housemanship: OBGYN so far

3 weeks in OBGYN. 

Still new. So much things to learn. 

Had my first oncall last night. 

Alhamdulliah not so jonah :p 

Still able to sleep for a minute- two ha-ha. 

3 weeks in OBGYN so far. 

My first time conducting delivery of baby, I was scared to pull out the head. In the process of labour, after the baby had gone into the stage of crowning, baby will naturally rotate their head so that the occiput will be in line with the spine. Once the head already in position, we have to check for any cord round neck before pulling out the head, and then proceed with the delivery of anterior shoulder. To be honest, I still feel scared to pull out the head, afraid that I will break their neck. Because theyre so fragile. SO SOFT. The moment I saw the seniors did it, OKAY so the baby can just withstand the force ea? Wow. I did it softly haha macam mana kepala baby nak keluar? 

Now, talking about delivery of the placenta. 

The question is, what is the signs of placenta separation? 1. 2. 3. GO! 

First you'll see gushing of blood, second, lengthening of the cord and the fundus will look globular and hard. Once all these 3 appears, you can now pull the placenta out BUT in a controlled manner we call it Control Cord Traction. One hand put at the fundus, while the other hand pulling the cord in a gentle manner side to side. This to prevent uterine inversion from happening. The first time I did it, I was being scolded by the seniors "Tarik kuat sikit dik" hahahaha I was really afraid the cord would snap! Adoi-lah. Maciam-maciam. 

Vaginal examination. 

The patient will ask you, 

"Doktor jalan dah buka berapa cm? Lama lagi ke?"

The most important thing you need to differentiate between 3 cm and 4 cm. 3 cm still in latent phase of labour, can still admit patient to ward whereas 4 cm indicates its already active phase of labour, let's go to labour room! The baby's coming! 

For my finger, 

1 finger = 1 cm 

2 finger = 2 cm

3 cm I still feel tight 

4 cm ada lax sikit 

Yang lain tu agak-agak je ha-ha

Os fully = 10 cm is when semua dah lax, dah tak rasa cervical lip, kena pusing-pusing jari rasa sekeliling os tu. 

You know the first time I did VE I was confused between vagina and cervical os. Aiyoo. Vagina memanglah terbuka gitu, but cervical os you need to go deeper, and you'll feel another opening. Every woman's different. Some you just insert your finger je dah rasa (axial), some need to go deeper (posterior). 

Perineal repair. 

Still learning. The difficult part when there's too much tear. The moment akak nurse compliment me, "cantik dah ni dokter jahit" I feel proud kejap hahahahaha. Still need to improve a lot! Barang nak pakai lama kenalah jahit cantik-cantik. 

Cases that Ive seen so far; 

Most of the preggy ladies will come with, 

Leaking liquor, contraction pain, and show. These are the signs of labour. 

Hence, the common cases in clerking bay are: PROM - air ketuban pecah bila baby dah matang more than 37 weeks, PPROM- air ketuban pecah sebelum masanya which baby tak matang lagi <37 weeks, latent phase of labour, active phase of labour some datang dah os fully straight away we push to labour room, some tak sempat thus terberanak dekat clerking bay!, thereatened preterm labour, false labour, pre eclampsia, elective admission for induction of labour (IOL), postdate, hmm lagi apa ya? GDM kencing manis masa mengandung referred from KK for BSP optimization. 

Have you noticed I mentioned labour so many times? 

Latent Phase of Labour

Active Phase of Labour 

Threatened Preterm Labour 

False Labour

This brings to the favorite question from my superiors, 

WHAT IS LABOUR? 

When there is strong regular contraction, that leads to the descending of the presenting part, cervical dilatation and effacement and delivery of the baby and placenta. 

From the definition itself, it explains all the 3 stages of labour. 

These are the next favorite question after the definition of labour! Ha-ha. 

- So latent phase of labour is when the lady at term gestation (37 weeks and above), come with contraction pain mostly irregular and +/- other labour symptoms eg leaking liquor/show and the os is still 3 cm and below. 

- Active phase of labour, usually contraction dah regular, then os is 4 cm and above. 

- Threatened Preterm Labour, when the mentioned things above occurs in a lady at gestation <37 weeks

- False labour is when the definition of labour is not fulfilled.

- When the patient come with leaking liquor, irregular contraction, os closed it's either PROM or PPROM depends on the gestational age. 

Need to get the diagnosis right, different diagnosis, different management. In OBGYN the management is case to case basis, not solely from textbook. I have encounter some mother with premature gestation come with labour symptoms we didnt give IM dexa/tocolytic agent pun, we just allow the labour to progress. Tapi ni kes yang bukan severe prem lah of course, borderline prem dalam 34/35 weeks. So much things to learn and I guess I started to enjoy this posting. 

Hopefully I will survive this posting. 

Ameen ameen inshallah. 

Okay,

Happy fasting for those fasting today

& 

Happy Eidul-Adha people

:) 

housemanship: a year has passed

7/7/2019

My first day being a medical doctor.

I will always remember my first day. 

I was clueless. I was very slow. 

I was assigned to Ward 8 Male, which turned out to be an active ward that day. Meaning it was the busiest ward. I was in charge of cube 5, where chronic cases like ESRF, congestive cardiac failure, COPD, AEBA were in. I came at 5 am, it took me 3 hours to review 8 patients. It was very hard for me to digest things. I introduced myself to MO and Specialist during round, first poster, day one of life, please guide me. They convinced me, 

" If you survive medical, you will survive all" 

Post round, I needed to request for MRI brain. Heck no. Straight away fancy investigation. On my first day some more? How am I suppose to do this? With the help of my senior, I went down to MRI suite. Feeling clueless, I just watched him presenting the case to the radiologist, and granted. The next day onwards, I tried my luck and the moment they said "okay, bring the patient down" I felt like ACHIEVEMENT UNLOCKED. Ha-ha! 

Endorsing medications on PHIS were troublesome for me. Took me almost half an hour. Like I said, I was very slow. Next helliest thing was blood taking especially when boss ordered multiple blood investigations for just one patients, then you multiply by 3. I need to remember each colored bottle stands for specific blood investigation. For example, purple is for full blood count, HbA1c, coombs test. Grey is for fasting blood glucose. Red is for therapeutic drug monitoring. And many more. The minute boss ordered many blood investigations in one go, many times I had trouble to calculate how much blood I need to withdraw, and taking ESRF patient that need to spare one limbs- while the other limbs already had branula with drips/ drugs - and other veins already collapsed- which lead me to the last resort- I need to poke the artery- into account, I need S.O.S STAT.

Yup, my first few weeks in medical was hell. 

I didn't know how to manage my job-list. Blood taking STAT, requesting urgent imaging, tracing blood investigations, discharging patients, clerking new cases. I didn't even have time to eat! 3 days in row I ate nothing. Not lying. Because I seriously couldn't find time to eat. Multiple times I sought seniors help. Especially blood taking and branula insertion. It was hard. Some willingly offered their hands to help, some just ignored me. Many days I wake up feeling empty. I felt like how nice it is if I cant wake up in the morning, like let me sleep forever, I don't want to go to work. There were days I felt regret for requesting medical as my first posting. I felt like I am a burden to all since I was so slow. 

Nevertheless, I am grateful that I chose Hospital Muar to do my housemanship. My family is always with me. They were there on my gloomy days, I cried a lot. My parents woke up early in the morning to send me to work, and waited for hours in the car up till the middle of the night. Yeah on papers they said tagging is from 7 am - 10 pm, hell no! you can only go back after you finish all your jobs. There were days I ended up going back at 2 am, slept for only 2 hours, at 530 am I already came to work doing morning reviews. My parents sacrifices their time for me. My father never stopped motivating me every single morning while on the road to work. My grandparents prayed a lot for me too. 

Thus, my only tips to those who are currently waiting for housemanship, choose the one that is close to your family. No need to read reviews on this-this hospital. Just forget it. In any hospitals, there will always be shits, malignant seniors/ superiors that you need to face, so whatever it is you need to adapt fast to the environment. 

"It is survival of the fittest" 

It is my family and endless prayers from them that keep me going through this field.
And for that, I am thankful enough to Allah. 

Till then :) 

it's july already

Well, it's July already. 

Means it's just months away before forever begins inshallah :) 

Tonight will be my last oncall in paediatrics department, soon I'll be moving to Obs & Gynae where I will witness the tears and joy of giving birth to the little creatures. I am so nervous. It is the usual feelings whenever I'm moving from one department to another. Surely, I'll be missing paediatrics like what happened to previous postings ha-ha. Hope I will learn a lot. 

July 7 marks the first year of me being a medical doctor. 

It feels like yesterday I received the email for e-houseman, choosing Hospital Muar for my housemanship, the nervousness to start working, the anxiety every time waking up in the morning, felt so tired and exhausted at the end of the day but still need to get up the next day and be a full functioning doctor, sometimes felt like quiting and just do nothing at home, alhamdulliah I survived my first year. 

But still...a long road to go. 

3 more postings. 

Inshallah this too shall pass. 

Forever begins in few months from now. 

Please do pray for us. 

Feels pretty relieved now that everyone can hold their wedding ceremonies. 

Hoping the best for next year. 

Hopefully it is much more easier than the current SOP. 

Till then :)