the spot that suffers from the worst infestation of cigarette smokers and after sundown, these goons would congregate there to enjoy their little tobacco penises. You'll see many signs hanging thereabouts cautioning would-be transgressors that anyone caught smoking there would incur a RM 5,000 fine but they were about as impotent as the graphic pictures of cancer and stillbirth on the cigarette packs at deterring these feckless butt-tonguing ash-bandits.

Today, while walking between two parked ambulances, I caught the scent of burnt tobacco wafting in the air. And it wasn't even dark yet! Unlike most other members of the hospital staff, I would always take the time to deal with these shitheads who dare smoke on hospital grounds - mostly because I really, really, really hate smokers. I honestly hate them more than I hate heroin junkies, and I daresay I hate them as much as I hate child rapists. Someday, I will write a full-length thesis on why they should be shot on sight but for now, I'll just commit to the current plot.

As I was saying, I instinctively drew my camera from my satchel and started hunting down the source of the hellish fumes. I soon found him - a smelly middle-aged man with the unhealthily browned complexion of a chronic smoke inhaler leaning against a wall while fiddling with his tablet PC. A glowing fag was held lazily between two fingers on his left hand.

And the poo cherry on top of this dung pie? He was standing right below a "No Smoking" sign, bold as brass testicles!

Behold, the face of a lawbreaker. And note the number of cigarette butts around his feet.

Here is a closeup.

"What's this?!" he bellowed in irritation in Malay as I snapped his picture.

"Smoking is against the law on hospital grounds," I told him coldly, flashing my ID card.

"I just needed one cigarette," he explained. "I couldn't stand it anymore."

Now, anyone who couldn't do without a cigarette for any amount of time and would intentionally break the law to have one in a hospital is clearly an addict. I informed him that he would face a fine of 5,000 ringgit for his crime.

"Do you think I have that kind of money?" the smelly man argued insolently, cigarette still undiscarded.

"Clearly, you are rich enough to burn dozens of these everyday," I said, gesturing at the burning evidence in his hand. "And don't pretend that you don't know it's wrong. You are standing right beneath a 'No Smoking' sign."

He looked up briefly at the plastic plaque and then claimed that he didn't see it. That's how incorrigible the smokers in Kuching are. They light up in public without a care in the world, and would not even bother to try and find out if they are suppose to smoke wherever they are. I have lost count of the times I see smokers indulging in their dirty masturbatory habits in frustratingly close proximity to "No Smoking" signs as if they have collectively developed blind spots to such warnings through decades of practiced ignorance nurtured by permissive indifference. I am convinced that the city of Kuching has one of the worst public smoking problems in the world.

Then without warning, he ditched his cigarette and bolted. I am not kidding. The cowardly asshole simply ran away to avoid paying the fine. I didn't give chase because the Ministry of Health isn't paying me nearly enough for me to do my real job, let alone enough for me to run down stinky yellow-teethed cancer-giving scums of society like him through the hospital parking lot.

Anyway, there is a dire shortage of shame amongst Kuching's tobacco addicts so as a service to the public, I decided to post his uncensored mugshot here on the internet so everyone can look at how that craven criminal looks like. And let this be warning to all you inconsiderate dumbasses out there who think you can continue lighting up in my hospital with impunity: Your face might be the next one I exhibit here.



Addendum 23.01.2014: Apparently, those "graphic pictures of cancer and stillbirth" on cigarette packs DO work. My mistake.



Scourge of public smokers,
k0k s3n w4i

Devils in the Emergency Room

"Men never do evil so completely and cheerfully as when they do it from a religious conviction."

Blaise Pascal

Mr Pascal's Wager himself.

Yesterday night, at the beginning of my graveyard shift in Emergency & Trauma, a trio of police officers frogmarched an 18-year-old Malay young lady into the Yellow Zone. She was clearly in a state of extreme agitation, struggling, kicking and screeching glass-shattering notes at the top of her lungs. Getting the savage screaming girl down onto a bed and restraining her consumed my attention for five whole minutes and by the time I looked around, the policemen were nowhere to be seen. So there I was, left with a very disturbed young woman tied down to a bed who continued to yell abuses at me and I had no idea what transpired, where she came from or who I could contact to find out. Our tax money well-spent right there. Thanks a lot, our boys in blue.

After taking a deep anger-purging breath, I had the medical assistant take her vital signs, shoved an IV cannula into a vein (she tried to bite me in the bid) and took some blood. I turned my back for a minute to run some initial tests on her blood but when I returned, I found two strange portly men wearing songkoks and ankle length robes standing by the patient’s side. 

Must be her family members, I thought. They recited Arabic prayers at her while she barked curses back at them. I rolled my eyes at that and left them to it, thinking I could interview them when they were done – because Muslims in our country can be real explosive when you interfere in anything pertaining to their Religion of Peace™. I didn’t want to make the news. I could already see the headline in my head: ATHEIST DOCTOR FORBIDS MUSLIM FAMILY FROM PRAYING FOR THEIR LOVED ONES IN EMERGENCY ROOM. 

I returned shortly after and found that the men had drawn the curtains all around her bed. A whole lot of commotion and noise were coming from within so I took a peek. One of them was hunched over her at the head of the bed. His hands were clasped around her face and he was shouting angrish at her while she shouted back. He was trying to get her to recite something Arabic but that was to no avail. At one point, he even threatened to murder her (or what he believed was inside her). As he became increasingly more flustered, I saw his fingers pressing harder and harder onto her mastoid processes - those are the bony bumps behind your ears - till his knuckles were white and trembling. The girl started whimpering in pain and cried out, begging him to stop hurting her.

"What is your name?" the man asked again. Eyes screwed up in agony, she said it. He appeared satisfied at her response and lifted his fingers off her mastoids. Then, looking at me and smiling a winning smile, he informed me that everything was under control. He casually gestured at the IV canulla I inserted earlier and said: 

"You can pull that out now. You won’t be needing that anymore."

It takes a lot to surprise me but for I confess that I was stunned for a second by what he was telling me to do.

"Who are you?" I finally asked, my hackles rising. Who the fuck are you?

"I am Ustaz Aladdin and my companion here is Ustaz Ali Baba," the spectating partner of the pair explained in Malay. The names had been changed to minimize my own risk of getting sued. "This young lady here was possessed by an evil spirit. It was a difficult battle but we finally cast it out."

"Oh really?" I remarked acidly as my eyebrows climbed my forehead. "Are you related to her?"

"No, we just wanted to help."

At this point, the girl hulked out again and renewed her commitment to contact space aliens using only the strength of her voice alone. She struggled so violently against her bonds that I was afraid that she was going to dislocate something or worse, damage our expensive bed. Ustaz Ali Baba clamped down on her face again in a hurry with his fingers positioned behind her ears, ready to unleash torture anew. He began murmuring something Quranic.

From right to left: the patient, Ustaz Ali Baba, Ustaz Aladdin, and
the beer gut of the security guard I brought with me to confront them.

"Please unhand my patient," I told him. "You failed. Whatever you did to her is obviously not working."

Also you shamans are not part of hospital personnel and are of no relations to her – how dare you curtained yourselves off alone with her without any chaperones and manhandled her without her or her family’s consent? What you motherfakirs were doing is called assault and battery, and that shit is highly illegal. And who died and made you King of the ER that you deem yourselves to be in any position of authority to order me to remove my acutely psychotic patient's IV cannula? Also, if you claim to represent and speak for Allah, you better have papers bearing his almighty signature to prove it, you goat-bearded wizard-robed balderdashers.

Besides, isn't it haram to touch a non-mahram stranger of the opposite sex based on what the Prophet Muhammad said? These two ustaz (ustazes?) clearly didn't think so.

While I was addressing them, my patient started retching. Ustaz Aladdin cried excitedly, declaring that the young lady was about to cough up the demon possessing her. I ignored him and quickly turned her on her side to prevent her from aspirating her vomitus. When she stopped dry heaving, she - surprise, surprise! - remained aggressive and unruly. I stared daggers at the pair of defeated exorcists and said, "Please leave now."

To calm her down and to prevent her from injuring herself and her caregivers, I gave her 5 milligrams of midazolam. In just a moment, she winked out like a light (something I couldn't have done without an IV cannula).

It must had been a strange sort of ghost, demon, or djinn that can be subdued by a sedative which only affects her brain and not her body. It's almost like her psychotic actions were, gosh, all dictated by her own brain! I wanted to point this out to our Saracenic Tweedledee and Tweedledum but they had already evaporated from the Yellow Zone. Got it under control, they said. Pull out the IV cannula, they said.

When the sedative wore off and she came to an hour later, she was acting normally again.

More than even the belief in superstitions and the insistence on blaming mental illness on demonic possession, I was shocked by the gall and presumptions of the two Muslim clerics - civilians all - who thought that it was okay for them to walk into a restricted area of the Accident and Emergency department without authorisation, impose themselves onto an ill patient whom they do not know, commit assault and battery on her, and then somehow have enough nerve left in them to tell the patient's doctor what to do in regards to her medical treatment. No one, not the security guards, not my colleagues, not even my senior officers dared to reproach them for their highly unethical and unlawful actions towards a patient that was entrusted to our care. It is because they are afraid of offending the religious over-sensitivities which certain people professing to certain faiths wear around themselves like some sort of criticism-proof Kevlar jacket. It is because they afford certain people far more respect that they rightfully deserve, as their deplorable conduct showed.

It is this same misplaced respect and cowardice of standing up for what's right that led to this brutal attack orchestrated by an imam on a poor innocent Muslim woman in the UK, and this fatal exorcism in Belgium conducted by a "sheikh" and his acolytes in Belgium which ended in the death of another Muslimah.

It is high time we point out the painfully obvious fact that these self-professed spokespersons of their respective gods have no fucking clue what they are doing. Two such lowlifes attacked my patient, and I had a responsibility to protect her so I did what's right. Also, mistaking mental illness for demonic possession was something medieval yokels would do, back when trepanation and having holes in the head was still in vogue. Now that we are living in the age of smartphones, the internet and self-flushing toilets, I can't believe that people can still be this stupid.



P.S. When I related this incident to one of my colleagues who witnessed the whole thing, she told me she thinks that my patient might be possessed for real - but she disapproved of what the two ustaz was doing and probably thought that a Christian exorcist would had been more effective given her own beliefs. I just laughed loudly at her face and walked away.



Buster of ghostbusters,
k0k s3n w4i

You Can't Talk Politics with Stupid People

"You can swim all day in the Sea of Knowledge and still come out completely dry. Most people do."

The Phantom Tollboth (1961) by Norman Juster

I seldom discuss politics and for the longest time, all I know on the subject is that "poly-ticks" means "many parasites". Now that I have married a very passionate politically conscious journo (albeit a non-practicing one), I have levelled up on political knowledge just so I am better armed at aggravating her in our arguments.

After our 13th Malaysian General Election on Sunday, everyone became self-appointed expert political analysts and developed their own genius theories on how this country can best be run - and it wouldn't be so bad if most people aren't complete doofuses. Today, after an overnight call in the Neonatal Intensive Care Unit, I was reluctantly roped into a conversation by some of the senior nurses on the May 8 rally at the Kelana Jaya Stadium where an estimated 120,000 gathered to protest the results of the recent election which was considered by a substantial portion of the voting public (if not the majority) as a fraudulent farce. The nurses I talked to were very disapproving of such public displays of discontentment, fearing it will lead to rioting and other similarly fun family activities.

Most of the nurses I work with, particularly the ethnic Malay ones, supported Barisan Nasional (which is the party which won Sunday's election without the mandate of the majority). The reasons they cited most frequently for doing so are twofold: they want to preserve stability and peace in this country, and that they do not have confidence in the ability of the opposition coalition to govern our nation.

Seeing as I was talking to an audience which consisted of highly-educated professionals (as nurses are rumoured to be) who live in urban Kuching, I brought up the recent Global Witness viral video which exposed Sarawak's Chief Minister, Taib Mahmud's corrupt and underhanded dealings that screwed the Sarawakian natives while profiting himself and his elite band of cronies handsomely.



The nurses (one of which is actually related to Taib Mahmud) told me that Taib's backdoor penetration of Sarawak's densely forested asshole is an open secret amongst Sarawakians long before Global Witness' investigation and exposé hit YouTube. Now, at this point, I got very confused. If they knew how corrupted Taib is, why do they persists in voting him back to power over and over again? Are they some sort of masochists for socioeconomical sodomy?

One of the nurses helpfully offered: "When I vote, I don't really care who the candidate is, as long as he belongs to the party I want - and that is BN."

Never mind the critical failure of logic here. Never mind that these people, Taib, Najib, Shahrizat et al belongs to BN and that a party is essentially the people in it. They are seeing BN as an eternally unsullied and incorruptible banner of our nationhood and it doesn't matter one whit to them even if everyone flying that banner might be crooks, thieves and exploders of Mongolian girls. At this point, William Gibbs McAdoo's words echoed in my head like the meaningful flashbacks that movie characters have: "It is impossible to defeat an ignorant man in argument." Not helping, Bill.

But I tried valiantly anyway. I pointed out the numerous patients we have who had to be flown on welfare for treatment because of the lack of an effective healthcare infrastructure penetrating most of the Sarawakian heartland unlike Taib's cock. I recounted one particular story of a patient I had when I was serving at the Heart Centre where I couldn't even discharge one diabetic patient home with insulin because they didn't have a fridge or even electricity where they came from. Sarawak boasts some of the most impoverished people in the whole of Malaysia in spite being probably the richest state in terms of raw natural resources, and this poverty had been carefully maintained under BN's watch.

This ignited an often murmured sentiment amongst Sarawakians. One nurse turned that sentiment into audible noise, "All of Sarawak's wealth is being siphoned to federal government. We are better off if we secede from Malaysian."

OH MY FUCKING GOURD WHICH IS THE SOLE PARTY CONTROLLING FEDERAL GOVERNMENT SINCE MALAYSIA'S FOUNDING IN 1963? IT IS BN YOU SMELLY BAG OF BUTTS.

I couldn't yell all of those at the top of my voice in the NICU, of course. I was also called away to attend to a patient at that time. Luckily. On a lighter note, here is mock film poster on the Chinese Tsunami controversy I mentioned in my previous post which I put together while fooling around in Photoshop,

Najib's Chinese Tsunami! Now a major motion picture!

Not a Sarawakian,
k0k s3n w4i

Being a Woman in Malaysia

"Feminism is the radical notion that women are people."

Cheris Kramarae and Paula Treichler

Still the most nail-head-hitting definition of feminism I know.

This post retells two of the recent stories I shared on the Malaysian Atheists, Freethinkers and Agnostics (MAFA) Facebook page on the subject of feminism, gender equality and sexism which I wonder if they will make you as angry as they made me.

You see, I always laugh a bitter laugh whenever they tell me that the fight for gender equality is over. We have won the war, they say. Women can now get educated, vote and work. The feminism movement should be put out to pasture to graze on the sweet, sweet grass of women's liberation. Why then, I ask, do the ghosts of inequality still haunt me every day? Why am I still seeing their ghoulish mocking faces in broad daylight?

Shortly after discovering that my gestating child is a baby boy last month, I started working on his name immediately. Names are something special to me, and even back in my high school days, I wondered why children are expected to carry their father's names. Why is it the cultural standard for my people, the ethnic Chinese? Why is it so for the Malays, Indians, and the other assorted minorities in Malaysia? Perhaps my fixation on surnames and patronyms stemmed from my history of being teased for mine, which is a homophone for the male organ - I don't know - but it always struck me as very odd that women would be okay with this arrangement.

The nobility of motherhood was deeply impressed upon me by society and school all my young life - y'know, the 9-month-long pregnancies and excruciatingly painful labour that they have to endure to bring every new person into this world. Why is it that as soon as the babies are out, everyone decides that it is fair to stamp these neonates with their father's name? I mean, every single cell, every molecule, in every human being who ever lived were made and assembled entirely in their mother's womb out their mother's flesh and blood. Theoretically, only half of the nucleus in one measly cell out of the billion bajillion cells in a newborn came from the father, from that one sperm that could. Even if you take the genetic or "intellectual property" viewpoint that half of the kid's DNA came from dad, it still seems ridiculously unfair to name every single baby after the male parent. It deeply upsets my sense of justice.

Hyphenated surnames are quite unsightly for Chinese names, so I decided that my child will bear his mother's name. I felt a sort of mild gut resistance to that idea initially but then I remember that this decision to allow your child to carry the name of your spouse is readily made every single day by almost every mother in the world in all of time without any fuss. Since, I don't even have to suffer the hardships of carrying our kid to term or experience the agony of bringing him out, why should I feel even a smidgen of entitlement at all? The boy is my son. He is my son no matter what name he bears because half his genes came from me and nothing will ever change that. I am not so insecure as other men that I need him to carry my name to reassure myself of that immutable fact.

The next step I took was phone the Registrar of Births and Deaths' office to find out if it can be done. A female staff member there answered my call and when I put my query to her, she was taken aback. She said no one has ever asked her such a thing before. And no, my child cannot carry his mother's surname, she told me. There is actually a rule in the Births and Deaths Registration Act of 1957 (Act 299) that does not permit it. Article 13A says,

The surname, if any, to be entered in respect of a legitimate child shall ordinarily be the surname, if any, of the father.

The Man says suck it, Woman.

"Is there any way around it?" I asked the lady.

She thought about it awhile and said, "Well, you can declare the child illegitimate. He or she will then take the mother's name."

Sainted copulating faeces! So, if I name my child after his mom, he is by default illegitimate? Are women considered so lowly in this country that only bastards are allowed to take their mother's name? The fact that a man's privilege to name his offspring after himself is protected by law is indicative of how sexism is legislated in this country. The fact that no one saw any problem with this is evidence of how sexist our culture and society are.

Tomorrow, the 13th General Election of my country and many are hopeful that it will finally turned this leaky, sinking ship of a country around after it was helmed for more than half a century by a radically racist, incredibly inept and cartoonishly corrupted government.

If you noticed, that is what today's Google Doodle is celebrating.

... and YouTube too.

One of the most hotly challenged issues is the providence of special rights and privileges for the ethnic Malay majority of this country in our constitution, and we cry so foul because it is racist, it is unfair, it is wrong to be discriminated against for not being Malay. However, we are completely silent when 50% of our population is being discriminated against by law and by society for not being men.

I see this cultural assent of women's inferiority all the time, particularly now that we are expecting. The first thing anyone always ask after finding out that my wife is pregnant is, "Is it a boy or a girl?" We get very hearty congratulations when we tell them that it's a male child. When I share the fact that my wife and I were playfully expecting a girl before we found out, they always ask me why - and not in a curious way either but more in a surprised fashion, as if it is unthinkable why anyone would prefer girls over the clearly superior boys. Last week, one of the medical officers I worked with brought his 3-day-old kid to the nursery for phototherapy because of neonatal jaundice, and I struck up a conversation with him about being new fathers. As expected, he congratulated me for producing a male heir, and when I talked about wanting to have a girl initially and that my wife actually sewed a dress, he asked "Wouldn't you want to get a boy first, and then try for a girl later?"

When I told him that we only want one kid, he asked, incredulous, "You wanted your only child to be a girl?" Mind you that this came from a modern medical doctor, not some peasant from the Tang dynasty.

So women of Malaysia, how do you feel about being considered as being deficient compared to men before you are even born?
 
And this ingrained cultural preference for boys is not harmless. Even though Malaysia is nowhere as bad as say, India where it is illegal for doctors to reveal the sex of unborn children for fear of parents aborting female babies, this baseline misogyny has very real and very insidious effects.

Recently, I attended to the Caesarean birth of a baby by an Indonesian woman who married a Malaysian. She had to undergo a Caesarean section because we deemed that her previous Caesarean scar, done less than one year ago, had not healed sufficiently to attempt safe natural birth (or "trial of scar" as we termed it). I did the maths and realised that she conceived just 2 months after her last child was born. Then, we found out that she did not use any contraceptives because her husband  forbade her to use any while he refused to use condoms himself. That made no sense. When we pressed her for the reason, she said it is because her husband wanted a boy as soon as possible, as their first child was a girl.

We generally counsel women to space their pregnancies two years apart, particularly if there is a previous scar that can rupture and kill them with blood loss during subsequent labour. We counselled this woman and her husband previously, so he knew full well he was wagering his wife's life. The last I heard of her (as I was not her primary physician), she was admitted to the Intensive Care Unit for severe postpartum haemorrhage.

But congratu-fucking-lations, he got what he wanted; a teeny tiny baby wang between his second child's legs. The wife's health and safety was clearly secondary to this goal because after all, that's what women are good for, aren't they? Means to an end.

So no, the fight for gender equality is far from over. There are still battles to be fought in the hearts of all Malaysians. There are still unbroken shackles in our minds, legacies of our barbaric ancestry, which we must see broken. This is completely arbitrary and personal, but the day I lay down arms is when half of all children born in our country can expect to be named after their mothers, and they will bear their names without any shame. It was what I thought is fair all the way back when I was in high school, and it will still serve as what I think is fair now.



P.S. Since the wording of article 13A in Act 299 seems to suggest some flexibility in interpretation, I wonder if it can be challenged.



Ironically named feminist,
k0k s3n w4i

The 25th March 2013 Fire at the Sarawak General Hospital

"Seems to me the basic conflict between men and women, sexually, is that men are like firemen. To men, sex is an emergency, and no matter what we're doing we can be ready in two minutes. Women, on the other hand, are like fire. They're very exciting, but the conditions have to be exactly right for it to occur."

Jerry Seinfeld

At 8:27 PM yesterday, one of my colleagues working the night shift in the Paediatric Intensive Care Unit (PICU) texted in our departmental Whatsapp group for house officers,

"Kebakaran!!!" wrote Olivia.

Unlike the cry of "fire" in the English language, the Malay word "kebakaran" specifically carries the meaning of a destructive fire-related event separate from the actual Malay word for fire, which is "api". That is besides the point, I know. I thought it was a joke but she confirmed it,

"Yes, in the hospital. Evacuating patients. LOL." I didn't add that. She really did say LOL.

Another house officer working yesterday night posted the following blurry camera-phone picture,

At the main entrance of the SGH.

And it wasn't a drill. Sarawak General Hospital made like Nero's Rome and burned. It was only successfully doused at about 9:30 PM and from real-time updates provided by my colleagues-on-duty, I assumed that it wasn't too bad because the evacuated patients were later carted back to their respective wards where they can continue dying at their own leisurely pace. Speculations were abound. As the smoke rose from the corner of the main building where the linen department's located, many assumed that someone must have dropped a cigarette butt into a basket of scrubs or something.

I am working tonight but this morning, I had to go to the hospital to give a presentation on vesicoureteric reflux. After that was dealt with, I hotfooted to the linen department and found that business was proceeding as usual there. After exploring the perimeter of the hospital for a couple of minutes, I found the site of interest right outside the west wing of the main hospital block. There were yellow tapes to keep the riffraff out but introducing myself as a doctor working in the PICU, I simply waltzed in and mingled amongst the fire investigators, journalists, and maintenance company reps.

It was the utility shaft.

I spoke to a firefighter on site and he told me that they were currently investigating how the conflagration conflagrated, and were questioning witnesses, taking pictures, looking at schematics, interviewing reps from the company responsible for maintaining the utility hardware and scribbling down notes and schematics - y'know, serious fire-investigating business.

As you can see in the picture above, the two biggest blackened pipes (which seemed to have grown some bumpy warts on them) are part of the air-conditioning system of the hospital and the extreme heat had warped the foam insulation around them. The smaller pipes carry all the other stuff that a hospital needs like water, nitrous oxide, medical air and oxygen. We were very lucky that the medical air and oxygen conduits didn't go kaboom and take half the hospital with it (the PICU, where I am currently posted in, is right above the spot). Those pipes were lined with asbestos. And considering that it happened right outside the Radiology Department, we could have lost our very, very, very expensive scanning equipments - even without the stopping power of a cinematic explosion.

I spoke to an electrician and he told me that the inferno probably started from the high voltage wires that also run in the utility shaft and one of them is a humongous, python-thick cable that supplies our MRI machine. I have no idea how much power is required to keep an MRI machine running but the cost of the maintenance of just one can go into obscene seven digit figures in just one year. He thinks that one of these cables must have overheated and cooked the shaft until it is crispy.

A photographer taking pictures of the exposed MRI power cable.

Here is a closeup.

I am no engineering expert, but having incredibly high voltage cables in the same utility shaft where a large pipeline filled with compressed oxygen also runs sounds stupidly dangerous to me.

And just in case you are interested, the utility shaft runs from here,

The powerhouse of that keeps the hospital running.

To here,

A hospital that is barely running.

While the Radiology Department is still semi-operational, all the MRI scan appointments were diverted to the MRI suite over to our sister hospital, the Heart Centre (PJHUS) and we have no idea when we can start firing up our machine again. Also, only emergency CT scans would be entertained for the day due to a risk of overheating. I heard that they were going to tear up the concrete-entombed part of the utility shaft to investigate further and repair the damage - so it is definitely going to take awhile.

The PICU smelled like people had been barbecuing char siew in there all night long and that made me hungry so I went to have char siew rice for lunch. The air-conditioning seemed to have gone kaput so I am seriously dreading tonight when I have to report for duty. Does it make me evil that a small part of me wish that the PICU was blown to smithereens just so I don't need to go to work? After the very sick children and babies were evacuated, of course. I am not a total monster.

Patients lodging at the billing counters. Photograph courtesy of Nadim Bokhari.

No one died.



Insider source,
k0k s3n w4i