Monday, November 29, 2004

Back to Work

I think I am well enough to go back to Kuantan to resume what I have left behind over there, my work. I have a friend who looks after my work over
there but I do not want to overtax him. I have been in KL for over 6 weeks
now, first my surgery and then my recovery period.

In fact I have tried to work, to earn my fair share of living. On Saturday I did some inspection work for Dewan Bandaraya KL and I found it not much of a strain. So I know that I can now resume my work. My wounds have now healed, at least what I see externally but what is internal I do not know. I can feel a slight pinch sometime, and a slight pain inside when I overstrain myself, but to me there is nothing much to worry about.

The Muslim Ramadan fasting month is now over and the Hari Raya (Eid) period is also now over. I went back to the kampong for the Hari Raya
period, but did not really celebrate it as I was still not feeling that well. But I did a couple of visitings to some relatives houses, just to pay them respects. After being in the kampong for a couple of days, I came back to KL where I rested further. But the period after the Hari Raya was no period for rest, it was still the Hari Raya period. I did some visitings in KL, the neighbours have their ‘open houses’ which I was obliged to attend and I also had many visitors coming over to the house whom I have to entertain the best I could. I just put a brave face so that they did not really know of my real situation. And I managed to go through all that with no ill effect. In fact just a couple of days ago my KL house was used as the staging point for an engagement ceremony for a male cousion of my wife. We had many relatives coming here then, eating and making merry for the ceremony. But luckily the main ceremony was some where else. Even then my house was almost full when they all arrived. And I am glad that I have so many visitors, both for the Hari Raya and the engagement ceremony.

Anyway, I am now almost 90% of my normal self so I have been all right
and shall be all right.,

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Wednesday, November 17, 2004

My Heart - Looking Back

How many of us would know when we have a heart attack? My Cardiologist told me, "Lias, you had a massive heart attack!" And I said to him, :"No, I did not". And he replied, "You are talking to a Cardiologist" and he said that after looking at my ECG traces and my echo sounding film. I must admit that I was lost for words.

I had this breathless feeling even as late as early June 2004. In Kuantan I used to walk about 3 km each morning in a garden by the beach, Taman Gelora, the area is cooled and shaded by casuarina trees. The place has got a walking track for jogging or for brisk walking and many people go there all day long to exercise. I was one of them and I go in the morning. One morning while I was walking for about less than I km I felt breathless and I slowed down to a stop. After a short rest I continued walking until I could not go any further, that was just about 200 m on. I actually stopped and sat on the ground for a rest. After about ½ an hour I continued slowly to my car, drove home and went to sleep. I woke up after 1 hour luckily. But I never told anyone about my problem. And the next morning I went again for a walk and the same thing happened. So I stopped, until I came back to KL in the middle of June.

In early July I was hospitalised in KL, supposedly due to an infection, and I do not know what that infection was. And in the first week of August, I went back to Kuantan and I was hospitalised the first night I was there, I did not even had time to sleep in my apartment then. In this case I had a clear sign of heart attack but the Doctor who attended to me never told me in so many words. I was hospitalised for 10 days, with all the symptoms and the treatment of a heart attack patient.

But when I was out of the hospital for a few days, I went on a prearranged trip to Taman Negara, with no ill effect. I even went to climb on a hill to get to a canopy walk and I did not feel tired. Anyway, on coming back from the Taman Negara trip, I went back to my Doctor in Kuantan and this time he advised me to quickly consult a Cardiologist about my heart. Still I did not go to see a Cardiologist. Instead when I went back to KL, I went on a trip to the PD Power Station with some exLLN retired officers. And in that trip I tried to be brave though I was in pain. In the power station I climbed 4 stair cases to reached the Control Room. I could have taken the lift but I did not. When I reached the Control Room, I had a very severe chest pain. And after a short while it went away. When I got back to KL, on walking back from the Kilat Club to the LRT station with an old friend, I had to walk very slowly. I had again a severe chest pain. Luckily my friend was very understanding and he walked slowly with me. And on climbing the steps to the overhead bridge to the LRT station, I nearly did not make it except for the encouragement given my friend. I got into the train all right until I reached home.
I decided then I did not want to be a hero anymore so the next day I went to see my Cardiologist. The rest is now history.

In would guess that I had been very lucky. Others may not be so lucky as I was. Many a story had been told earlier on others.

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My Heart - Home

While in Hospital a few weeks ago I happened to read an article in the Sunday Mail (under Health) by Lina Gourdin ( entitled "Facing the Reality of Illness". This article appears every fortnight, I think under a series called ‘My bitter pill’. It describes what happens in going through a major surgery, which she had gone through, and I think she had some problems with her lungs which lead to her being operated upon.. What interest me is that the lung exercise applies to her is the same when you have a heart bypass surgery, you will need to exercise your lungs. This week her article came in the form of "Using the Spirit to Cure the Body".

And interestingly enough in the same earlier week there appeared an article in the New Sunday Times (24 Oct 2004) by Rocky’s Bru ( under Sunday People entitled "A Soldier’s Privilege" on private hospitals in Malaysia.

These articles set me thinking. I was floating right through that tunnel.

Anyway, here I was home after the surgery. Not fully healthy but glad to get home. Glad to be away from that cold (climate wise and people wise) centrally air-conditioned building, from a hustle bustle of a hospital and on top of that from every RM for every minute you are in that Hospital. They took care of you well but when you do not now really need their services do you really need to be with them?. I suppose they being commercially minded, I became induced into that situation, I cannot help it but I become commercially minded. Their core business is to sell hospital beds. The earlier you leave, the earlier they get new patients, the earlier they make their returns on investment.

I live in a double storey terrace house, mango trees lined streets, overlooking the Keramat Valley (part of Klang Valley) just at the border between KL and Selangor but in the KL side. From my front door I can almost see the whole of that valley and the lime stone hills beyond (and flickers of light at Genting Highlands at night). Its a beautiful sight be it during the day and or the night. My front door facing the sunrise and my back facing the sunset, the back blocked by a row of houses and a hill. Really and ideal place to be convalescence. I told my wife to have me a bed downstairs as I dared not climb the staircase yet, I was too weak to do so, so I thought. Anyway I did not want to risk my ‘new’ heart when climbing the staircase, I might get into trouble and the Doctors are not there to assist. And I do not want to go back into a hospital. So my wife made room for a bed in the dining room area and the dining table was used to put all my medicines and all the knickknack, like in a hospital ward. And my wife becomes the Nurse. Luckily we have another dining table in the kitchen area so the family had no problem locating an eating area.

The bed location is quite ideal, we have a small toilet/bathroom near the kitchen and my PC is just in the Study next to the dining room so I could start using the PC when I was better. And the bed was not in the way of my children going up and down the stairs. Any visitor coming I could greet them and they can either be with me in the area next to my bed or in the sitting area just in front. And I have access to the main door, and by walking a few steps down I could control the electrically controlled main gate.

The home life is a bit routine. Medicines in the morning and in the evening, blood test in the morning and in the evening, insulin injection in the evening. Meals are now home cooked and the menu is now fully controlled by my wife and I, and I could have whatever I could afford within means as long as they are not too sweet, as I am a diabetic, or anything that may endanger the process of healing of my wounds. I have my hair cut short for ease of head management and control of dandruff. I dare not shower for fear of aggravating my wounds though the Doctors have already indicated that I could. So I washed whatever areas that I dared in the morning and evening. Visitors came, and I entertained them the best I could, and I enjoyed having them. Neighbours popped in now and then to see how I was progressing.

It was not until about 1 week later that I dared go out for short walk near the front of my house and a few days after that I was seriously walking on the slight slope on the street outside. First 1 round, then 2, then 3 and now I feel that I can do more but I do not want to overstrain myself. And I only dared to climb my staircase, go into my normal bedroom, and had my shower after being home for more than 10 days. I found it so refreshing. My only problem is that I cannot get rid of my cough and the slight pain sometimes and the tightness of my chest walls due to the stitching done during the surgery. Otherwise all the wounds are healing properly and you can se scabs coming off and fresh scars appearing. Glad that I had no major issue on healing.
I had a visit to the Doctors during the first week of getting home and I was cleared by the Surgeon. And I still have to visit my Cardiologist as follow ups and the Diabetic Doctor to see how my diabetic control have been managed. And I am glad to say that I even had visited a Shopping Mall and an exhibition area during the first 10 days of getting home. Quite an achievement I thought, though I must say that it was quite an effort to get to them and be in them especially so that these places are centrally air-conditioned and I still cannot tolerate the cold air.

Why did I have the surgery? I thought I was too ill and without the surgery I could have died due to the pain I suffered, not that painful my Cardiologist friend said (it could have been worse) as my pain was dulled by my being a diabetic. And my advisor is a Professional and friend. And my daughter in the UK said that she ‘saw’ me ‘suffering’.

Regrets? Not much. But I must admit that there are a few areas which may need improvement. It was rather unfortunate that I timed the surgery at the beginning of Ramadan, the Muslim fasting month. I could not fast even a single day during the month. I could not have helped that though, circumstances called. And of course I could not pray during the healing process, I could have but I did not do, there are ways. When at home after the surgery I tried to do my religious obligations, what I could the best I could.

And to those people who tolerated me during the healing perches, people who covered me up at my work place, people who helped out in my contractual obligations, and to my wife who became my Nurse and my Driver and to my children in KL who became my watch persons during the difficult period. There are many whom I owe obligations to and I cannot name them all.

And specific to the skills of Dato’ Dr Nik Zainal, the Consultant Cardiologist, Dr Lee Weng Seng, the Surgeon and Dr K Mohandas, the Anesthetist. And general to all the OT Technicians, the Nurses and those who had helped in making the surgery a success. Also to all who gave me the support through my difficult times.

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My Heart - Insurance

They call them Insurance Salesman. Years ago when I first graduated they came in numbers to me asking me to buy Insurance Policies with them, mostly for Life Insurance. In those days they could afford to give you meals while they talked about the benefits of Insurance and they tried to sell you them to the maximum coverage. Of course then we were lowly salaried so we could not buy much cover I bought a few, which of course as I got older I converted them for cash.

In my younger years I used to work for oragnisations which used to cover me for all sorts of risks, life, accident, hospitalisation mostly. And I never thought the importance of having any insurance coverage other than those I bought and later converted to cash. I thought it would be a waste of money; why not spend the money somewhere else or why not enjoy the hard earned money that you have. Or later why not put the money into ASB or similar.

But time passes, and you get older and you retire. When that happens then that big umbrella is taken away from you. And if you are sick or hospitalised then you have to use whatever resources you have to overcome your hospitalisation damages. And these are not cheap.

For my heart bypass surgery, I was admitted into the Gleneagle Intan Mediacl Centre in KL by using a Hospitalisation Insurance card from an Insurance Co. - Global something, a Chinese Malaysian Bank insurance. And I suppose the Hospital must have checked with the Insurance Co. that it was a valid Insurance card and so admitted me with only an entrance fees for RM 800.00 to be paid. And I informed my Insurance Agent about it. There was no protest from my Insurance Agent. And the Co. faxed the Insurance form which I signed before being admitted. And things went smoothly and I was operated upon a day later.

And then the surprise came. When I was transferred to Room 564, a few days after being in the ICU, the Insurance Agent came and he must have asked my Doctors to fill in all the Insurance forms. And my wife later got a call from the Insurance Co. that they wanted me to pay for all my hospitalisation fees. Well well, what happened to my Insurance? I did not understand. And by the afternoon the Hospital Accountant (or was he just the Cashier? Loh?) came over asking for a deposit of RM 20,000.00 with the final bill to be paid later in whatever form before being discharged. And he was quite rude about it. The Hospital had been very nice to me but that Accountant (Cashier?) guy was very demanding, and in that Room then was only my son and I. I was lying horizontal (quite helpless) and he was standing there very authoritatively. What a mess I thought. When my wife came later that afternoon we told our Insurance Agent about and he was of no help. Not that we have no money to pay for my surgery and the hospitalisation fees but I felt a bit insulted by the Hospital Accountant (Cashier?) and the man on the phone from the Insurance Co. who phoned about the invalidity (?) of my Insurance coverage. I thought I have been paying my insurance premium very religiously every year.

Now this Insurance Co. that I am insured with was selected by me a few years back when I first retired from a Co. I used to work for. I had Sihat Malaysia originally but when I tried to claim from them when my wife was admitted into a private Hospital in Ampang KL that year I was refused. They said that I have not been their client for over 1 year. Fair enough I thought. And while walking in the lobby of that Hospital I was approached by this Insurance Salesman who was promoting the Global something Insurance, (he had a desk there then) telling me how good his Insurance is and how superior it is compared to Sihat Malaysia. I got influenced by his sweet talk and I signed, for me, for my wife, and my 2 children. My premium was quite heavy so was for my wife but for my children they were quite cheap. Later my children were not interested anymore in the Insurance so left the insurance to be covered for my wife and I. And I stopped being insured by Sihat Malaysia.

Of course when I think seriously about hospitalisation, why not be admitted into a Government Hospital when you are ill. Easily said than done. Anyone have tried that? If you are a retired and pensioned off Civil (Government) Servant probably you have a better treatment but for a retiree like me, I am just a person with an IC no.

In July this year I was taken ill and I admitted myself into a private Hospital in Ampang. I called the Insurance Co., got admitted into the Hospital by using the Insurance card. But later the Insurance Co, asked me to pay in full and claim from them later. Luckily I was only there for a couple of days so it was not that expensive. Now how do I claim?. The Insurance Co. instructed me to call on my Insurance Agent and make my claim through him. I got his old card and tried to call him. I failed - he either have left the Co. or he had changed his phone no. I called the Insurance Co. asking for this guy, and I was told to quote his Agent No. My God, how was I know?. After a few desperate calls, and calling names (tried to very civil at first) on the phone - all heated up - and saying that I must have been cheated, a nice sing song voice at the other end told me to leave a message and she would try to get the message to the Insurance Agent. I was getting somewhere after roughing up a few people. And the Insurance Agent called me up a few days later, and I recorded his hp no. on my handphone so that I may call on him again.

Unfortunately, about 1 week later I was again admitted into a Hospital but this time in Kuantan, this time for a suspected heart attack which I did not know about then. I was hospitalised for about 10 days, and again I used the Insurance card to get admitted. And the Insurance Co. agreed. But a few days later they turned on me by saying that I should pay first and claim later. I thought, there we go again. But I had no choice really.

I managed to meet my Insurance Agent in KL after I got out of the Hospital in Kuantan. I gave him my claims, signed a few forms and he said that there should be no be any problem with my claims. He would however need to give the claim form to the Doctor in charge of me at the Ampang Hospital for endorsement. I agreed. A few days later when I called him he said I should check with the Doctor whether the Doctor had endorsed the claim form, and I did. I found that the form had been endorsed and I told my Insurance Agent to collect it from the Doctor’s office at the Hospital. Until today I am still awaiting the answer on whether my claims have been approved or not.

The claims for my hospitalisation in Kuantan, I gave it to the Insurance Agent when I was in bed recovering from my heart surgery in Room 564. I am waiting as well. Now that I have paid fully for all my hospitalisation fees for the heart surgery, I am still to claim for what I have paid. I bet the Insurance Co. will find excuses of not paying me all my claims. Just my evil thoughts, but I suppose I am right.

What I wish to share here is that the conditions of hospitalisation Insurance or whatever Insurance that one takes on any coverage must be well understood. Insurance Salesman can easily cheat you, their sweet talk can influence you and you get trapped into paying heavy premium without reaping the benefits. And when you need them they will shy away from you, giving all sorts of excuses, and even telling you that they have no authority to approve your claim or that some small prints in the Insurance Certificate do not allow you to claim for that and for this. And the other people in that Insurance Co. are just faceless voices at the end of your phone lines. What to do? Have I been conned?.

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My Heart - A Girl

I am Lias, that is what they call me, that is what my father gave me the name of at birth, and that is what is written in my birth certificate. And of course in my Passport, in my I/C, in all my Certificates, documents and in all else what is and what not. What is worth, I am Lias. So "L" - Lovable, Loyal, Lucky, and Lively. Where do those words come from? From a cute teddy bear, small and green in colour given by an admirer (?), a Chinese girl I met at the Hospital.

Its a long story really. When I went in earlier (about 3 weeks ago) to do have my angiogramme done, I stayed in a 4-man room - a sort of dormitory for the sick at the Hospital, as I thought then would have been a waste of time and money to have a single room for myself. Among those in the room (just opposite me) was a Chinese man who had some sort of lung infection and was coughing the whole night, if not on his handphone the whole day. Anyway he did not have many visitors, but of his regular was a girl who claimed that she was his daughter, pilial daughter it seemed. The brothers were to busy minding their affairs.

By chance, my wife, my daughter and I got talking to this girl and we sort of clicked. And before I left the Hospital, I sort of try to console her on her plight with her father (and brothers).
Anyway when I am in Hospital again for the surgery, and when I got back into the Room after the ICU stint, she saw me when I went for my physiotherapy in the Physiotherapy Room. She happened to be there also doing some sort of physiotherapy. She said ‘Hello’ and I was not sure of her then as she looked quite different and that she was the patient and not her father. I was too sick to talk to anyone then.

A couple of days in the Room later, my Cardiologist friend walked in and said, "There was a girl outside there who gave me this teddy bear to hand over to you". That shocked me, I mean that this Cardiologist being a very senior person at the Hospital and a girl (stranger) dared to give a teddy bear through him to me. All the Nurses over there know how strict this Cardiologist is.
The teddy bear was nicely packed in a plastic container, and there it was. With a nice Gift For You card which was handwritten on it "SMILE "(sunny picture), 21/OCT/04, and EN LIAS GET WELL SOON.................JUST ME (a picture of a heart) - or was it just the head of a fly?
And that evening I got another handwritten note. 21/OCT/2004, 8.05 pm. To EN LIAS ISTERI & ANAK ------WARD 5B. #JUST SETTLED IN. GOING TO REST!# TAKE CARE!!! JUST ME! Anyway when my wife asked about the girl, the Nurses told her that she had moved to another floor, and checking her room confirmed this. But on the morrow she pop in near my Room door with a big smile. Mysterious? Well maybe. I would not like to ask more about her or to tell more about her but I am told that she has made the Hospital her second home.

And I don’t even know her name. But I remember one of the Physiotherapist called her "Miss Wong".

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My Heart - Routine

I lost about 5 KG during my about 2 weeks stay at the Hospital, after the surgery. But that was to be expected.

I must have lost a lot of blood and fluid during the surgery with of course the Hospital replacing these during and after the surgery. And in the ICU I could not replenish my body content properly, what with all the drugs and the medicines and the inadequate food. On top of that they seemed to be taking tubes of my blood for analysis. So much blood had been taken away I lost count or could not count the no. of times they did them. The Nurses seemed to have come every so often to take my blood samples, like vampire they were. It was almost a routine which I dreaded.

When I was released from the ICU into the Ward again, Room 564, I was very weak - I thought I was stronger. As soon as they dunked me into another bed from the bed they wheeled me into the Room, I felt relieved and I wanted to relieve myself. I waited until all was quiet and I tried to get up. Well you know that hospital beds are those mechanical bed which in my case then was electrically (or was it hydraulically) operated where you press certain button and the head come up to about 80 deg (or about). Then only you try to maneuver yourself into a comfortable position either to sleep that way or to get up. Even then if you are helpless like I was you will need someone to adjust your head so that you are comfortably sit or lie up. At least I knew then how Christopher Reeves (Superman) felt like when he was made invalid after the riding accident. Anyway as I said I tried to get up on my own but I could not. I had to call for help. When I sat up my head swam and I almost blacked out. I tried to get on my feet but I could not, my feed did not respond as usually, I have not used them for 5 days now and they refused to respond to my command when wanting to stand up. I had a lot of difficulties to get them to operate normally, and with the help of my wife and a Nurse I managed to go step by step to the toilet. When sitting to relieve myself, it was a torture of the first kind, you probably know how it felt like to relieve yourself after 5 days of not relieving yourself, forced to into that condition and also medicated. Only air came out at first. It must have been about half an hour before anything solid happened and I was really exhausted from sitting there, from the pain in my chest, from my bottom and from not used to be up almost vertical like that. It was a real relief when the process was over, and I being helped back into bed.

The bed routine is something that most people will not understand unless her/she has undergone a major surgery. I think that heart bypass is a major surgery though by modern standard its a common surgery. In that Hospital they do more than 2 a day. And in the major hospitals in Malaysia they may do more than 10 a day and most survive unless the case was too close to the heart not functioning at all. Back to hospital beds, these hospital beds have two major buttons, one to call the Nurse and another to manipulate your bed, by manipulating I mean just to make the head and the feet go up and down to a comfortable level to you. And when you are ill no position is a comfortable position so you try to make the best of whatever bed position that you or your Nurse can make it to. I normally have the head just slightly raised and the feed just above horizontal. And every morning they ask you to get up, out of bed while they change the sheets and the pillow cases. I hated that when I have to do that. Luckily they do not scrub you in bed. And in the room there is a TV to keep you entertained but when you are ill who wants to be entertained. I never switched on the TV.

The routine of going to toilets goes on, and the torture while trying to relieve yourself is a continuos saga. And the pain in the chest when trying to cough is a drag, and you having to hug a small pillow while walking about makes you feel like a real invalid. And of course every so often they give you the meal menu asking you to fill them up, which I never did - but my wife did that for me. And when the food arrives, after they saw what my wife ordered, the food smelled terrible and I bet they must have tasted terrible. In fact I tried to taste some of them and I wondered where these Hospital cooks learn their cooking. They were the most unpalatable food you can ever imagine that ever you have tasted in your life. Probably I was too sick then to have good taste of any food. But I think I was not the only one thinking about how terrible the food was, even the Hospital staff whose condition of service includes free meal at the Hospital complained to me quietly about how terrible the Hospital food was. I tried to continue with having oatmeal but I could not take them anymore, they now tasted bland to me. So I had my wife bring me white rice and some salted snake head fish flesh - snake head fish seemed to be the traditional medical food after a surgery and I believed in that. I never touched the hospital food after that. And I had my wife also bring me apples and pears and dragon fruits for my desert. And I drank plain cold water. To me these were satisfactory enough. Of course many visitors brought a lot of other fruits in baskets but I dare not take them as I am a diabetic and I was under medication for being a diabetic.

The Doctors came once or twice to check on my progress and the Nurses came to give me medicines and to check on my bodily functions like blood pressure, temperature, heart beat and also glucose level. Nothing major and nothing of concern was detected. Once of twice they came to take tubeful of blood samples from me but not as much or as many times taken as I experienced in ICU.

I never bathed or showered after the surgery though the Doctors told me that I could shower. My wound is seemed have been sealed by a thin layer of compound and will not get wet. But I dare not take the risk. I have seen how wound gets wet, got infected and have to be dressed up daily. And they seemed to be suffering in the process. Daily the Physiotherapist came to bring me down for physiotherapy, where I had to learn to walk properly again, to do cycling, walking on a ramp and up and down steps/staircases. One day a Physiotherapist brought me out to an open yard and I felt so good to be out into the open and out of the air/cond building. I have wanted that. After that I looked forward to being discharged from the Hospital to be out, out of such cold air/cond hospital environment.

Again I must say that I have friends. Many came to visit me, from far and near, those I knew and those I just know, neighbours and relatives, came to see me and to wish me fast recovery. I enjoyed their company and I thank them for the visits. Some came many times, from the day I first entered the Hospital, to when I was in the ICU and now when I was recovering in the Room. These people make me feel worth the living.

I was supposed to be discharged the weekend after the 2nd Wednesday of my surgery but due to my having medications for diabetic, I could not be discharged. I waited until after the weekend, when all the hospital administration had been completed and on Monday the 3rd week of my surgery I was discharged and I went home. Still sick, still not fully recovered, still in pain, still groggy, still on medications but I was going home.

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My Heart - The Book

A book which a friend lent me during my recovery period was "The Lost Art of Healing" by Bernard Lown MD, Published by Houghton Mifflin Company, Boston New York in 1996. Its author is a Cardiologist, a famous one at that. Bernard Lown is Professor Emeritus of Cardiology at Harvard School of Public Health at the time when he wrote the book.

Its a good book if one wants to know about the history of cardiology and a Doctor’s views and moral values of the relationship between a Doctor and a patient. Certain aspect I like most were on various aspects of heart problems. In one of the Chapters, he wrote (I stand corrected) about external massaging the chest walls when there is suspect problem to the heart, (which I understood it that way anyway - its open to others interpretation). I remember when I was about 4 or 5 years old, I had very severe chest pain and I nearly died. (I suppose it was my heart). But every time the pain came, my grandmother used to massage my chest cage hard and I came to be well. That lasted for a few days but it just went away for good after that few days incident and I grew up, not so healthy but strong enough to live until today. Another Chapter he wrote (I stand corrected) about having a heart attack, (which I understood it to be that way anyway - its open to others interpretation). He said that the attack mostly come at the quiet hours, night time so I interpret, you sleep and wake up because of the queer feeling in the chest or the exact whereabouts you cannot really point out to. That happened to me, which led me to the heart surgery.

There are many subjects on heart and on doctoring which I learnt from the book where I would not have learnt about until I read it.

There are certain quotes which the author quoted in the book which I would like to share. These were said in jest but they are the truth. These are quotes from various people.

"I wouldn’t demand a lot of my doctor’s time. I just wish he would brood on my situation for perhaps five minutes, that he would give me his whole mind just once, be bonded with me for a brief space, survey my soul as well as my flesh to get at my illness, for each man is ill in his own way.........Just as he orders blood test and bone scans of my body, I’d like my doctor to scan me, to grope for my spirit as well as my prostate. Without some such recognition, I am nothing but my illness" ---------------Anatole Broyard .....1990 .....essayist.

"And all mistakes, sins that have been secreted,
Pound themselves like epileptics,
Saying, ‘That which is not expressed will be forgotten,
And what is forgotten will happen again’"................................Yevtushenko .........poet.

"Virtue itself turn vice, being misapplied;
And vice sometime’s by action dignified.
Within the infant rind of this small flower
Poison hath residence, and medicine power".......................Shakespeare ----Romeo & Juliet.

"Jogging causes heart attacks in the elderly, and slipped disks in the young; bed rest encourages blood leads to gout; tea is constipating; eggs clog the arteries. If you bib wine expect cancer of the larynx. If you sleep, you dream, and an exciting dream may wind up in coronary occlusion. To cap the climax, as advocates birth control might put it, semen has been charged with responsibility for cancer of the cervix....Living may be dangerous for your health"..................................Willard R Espy.....................Alamanac of Word Play.

"We live by the rules of the elderly. If the toothbrush is wet, you have cleaned your teeth...if you are wearing one brown and one black shoe, quite possible there is a similar pair in the closet. I stagger when I walk, and small boys follow me, making bets on which way I’ll go. This upsets me. Children should not gamble"..................Bruce Bliven.....former of The New Republic...on blights of age.

"Though you are young and I am old
Though your vaines hot and my blood is colde,
Though youth is moist and age is drie,
Yet embers live when flames die"................Thomas Campion.....a musician, poet and physician.16th-17th Cent.

"The physician is not just a prescriber of mdicaments but a symbol of all that is transferable from one human being to another short of immortality. We may not be able to live forever, but we persist in the notion that the physician possesses the science and the artistary that will provide us with endless deferrals. He seems to be in command of those fastness where the secret of life are stored"....................Norman The Healing Heart.

"When death was regarded as a metasphysic event, it commanded a kind of respect. Today when the process is long protracted it seems as evidence of failure. A dying patient is a kind of freak. It is most unacceptable of all abnormalities, an offense against nature itself....In a sense quite new to our culture, we have become ashamed of death, and we try to hide ourselves away from it. It is, in our way of thinking, failure...There is really no such thing as the agony of dying. I’m quite sure that pain is shut off at the moment of death...Something happens when the body is about to go. Peptide hormone are released by cells in the hypothalamus and pituitary glands. Endorphins. They attach themselves to the cells responsible for feeling pain...On the whole...I believe in the kindness of nature at the time of death".......................Lewis Thomas.......essayist & physician....1993.........Interviewed by Roger Rosenblatt of New York Times.

I have not become wiser by reading the book but I have become more knowledgeable.

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My Heart - ICU

I can imagine how Frankiestein felt when he woke up after being on the operating table and not knowing where he was. He went amok. What with all the gadgets, the meters, the tubes etc etc and the strange environment. I woke up in the ICU, barely conscious, but knowing well what had happened as I was already introduced to the place before the surgery. There I was in bed, light dimmed, cold, wires attached, meters tooting, tubes in, and drains out. I could hardly move. I felt constraint all over, the effect of the surgery, the effect of all the wirings and the tubes, the effect of the drugs and the pain killers, and the effect of the low temperature. I felt I wanted to wee and I did not even know that at that time a catheter had been inserted into my urethra., And I wondered with all these constraints how was I to relieve myself if I had to. Bed pan? Most difficult!

I opened my eyes and there before me was my friend the Doctor, the Cardiologist saying ‘Hello’ to me, he and his wife I think (cannot remember properly) and next came my wife, my daughter in KL and at the back my son, keeping a distance away. I could hear them saying ‘Hello’ to me but I could hardly reply. After that the Nurse came and she told me that I will need to drink some water later and then she would give me Ovaltine (or was it Milo?). Anyway I was not interested in all these drinks, I was more interested to make myself comfortable.
Did I feel wounded? Most certainly, tightness in the chest and a plastered bandage on the right leg (where they took out a spared blood vessel). But those did not really bothered me, I already had mental pictures that would have happened anyway.

Well, time seemed to have been lost, I did not how long I have been there then. But what I was glad about was that I received a stream of visitors, friends and relatives, brothers and sister, colleagues and ex-colleagues, old Classmates an all, and even strangers brought by friends and relatives. I cannot remember all of them but they all came to wish me good health. I was so happy about that.

There were Nurses all over the place it seemed, one Nurse to each patient - and I have a Nurse attending to me all the time. And along with that Nurse was a Trainee Nurse. The Nurse seemed to know everything and what to do all the time, whereas the Trainee Nurse just waited for instructions. The Nurse are really busy bees, do that, do this, take that, take this, record readings and in fact very exact in their duties. They seemed to be very well trained. When they changed shift I could hear them briefing each other during the shift change, clear specific instructions about the patients and the medications and about what else necessary to be informed about. And the time of my surgery then was about the beginning of the Muslim Fasting Month, the Nurses all seemed to be very happy and sharing the food they have at ‘break fast’ time. And somehow in their busy schedules they still had time to chit chat, laugh and share food. I wonder how they squeezed time to eat their food. And the Nurses are mostly Chinese with a few Indians and Malays and probably others but they all seemed to get along very well - typically Malaysian.

In the ICU the part I hated most was during the ‘bed bath’ when they roll you over, wipe you and change your sheets. They have to make you push up to your bed top while lying down face up, they helped in pulling you from the head and you bend your knees and kick your feet, and when that is over they will instruct you to roll over. That was uncomfortable to say the least, with all the tubes and the wires attached to you. They strip you almost naked to wipe your back and a bit of your front, and to check on your catheter while they change your sheets. Probably there would be about 3 to 5 of them to do all these and to be sure that you are as comfortable as humanly possible in that uncomfortable situation. They did this to me almost every morning whilst I was there, and I was there for 5 days and 4 nights.

In the process of ‘bathing’ me, on the 3rd day when I was supposed to get out of the ICU, they bathed me in cold water (warm the Nurse said) and I caught the ‘chill’ - rigour they call it. And I was shivering for two hours that morning with my body temperature reaching up to 40 deg C (was it or did I mishear?). They almost panic. And after about 2 hours of that shivering, after they have covered me with 4 blankets and a heater above me, I felt asleep. When I woke up I have lost the ‘chill’ but felt quite bad. Anyway I was to stay there for another day and only on the 5th day I made efforts to ask to get out of the ICU.

While in the ICU, they really take care of your medicines - not that outside the ICU they do not take care of your medicines. But in the ICU they took very special care. Medicines were varied and very regular, some by oral and some through tubes to you veins. I cannot tell what those medicines were but they must have been for my own good.

But ICU is not the best place to stay unless you are very sick. During my stay there I heard a few deaths occurred, and one was just next to my room. I could hear them saying prayers and then saw them taking the body out. And also the rooms in ICU is so precious that every room was needed for the newly arrived sick and I was considered old sick after 2 days. So I was moved further and further away from the Main Nurses control table. Not that I minded really, I think others who were more ill would need to be closer to the Nurses’ control table, but I found that moving room disturbed my mental well being at getting well quickly.

And whilst in the ICU I could not sleep properly. The wires and the tubes were one thing but being not well and just recently being cut up and stitched back affected my mental picture, and my physical feelings. I had dreams, strange dreams, dream in colours, psychedelic and dreams of something that I can hardly imagine and I can hardly remember now. But they were not frightening dreams luckily, though physically I was in a state of scare, scared to deaths occurring around me.

Somehow I realised that in the ICU they give you something that stops you from needing to go to the toilet. And of course realising this I only asked them for oatmeal for all my meals. But anyhow hospital food are inedible, they do not suit my tender palate, they smell somehow especially the Malaysian food. And I drank water quite a bit as I then knew that I could wee in my pants with the catheter in my urethra. And I took Ovaltine once but I could not keep it down, I vomited. After that I only drank cold water given by hands by the Nurses through a straw, (and I only ate oat meals!).

Not forgetting of course, in the course of being in the ICU, the hospital physiotherapist came every day. Asking you to wiggle your toes and feet, to breath in and out of their ‘toy’ breathing measuring instruments. And to lift you arms up and down and bend them occasionally. And they try to make you cough. And I think, coughing or trying to cough is the most painful part of the surgery. The rest were routine compared. And to do this you must always hug a pillow or your ‘chest will burst’.

I was so happy when it was approved that I got out of the ICU to normal Room 564 on the 5th day. The wires and all the tubes taken out.

I must share this experience on how they took out the tubes from my guts. The Doctor actually pulled the tubes out, and you felt like you have been stabbed and then the stabbing instrument being pulled out. And there were two such tubes, one on the right and one on the left.

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My Heart - Preparation

One thing about going into a surgery is their concern about ‘fur’. Yes, your ‘fur’, all body hair. The last time I went into a minor surgery (about 10 days before that for my angiogramme), they sent a beautiful Nurse to shave my pubic hair. I knew that would happen so I have already shaven that before hand. And I politely told her so. But she insisted on checking. I showed her and I showed her ‘everything’. I suppose it was just her ‘job’.

This time I knew that I have to be ‘shaven’ further, but I did not know how much further. It seems that I have to be shaven the whole of my front including my legs. It was all right, I do not have chest hair though so I thought I lost nothing.

On the Tuesday when I was admitted, I was told to clear all visitors by about 7.00 pm as I was about to be shaven. So I politely told my visitors so. And who walked in but a young male in green robe, with shavers. Well I thought, "Male Nurse". Its was OK for me. I was asked to strip and he went about his business quite efficiently so it seemed. Anyway on talking to him, I learned that he was an Electrician. What was he doing on the shaving job anyway?. Part time job he said. My my, I could not believe what I heard. By then it was too late, he was in the middle of finishing shaving me. Would it be not much nicer then if I have had a beautiful female Nurse shaving me? After the shaving job done he left, none the worse for me though but a bit disappointed.

That night I was supposed to be given a sedative to let me sleep peacefully to prepare for my surgery the next day. But all my visitors left very late and the Nurse forgot to give me sedative earlier. At last when all my visitors have left the Nurse came with the sedative. But to me sedative or not I slept peacefully the whole night.

Before the day was over, the Surgeon came to see me to discuss on what was (if any) in my mind about the surgery. He explained briefly on the procedure and gave me the chance to discuss with him matters that I have doubts about. I was free to ask any question. And he answered them the best he could without going into technical details. Then the Anesthetist came. He also explained to me what his job was and how he helps in the surgery. After that my family and I were taken to the ICU to see what the place looks like, the place I was supposed to be ‘living’ for a few days of my life, the critical period after the surgery. I suppose what they wanted me to know was that I should not be shocked when I would be in ICU in that condition when I wake up from the OT.

And I was also supposed to be given something through my anus the next morning before the surgery (or was it the night before?) to clear my large bowels. This was to be ready for the surgery and my ‘living’ in the ICU for a few days. If I remember properly, the next morning the Nurse just did that and I was running to the toilet pretty fast.

Also early the next day (the surgery D-Day) the Nurse came with a Phisohex soap, and a back-to-front knee length gown. Surgery gown. She told me to have a shower using the Phisohex soap to soap my body, for a general cleanliness, and antiseptic. I did just that and felt very refreshed. And I changed into the back-to-front knee length gown but still keeping my sarong on. I found that the gown was too thin and I did not like that. And I had no meal since last night, and after rushing to the toilet earlier I had nothing to worry about.

I thought, well I can wait for my time. A Nurse came, she gave me some pills to swallow - to calm me down she said. I swallowed them and I was told (by others in the room that morning and my wife) that just a few minutes later I was just a limp body.

The next thing I knew I was already in the ICU, just waking up. Surgery done.

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My Heart - Doubts

There is always some doubts in ones life. Like before you are circumcised, like just before your wedding vow, like before you step on an aeroplane. One of mine was when I have beautifully admitted myself into the hospital ward for my heart bypass surgery. Questions. Questions. Questions. Questions. How painful will the surgery be? Will I survive the surgery? How long will I recover fully after the surgery? What happen after the surgery? How will the ICU be like? Will I ever be able to lead a normal life after the surgery. All these total to DOUBTS.

With all the questions and doubts in my mind, I have to use outside help to ride over the fears and to enter into the surgery, some mean of sharing the doubts, some mean of telling someone indirectly about your doubts, some mean of sharing the fear. Which means that you have to share them with many people. Spread the risk ‘sort of’. So I SMS all those in my handphone list about my surgery, tell everybody. Spread the words around. And incidentally my wife had also spread the words around as well, she has many friends especially women. By the women knowing, the men will also know. And my Cardiologist who happens to be my old Classmate have also spread the words around to all my old Classmates and so words got spread around like wildfire. And added to that my old working colleagues from a couple of organisations that I have worked in before also knew and more words got spread around.

How come the Cardiologist be my Classmate?. We were together taking the Malaysian Certificate of Education examinations (equivalent to GCE ‘O’ Level) in 1960. So we call it the Class of 60. And these guys (they are all guys!) have been together, some from 1953, others from 1957 and some others from 1959. There were 60 of us originally in that Class of 60 (year and not number, number 60 just happened to be a coincident). And we all took the same exams. And as we spread around the world, got qualified and most return to the old country, and the Alma Mater. And we got together again, and renewed our friendships. We try to meet at least once a month (though not that always successfully) but we try. We have meals together, we talk shop and we talk about old time, gathering sympathies with each other, and comforting some of the widows whose husbands have left us - and there are a few of us who have gone.

Anyway words got around, friends and relative came, from far and near to be with me on the evening and on the night of the surgery. Even the Nurses at the Hospital wondered how come I have so many visitors and I am no politician or anyone famous for that matter. They all came to wish me well, to share my risk, to give comfort. I cannot mention the names, there were too many and its not fair to mention anyone by name. And they were there until about the midnight when they all have to go away, by Hospital rules.

I bathed in my glory. My fear subsided or shall I say taken away, shared. My doubts forgotten and whatever else were in my heart then were being inundated by the good wishes. I was ready.

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My Heart - Attack

The attack on the Sunday night a few days before the surgery stunt me. I was in Kuantan and it happened at about 11.30 pm, just when I was already in bed asleep. I felt it, woke me up and I got up as quietly as possible, trying not to wake up my wife. But she woke up. I took a glycerine pill, which I have by then was prescribed with, put it under my tongue and try to lie down on the sofa. I was very listless. And my wife seemed to be in a panicky state, there were only two of us in the flat then, asking a lot of questions which I was too sick to answer. Or was it that I did not feel like answering, not when you are in that listless condition. In the end I called the phone no. of Dr Nik Zainal, my friend and my Cardiologist in KL. I could not really remember his house tel. no. Or his hp no. But I dialed the first no. available and his wife answered. I ask as to what I should do then. She calmly told me that if I have already taken the glycerine pill, I should be all right, the pain would go away and I should then go to bed. And if the pain does not go away, then rush to the nearest hospital and get medical help. My wife panicky state did not help, she started crying (women!). And she called her sister who happens to live in Kuantan to seek solace. Anyway the pain went away and I went to bed, after telling my wife that we should go back to KL early the next morning, to see my Cardiologist and decide what to do after listening to his views.

The next morning, we packed early, my mother-in-law and sister-in-law came to the flat, I gave the keys to my other car to my brother-in-law and asked him to sell it, to pay for my surgery and hospitalisation. And he gave me a cheque for RM20,000.00 to tidy me over. Anyway this I hope will be paid back by the sales of my the other car. We left Kuantan as early as we could, arriving in KL about 2 hours later. After going back into my KL house, where my children are staying, we went straight away to see my Cardiologist, who happened to be quite free that day. He saw me and I said to him that I have decided to have the surgery. He was kind enough to allow me to ask many questions about the surgery, and after going over with him I decided that it was worth the risks. He called his friend the Surgeon, got him after some time. And the Surgeon, a Dr Lee Weng Seng was a very pleasant young man (not young really - about 50 years old but he looked young to me as I am older than him). He said he could make room for me on the Wednesday (he postponed a few other surgery, those he considered not urgent as he viewed my case as being very urgent). So Wednesday it would be, Wednesday 13 Oct. 2004.
I made arrangement to check in into the hospital on the Tuesday afternoon, got a room, Room 566 at the Gleneagle Intan Medical Centre KL. I did not know what to expect really and I did not care as I thought that a surgery may be worth the effort instead of waiting for the next heart attack which may either kill me outright or make a me a cripple. I had no other choice really and I was ready to face whatever was coming.

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My Heart - Introduction

It has been some time since I am at this blog. Since then they have opened up my chest, bypassed the blood vessels for my heart, closed my chest and let me recover. It was a difficult recovery, at least for me, but the Doctors said that it was an easy one. I do not know really as this is my first heart bypass surgery and hopefully my last. Other may have a different experience.

In the next few notes I am going to describe my experience in my this blog on what had transpired before, during and after thesurgery, to the best of my knowledge and to thefill of my memory. These may not beexact but anything else I forget, others who had the same experience may liketo fill in.

So bear with me.

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