Bismillah...

It's been 3 days my sister's grandma in ICU. She had Myocardial Infarction when I found her weak and hypotension. Today, she's getting worse due to new heart attack event. It's STEMI now (whereas yesterday still NSTEMI). She must got knocked down first in order to keep her circulation in stable state. I think, she's a strong woman because it was a rare thing to find an 80 y.o woman that already got cerebrovascular event and complicated by hypertension and diabetic to survive.

When I standby at the hospital to keep my sister's grandma, I met my colleague at the waiting room and just knew that her husband get serious illness. Brain tumor! I couldn't say anything to cheer up and lift her spirit. What God have planned for her. She's just getting married for 6 months and 'walaaah' her husband lie on the bed unconscious and paralysis. So, I need to pray for them, for my sister's grandma and my colleague for their goodness and strength. And hoping that they can clear stuff that never been clear with their family. I realize my situation right now is more more more better and been blessed til today. May Allah keep my father and my mother in a great health, because I'm here far away from them. Amin. Pray and poem for both of them, my sister's grandma and my colleague I presented...

You would know the secret of death.

But how shall you find itunless you seek it in the heart of life?The owl whose night-bound eyes are blind unto the daycannot unveil the mystery of light.If you would indeed behold the spirit of death,open your heart wide unto the body of life.For life and death are one,

even as the river and the sea are one.

In the depth of your hopes and desires lies your silent knowledge of the beyond;And like the seeds dreaming beneath the snow

your heart dreams of spring.

Trust the dreams,

for in them is hidden the gate to eternity.

Your fear of death is but the trembling of the shepherdwhen he stands before the king whose hand

is to be laid upon him in honor.

Is the shepherd not joyful beneath his trembling,that he shall wear the mark of the king?

Yet is he not more mindful of his trembling?

For what is it to die but to stand naked in the windand to melt into the sun?And what is it to cease breathing,but to free the breath from its restless tides,

that it may rise and expand and seek God unencumbered?

Only when you drink from the river of silenceshall you indeed sing.And when you have reached the mountain top,then you shall begin to climb.And when the earth shall claim your limbs,

then shall you truly dance.

- The Prophet -- Kahlil Gibran -- Walker & Company -

- Phoenix Press, 1923 -

On the day I die, when I'm being carried

toward the grave, don't weep. Don't say,He's gone! He's gone. Death has nothing

to do with going away. The sun sets and

the moon sets, but they're not gone.

Death is a coming together. The tomb

looks like a prison, but it's really

release into union. The human seed goes

down in the ground like a bucket into

the well where Joseph is. It grows and

comes up full of some unimagined beauty.

Your mouth closes here and immediately

opens with a shout of joy there.

- Mevlana Jelaluddin Rumi, 13th Century -

http://locallygrownnorthfield.org/post/9747/

Our Lord! forgive us
our sins and anything
we may have done
that transgressed our duty:
Establish our feet firmly,
and help us against
those that resistFaith.

- Qur'an – 3:147 -
- Al 'imran: The Family of Imran -

Lover

by: Ibn al Farid (Translation)

Every part of my body awaits him,

even he's not with me, in every substance which are soft, tender, pure and happy.

Inside guitar string and melodious flute fused in vibrating tone.

And inside deer's grass field that are very fertile green, in a cool twilight and in bright of first beam of the dawn.

And in the foggy rain whom to go down from the cloud to the flower garden.

And when the wind blow so gentle bring his robe and spread to me a scent of rose fragrant in a soft of dawning day...

And when I kiss the lip of goblet, I smell of pure grapes in cheerful and happiness...

I'm not expelled from my country if he was with me ; my mind won't bothered everywhere we belong ; that place is where I was born if my lover also been there ; where there is a slope sand hill--- that's the place I will have to stop...

AN NAZI'AT (THOSE WHO DRAG FORTH)

Just read one of short Surrah of The Holy Qur'an and always being fascinated by the word of ALLAH SWT :) Alhamdulillah

بسم الله الرحمن الرحيم

..................

79:42

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Sahih International

They ask you, [O Muhammad], about the Hour: when is its arrival?

79:43

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Sahih International

In what [position] are you that you should mention it?

79:44

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Sahih International

To your Lord is its finality.

79:45

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Sahih International

You are only a warner for those who fear it.

79:46

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Sahih International

It will be, on the Day they see it, as though they had not remained [in the world] except for an afternoon or a morning thereof.

One Fine Day @ Tidung Island with Neurology Fellows

This is some of my collected image from Neuro Gathering event. Good job Galz! Proud of you ;p

One look is worth a thousand listens---Merrill C. Sosman (US Psychiatrist) 1890–1959

TOP MOVIES QUOTES that Raul Remembered...so far :p

1. A Walk To Remember (2002) :

Love is always patient and kind. It is never jealous. Love is never boastful or conceited. It is never rude or selfish. It does not take offense and is not resentful.

2. With Honors (1994) :

You shall no longer take things at second or third hand, not look through the eyes of the dead, nor feed on the spectres in books. You shall not look through my eyes either, nor take things from me, you shall listen to all sides and filter them from yourself

3. The Lovely Bones (2009) :

If I had but an hour of love, If that be all that is given me, An hour of love upon this earth, I would give my love to thee.

4. Love in the Time of Cholera (2007) :

I discovered to my joy, that it is life, not death, that has no limits.

5. The Brave One (2007) :

I always believed that fear belonged to other people, weaker people, and that it never touched me. And then it did. And when it touches you, you know that it's been there all along, waiting beneath the surfaces of everything you loved.

Pause Dependent Torsade de Pointes caused by amiodarone administration complicated by thyroid heart disease

31 years old female admitted

to ER with chief complaint syncope since 4 days ago. She just had undergone P1A0L1 spontaneous parturition 2 months ago, and in breast feeding period. She feels fatigue, palpitation and over-sweating since she delivered her baby. No history of congenital heart disease, hypertension in pregnancy, and this is the first time she got detected an arrhytmia.

Early VS :

Compos mentis, BP 90/50,HR 101x/min,RR 28x/min,Temp 36,0 C.

No detectable murmur, irregular pulses, no rhonchi, no wheezing. No enlargement of spleen and liver, with normal peristaltic sounds. No lower extremity edema.

ECG : VES bigemini running to Ventricular tachyarrhytmia.

Lab : Trombocyte=145.000;Ht=41%;

Random blood sugar=101mg/dl; Calcium=8.4mg/dl;

Na=141meq/l;K=2.8meq/l;Cl=104meq/l.

patient has administered Amiodarone 150

mg pushed;

continue with maintenance Kendaron drip 600mg

(start 2.1cc/hours) and suggested to check plasma

magnesium and thyroid function.

40 mins after admission, patient had undergone monomorphic VT followed by general tonic clonic seizure and GP decided to give cardioversion.

Neurology consultation suggested to prepare diazepam intravenous 10 mg pushed slowly. Neurologist recommendation to control metabolic deterioration and manage the tachyarrhytmia.

After 200 joules shock for 2 times, ECG changed back to VES bigemini multifocal but with worsening pattern of ECG that tend to show running VT.

After 5 hours treatment, patient developed to many forms of tachyarrhytmia :monomorphic VT-polymorphic, VT(Torsade de Pointes)-T wave alternans.

Result for plasm magnesium=1.9meq/l and

thyroid function:TSH=4.5 mcg/ml;

FT4=35 mg/dl;T3=2.8 mmol/l &T4=165 mg/dl.

In this scenario, General Practitioner had misdiagnosed patient without considering thyroid involvement in patient's arrhytmia. So, as a general guidelines for Ventricular tachyarrhytmia, GP gave amiodarone as drug of choice for this patient. Au contraire, Amiodarone worsening the patient's condition.

After Amiodarone's restriction, and 2 gr intravenous magnesium drip, patient start reducing her refractory Torsade de Pointes along the fits and back to the early ECG pattern when she came to the hospital.

Next question is, what are drugs that should she has for her arrhytmia.

"SONG OF MYSELF"
By : Walt Whitman

You shall no longer take things at second or third hand,
not look through the eyes of the dead,
nor feed on the spectres in books.

You shall not look through my eyes either,
nor take things from me,
you shall listen to all sides and filter them from yourself