Ephemeral: Sunrise at Mulia Bali

I woke up early and went down to the main pool near the beach, the best spot to watch sunrise in Mulia Bali Resort, Nusa Dua. When the light break through the cloud I set my tripod to attain a symmetry. The sunrise last about 10 minutes before it’s fully bright and people swarming the poolside. It was one from many best sunrise I’ve seen and recently Mulia Bali is awarded as the best resort in the world by Conde Nast Traveler.

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Ephemeral: Knysna at Sunset

I was sitting restless inside a bus, waiting to get on the ground as soon as possible. I was looking at perhaps the most magical landscape in my life after a day touring Southern part of Africa. The moon, the transition of colour in the sky, the boats on water, everything looks perfect. As soon as the bus parked, I rushed with my camera attached to a tripod ready to be used. I took only two shots before it went completely dark.

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WPC

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Ephemeral: Dusk at Knysna Harbour, South Africa

Ephemeral: something that doesn’t last for long time, just like this picture I took one year ago. I was in the harbour bridge for an hour, but only one shot creates a beautiful combination between the water and sky, the one you are looking at now.

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WPC

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Medical Student View on Medicine and Death

-I kept the ultrasound. Someone I never met.-

It was a usual morning in the neurology ward I studied at, beginning with patient’s morning assessment and completed with morning report. Suddenly we hear a man shouting outside the room, he was rambling and I couldn’t hear clearly what he said but it was full of negativity. There were thirteen of us inside the room, having a daily report of each patient’s condition with a neurologist. Shortly after, a friend of mine from other department opened the door and in a panic tone said, “ISO1 is having an apnea.” Apnea is a medical term for patient who couldn’t breath spontaneously, it is an emergency condition which could be fatal to the brain and life if not treated adequately. Nearly all of us looked in shocked, although this is not the first time we are in such situation. But this time it is different to me, because it is my patient. The same patient I had in my last post.

I rushed outside and went to the isolation room, the same room I was at just two hours ago for my routine assessment. Six doctors were inside the room already, two people doing electrocardiogram (ECG), one trying to install an ETT tube to ensure patent airway for the patient to breath, one squeezing a bottle of NaCL 0.9% to give fluid and prevent hypovolemic shock, one injecting an epinephrine, and one person doing cardiopulmonary resuscitation. I was assessing the patient ECG and blood pressure, then replace my friend in doing CPR. I did 15 cycle before we transferred the patient together to the ICU room while ventilating the patient.

Doing CPR for 2-3 minutes to the patient let me observe and be aware of what happening during the emergency phase. While counting the rate and depth of the CPR, I could saw her eyes opened not symmetrically and unresponsive. We were concerned about the patient, but we were more concerned about the baby inside her. She was treated 5 days before going into semi-coma state, but because of her pregnancy doctors couldn’t do procedures she should has if she hadn’t been pregnant. We have to wait for MRI from other hospital and couldn’t use CT-scan to detect cerebral edema in her head. Many drugs couldn’t be administered either. It was a hard case even for senior doctors.

In two weeks of routine care, I have become familiar with her husband who’s waiting for her in the hospital. They were both still young in their twenty’s, and they were waiting for their second child to be born. We met at least three times everyday for assessment, discussing the prognoses and next step of care with neurologist, but there was nothing much we could do. In the next two days after being administered to ICU she needs two other CPR, she was still alive but in the morning when we were about count the baby’s heart rate, we couldn’t find any. IUFD, intra-uterine fetal death, that’s the medical term for it. Her husband were told about the condition and he has accept it, a spark of happiness he had just a month ago was now gone. It wasn’t easy to watch senior doctor talking to the patient’s family for such loss.

When I was on a night shift last Tuesday, her family ask to chant an approaching death prayer for her outside the time permitted. Of course we allow it, that was the least thing we could do other than comforting the family. Sunday morning she passed away, her heart rates keep on going down and unresponsive to any drugs. But we all know it will happen sooner or later, her family knew it as well. There’s nothing much doctors could do but to treat her symptoms. Two lives enter the hospital, none goes out. So if we, doctors couldn’t cure patient, what do we do? Perhaps this was the meaning of a saying from the father of medicine:

“Cure sometimes, treat often, comfort always.” - Hippocrates dp

A lot of times, doctor and science couldn’t help to save life. But we do try our best to alleviate pain and give a proper way to death.

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Fresh: Compilation from South Africa

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Canola Flowers at winter along the garden route of South Africa. On the way from Knysna to Cape Town, for two out of ten hours we enjoyed the scenery of vast landscape. All my life, I haven’t seen anything so magnificent and refreshing to my eyes.

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Waterfall at Sun City Resort, South Africa.

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Cape of Good Hope, the most South-East Point in Afica. The blue water was refreshing and the wind on the top of mountain is chilling.

WPC

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Human and Desperation

“Don’t dare a person who has nothing else left to lose.”

― Susan Elizabeth PhillipsKiss an Angel

I was on neurology department for my medical clerkship this month when a 19 years old women came two weeks ago. She is having her second child and feel sick for two weeks before going to hospital, her eyes couldn’t see outward and she complained about her headache. More than that, her husband was worried about their child and so does the doctors managing her. Now she still lies on the bed in ICU with her husband waiting nearby.

Just two weeks before a 20 years old man came with a seizure and unconsciousness due to meningitis, a viral infection in the brain with few complication. From few talks with her mother, this man was about to get married in next two weeks after admission. Now he is sometime awake, then unconscious for the next few hours. Her mother is waiting for him beside the bed. Both of patients family said the same thing, “please do whatever best for my family”. As a doctor I was wondering what “best” actually means. For the pregnant women, the best medicine for her would not be the same with the best medication for the baby inside her. And for the man, even the best medication would result in impairment of his brain. His meningitis has turned into a haemorrhage in the brain’s ventricle.

Neurologist and internist are doing their “best” in improving the patient’s condition, the stakes are life and a mistake could cause further damage.  The doctors knew this, and the family are told about it as well. In this post, I want to assess the psychological damage of such condition for the patient’s family instead of focusing on the medical aspect of the patients.

Medical students are taught since their first year to have empathy for the patient. Empathy is the experience of understanding another person’s condition from their perspective. You place yourself in their shoes and feel what they are feeling. Now imagine yourself in the position of a man being worried about your wife’s life and your second child’s life. You don’t know whether your wife would still be alive conscious tomorrow, whether your will see your second child, or see your wife the way it used to be. It’s not strange for a man in such position to give everything he has to “get his wife back to normal”, and that’s what he did.

Even when the government’s medical insurance doesn’t cover the procedure she has to do, he paid the cost of it which is about equal to his one month salary. Or if you were a parent, would you expect to burry you own child? How would you feel knowing that your child might be gone, perhaps the most treasured thing you have in this world? How far would you go to save the one you love? Humanity have a word to describe such feeling, feeling of desperation. When we have our low, when everything that could go wrong does, when we couldn’t imagine how we could be alive next month, that’s when we reflect on our life.

There are two response coming from desperation, spiralling down to the bottom of life and making a leap forward. You know what I mean by “spiralling down to the bottom of life”, alcohol, drugs, and many ways to avoid conscious thinking because people hate the condition they are in. The other alternative is to reflect on own’s life, where they thought they were going and where they are now, and making a resolution for the future. Such period of life could be a turnaround phase from bad to good, from good to better.

Making a contribution to the society is what people usually promise to do when they are desperate. And many did it afterward. People who “have been there” knows exactly how it feels dealing with such problem and what they need at the time. In turn to relief others suffering with the same problem, these people help others in similar situation.

A good deed of action produce another, multiplying exponentially over time. Perhaps that’s what a quote means:

“Hard things are put in our way, not to stop us, but to call out our courage and strength.”

If you are having you life’s all-time-low, or desperate of numerous problems, hang in there! You are not the only one who have been there, and sooner or later time will resolve it.

DP

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Lunch at Spectrum, Fairmont Hotel Jakarta, Indonesia

Fairmont Hotel is a recently opened 5-star hotel in Jakarta, Indonesia. It is strategically located in Senayan, next to a shopping mall, across a golf course, certainly one of the best location in Jakarta to build a hotel. My family has a hobby to eat buffet at hotel around Jakarta once or twice a month, usually at weekend. After years of touring around Mulia, Shangrila, Ritz Carlton, Pullman, Hyatt and other hotels in Jakarta this week we are eating in Spectrum, an international buffet restaurant in Fairmont.
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The hotel itself is very new, despite its 5-star rating the hotel’s lobby occupied by very few staff. It even feels like an empty office building rather than a hotel. We saw very few customers and staff on our way to the second floor where the restaurant located. However the staff at the Spectrum restaurant are helpful and nice. The restaurant has variety of food ranging from Japanese, Indonesian, western, and desert space.
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If you are used to eating in buffet restaurant in other hotels in Jakarta, you should expect the same, the food resembles Mulia, but the space and design looks more like Collage at Pullman. The price at Saturday for lunch is Rp 333.000 nett, drinks are not included. For a one litre bottle of Aqua Panna cost Rp 110.000 ($9), very expensive.
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The sushi and sashimi lacks variety, heck, they even ran out of salmon. However they serve octopus which is quite rare to be found in other restaurant, except at d’cafe Mulia. Their sashimi is very good, but again lack of variety. Next to the sashimi counter there is a soup counter where you could choose mussel, squid, meatball, noodles. Then you give your bowl to the chef and he will cook it for you.
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Chinese counter has duck, chicken, hainan rice, etc. Things you would expect from a chinese restaurant. On the right side of the restaurant is pasta section, here you could order pasta of your choice, cooked with choice of general sauces available and toppings.
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On the middle of the restaurant there are two long tables. One table has eight to nine main foods, lamb chop, sirloin steak, rice, vegetables, and assorted seafood. The other table has breads and appetisers. The desert section consist of mainly Indonesian desert, puddings, ice cream, and apple strudel.

On conclusion, the restaurant design 4/5, food taste 4.5/5, varieties 4/5, price 3.5/5. What I like from the restaurant is the concentrated food counters, making it less confusing and more observable to what we want to eat next. On the downside, drink is not included even a one litre bottle of water cost way too expensive. I personally think it would be better for the restaurant to charge more and include free-flow water instead.

Jl. Asia Afrika No.8
Gelora Bung Karno
Jakarta Pusat, Indonesia
10270
TEL + 62 21 2970 3333
FAX + 62 21 2970 3334

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Why I choose Omega Seamaster 300 Master Co-axial over Rolex Submariner

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Last year when Omega introduced it’s master co-axial movement in Aqua Terra I was thrilled by its ability to resist magnetic fields <15.000 gauss, it is by far the most resistant watch available for people interested in such technical specification. Before the announcement there was limited option for watches with magnetic resistance, one of the most popular was Rolex Milgauss which could resist only 1000 gauss. In our daily activities, magnetic fields are everywhere, in a clutch, bags, refrigerator, etc. Most of those magnetic fields won’t magnetise our watch and make it stop working, but it could.
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To me it becomes more important as I enter my residency in hospital surrounded by perhaps the strongest magnetic equipment encountered daily by men, the MRI machine. MRI machine use magnetic force ranging from 5.000 to 30.000 gauss. Of course doctors are not allowed to wear anything magnetic when performing the scan, but what about when we are passing in front of the room when scanning is performed? The magnetic force won’t be as powerful as inside the room, but it might be powerful enough to magnetise our watch. That was the time I know I had to have watch with greater magnetic resistance.
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The reason I didn’t bought Aqua Terra was due to the yellow second-hand and the design just didn’t caught my eyes. Then Omega introduced a reborn of their classic watch, Seamaster 300 with Master Co-axial movement. This time Omega had my attention, the design, technical specification, movement, and everything else is near perfection. I was hooked. At December last year I was also eyeing on Rolex Submariner no-date, a timeless classic that would be nice to join my collection. After a rigorous assessment, I concluded Omega is technically superior than Rolex Submariner, although the history, brand and resale value of Rolex is currently better than Omega. But again, I didn’t buy a watch only to sell it later.
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I physically saw and tried Omega Seamaster 300 master co-axial earlier this year when my plane was delayed in Abu Dhabi. I went to Marina Mall and got inside Omega store, after some clear thinking, assessing whether my next watch would be Rolex Submariner or the new Omega Seamaster, I decided to take the bite. I went back home with Seamaster 300 master co-axial on my wrist, previously I was wearing Omega Seamaster 300 GMT bond.
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Despite many commentaries about the vintage-lume on SM300mc, I really like it. JLC used it before, so does Panerai but few people actually talk about it. But Omega use it now and BAM…. everybody loses their mind. The case resembles the original Seamaster in 1957, with slight modification and it is a good thing. But the movement is perhaps the best movement available today, an in-house calibre 8400, chronometer certified, 60 hours power reserve. For a WIS who rotate between watches daily, 60 hours power reserve is more than enough to use it without having to set the time for 2 days. Old dog, new tricks.
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For WIS looking to add a classic to their collection, this is it. Rolex may hold the ground for the next few years, but with the invention Omega is doing in the recent years, Omega is certainly on the rise. Common people may value Submariner more than Seamaster 300mc, but a WIS know what I’m talking about.

Conclusion SM300mc: movement is arguably better than Rolex Submariner, design depends on individual’s taste, transparent case back makes the movement admirable, vintage-lume for people who like it. Omega also has 60 hours power reserve compared to Rolex 48 hours. Both watches have ceramic bezel. However Rolex has a better resale value, brand recognition, and of course fake watches available.

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Wall from South Africa, USA, Indonesia, Japan

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Wall decoration in Voortrekker, a fort facing the city of Johannesburg, South Africa.

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Drawing at a wall of high rise building in Philadelphia, USA.

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Emergency buoy hanged as a decoration in Jakarta, Indonesia.

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An ageing wall in old city of Jakarta, Batavia in Indonesia.

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Walls made from bamboos in Fushimi Inari Temple, Japan.

WPC

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Nature of Humanity

Humans are social being, a small part in greater society we individually live in. For every person in this world, we have nuclear family, whether we know them or not (as in orphanage) we have them. We are born not because a person want to have a child, but at least two person wants to (this is debatable due to the the advancement of technology), but nature put us that way in the beginning. Thousand years ago when our ancestor were wandering in savannah and jungle, they live and travel together in group to support each other. They rely on hunting to eat, and to kill an animal took a coordination of several people doing their job (spotting the animal, kill with spears, trapping, etc.). If our ancestor failed to do so, we won’t be on earth today.

No wonder we are a social being, constantly rely ourselves on each other in living. To drink a cup of tea, there has to be tea leaves collected by the farmers, extracted in a factory, delivered to our regular supermarket. Then we pour hot water using a dispenser to a cup made somewhere overseas (I bet there’s a made in China label in one of your cup). To live better, humans need to work together doing our own parts in the greater world. Like a cogwheel in a machine, each of us need to do our part to get the machine working.

The good news is naturally we are programmed to help each other. There are people who egoistically tries to shape the world according to his view, some of them radically. Even in this “individualistic era” people couldn’t stand not helping when people around us need it. Remember how the US residence united together after 9/11? Or what happen to France after the shooting last year? Family strengthen each other, neighbours watch each other, people unite, the world collide against terrorism. Even though you could say that people unite because they have personal interest in their own safety, that’s okay, because it is also our nature to flee from danger. Before a person feel safe himself, chance are they won’t help.

Being safe ourselves before trying to safe other is crucial, not merely a selfish act. What happen if the plane you are on suddenly had cabin decompression and you try to put the oxygen mask to your 2 years old first before you do? Not only you jeopardised your life, you also jeopardised your child’s life for not able to help the next scene (crash landing). It’s two side of the same coin, the desire to help and the selfish nature of human. And it doesn’t have to be contradict each other, perhaps by trying to fulfil our own needs first, we also help the other. How could that be? By trying to enhance your quality of life, indirectly you also raise the living standard of people around you, by stimulating them to work better and smarter to enhance their life. Worldly speaking, you could donate more money to charity of your choice if you are rich than average people could (not that every rich people do). Could the formula be:

Help yourself = help other ?
Help yourself -> help other ?
Or perhaps both of them are right?

dp

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