oncallz

Probably one of my best call last night.

Bed sore grade 4. Ha-ha! No new case overnight, all patients were stable and I get to sleep well till 5 in the morning, just 2 blood coming morning to be taken. Alhamdulliah, what a wonderful night! 

This is my third call in orthobots. 

My tens call as a doctor, cannot remember dah how many. 

But I can still remember my first night call, disaster! 

11 cases overnight, there was unstable patient in acute, on NIV settings, desaturated. Called for my mo, and he's busy, so I just managed whatever I could, and alhamdulliah nothing worst happened. Blood coming morning hmm, I like almost all patients in the ward, blood had to be taken. The most difficult and irritating part in blood taking is when you gotta take blood from chronic illness patient plus very old one. Susah sangat. Especially in ESRF patient, then need to spare one limbs, while the other already bruising everywhere, veins collapsed, the only thing you can withdraw from is from the artery. And it is DAMN PAINFUL man. I tell you, because you just poke blindly into the area which you feel the pulse most palpable. I like to take from radial pulse and brachial. If it is damn too hard, my next and last resort preference would be the femoral line. 

That night, most of the new cases were pneumonia. So...when there is infection going on, we need to take blood culture and sensitivity, done under aseptic technique, need to wear apron, sterile gloves, need to maintain the sterility lah if not the result will be affected, because the blood already contaminated. I took a total of 7 blood c&s overnight. Blood gases pun banyak. I went back at 3 pm the next day. Barai nak mati. Not lying. My oncalls in medical were eventful in which no time to sleep or chill a bit T.T My highest number of new cases overnight was 14 hmm...

Jonah. 

It is not a medical term. I dont know where does this word come from. Jonah used to describe someone who has the ability to turn things from calm and chilly situation into a rainstorm. Like when the person come, a stable patient suddenly become unstable, desaturated requiring high flow oxygen, or worst case scenario, CPR need to be commenced. A chilly ward suddenly a flood of new cases come. Whenever you feel like you're free, dont ever express it, wow so chill lah no patients, freenya, rasa boring pula. Dont ever say that. Out of no where, all of sudden you dont even have time to sit! Ha-ha. Seriously! 

My oncalls during lockdown paling heaven. Few or zero admissions. Most of the time can lepak and tidur. Yelah siapa je taknak oncall yang chill chill kan? :p However, no matter how well I slept in the night, I still feel sleepy the day after, sooo every post night I will sleep! At least 2-3 hours pun dah already enough for me. I dont need a long nap pun. 

One of the best thing here we can request for off day before or after night call. Some days I would prefer my off day prior my oncall, some the day after. Thank God, in my hospital we get a solid day off weekly. I heard there are some hospitals dont allow their houseman to get a solid off, their reason, not enough staffs. Hmm. No commentlah.Whateverlah, yang penting our hospital give us a solid day off :) 

I would recommend those who are currently waiting for housemanship, come do your ho-ship in Muar, sebab best sangat, just joking ha-ha. My advise will always be the same, choose the one that is close to your family. Apa- apa hal senang, because housemanship is a tough time, you really really need a good support system, and having your family close to you is a bless. 

Nanti-nanti, 

:) 

deep thoughts

Fast forward 3 months, currently I'm in my 5th posting, Orthopedic, which leaves me one more posting to finish housemanship. Almost a month in orthopedic and I think I have totally adapted to the system in this department. Still missing O&G sometimes, I miss the smell of newborn, just freshly out from their mummy's womb, I miss being part of the beginning of motherhood, I miss the smell of liquor too ha-ha, the sound of baby's heart beat, the anxiousness whenever seeing there is a deceleration in the CTG, the excitement to cheer the mother to PUSH! PUSH! Sometime, when I look myself few years later, I'm seeing myself as an O&G medical officer, some other time, in an alternate future, I'm seeing myself as other than O&G doctor, maybe psychiatry, or working in Klinik Kesihatan. When I think I have made my decision to be in O&G team...suddenly I feel like am I suit enough to be one? 

It's okay, still have plenty of time to think. 

Now let's talk about wedding preparation. 

To be honest, I'm worried the wedding might get postponed. Look around, the COVID-19 cases keep on rising, up till yesterday the cases was 1400++. Of course as a woman I have my dream wedding. Even if the government allows only up 100 guests to be at one time, we would take that chance and do the ceremony. The problem is that, if, if the government make the rules NO GATHERINGS INCLUDING WEDDING on the date we have chose to get married, then only the solemnization would be held. The wedding? Postpone until the date to be determined later. What worries me is that what if it get postponed to months later and we were no longer in the mood to hold the wedding? 

If only the solemnization allowed in February, no wedding, I pray that we have the chance to choose the venue, and please be it HOME. Just please, so that I could have a mini wedding dais, so that we could take photos together with our families and loved ones for our own keep later. Ameen ameen inshallah. 

I agree with the fact that COVID-19 is surely a test to us all. 

Many loss their job, no money to put food on table, to keep the roof over their heads, some loss their family members due to this pandemic. I really really hope 2021 would be a good year. 

Now we are already in December, with the case shows no signs of improvement, I mean look at the numbers, everyday it is more than thousand cases, so my question is would 2021 be a good one for us? 

And the answer, 

Only Allah knows. 

Let's pray for the best

May Allah grant my prayers to get married and hold a wedding ceremony in February 2021. 

Inshallah. 

:) 

housemanship: 2 months in obgyn

2 months in OBGYN. Feels so fast. Tak sampai sebulan kena obstetrics ward, now dah turn gynae ward. Masih lagi banyak taktau. Masih tak pandai nak jahit episiotomy wound, aku macam tak boleh nak imagine macam mana nak dapatkan bentuk asal yang cantik lepas dia dah jadi macam tau fu fa. Datang kakak midwife, wow macam tak pernah beranak! Haha cantik je jahit. Experience matters in surgical based posting ni. What to expect from someone who just 2 months in obgyn? Lepastu bukannya hari hari sambut orang beranak and menjahit pun. 

My oncall last night was so eventful. It was my first time in charged labour room during oncall. Lepastu time tulah full house, then CTG semua nak poor tracing siap insertkan internal CTG lagi and then boleh tercabut pula because the patient was toooo restless! Primid. First time experiencing contraction pain. Must be tooo damn painful lah sampai dia pun dah macam apa tak keruannya. Yelah aku manalah pernah rasa. Since labour room kicap habis, 2 patients terberanak dekat ward. SO JONAH LAH. Ya ampun. 

My anti jay didnt work last night. Usually I can sleep during my night call, at least 15 minutes lah, but last night didnt even have time to scroll instagram! Ha-ha. Glad there were medical students help us throughout the night. They timed the contraction, open up the delivery and VE set, jaga CTG. Kalau takde diorang, aku taktaulah apa jadi dekat aku malam tadi. 

Hopefully ke-busy-an dekat obgyn ni menolong aku untuk mendapatkan bentuk badan ideal sebelum kawin hahahaha. Makan pun OD je sekarang. OD = once daily. Breakfast- lunch- sekalikan dengan dinner terus. Tak menyempat langsung bila dah berkicap sangat tu.

And I just had my first CBD few days back. The question was. 

26/ G7P6, unsure of date 

Unbooked, unscreened

All previous child were homebirth.

Brought by husband unconscious, you are MO in district hospital without specialist, what is your further management. 

I had thought block at first. 

This is a case of maternal collapse with perimortem Caesaren section.

First thing first, assess patient! 

Vitals unrecordable. Pulse not palpable. Start resus, insert two large bore branula, take blood for investigations, start fluid resus. Intubate patient, commencing CPR. No signs of bleeding. Uterus at 28 weeks. Scan, no retroplacental clot BUT FETAL HEART ABSENT! You are the team leader, you need to give command to your team. While CPR ongoing, see patient;s husband, ask regarding the event prior to the incident. Turned out husband taktau. He said bini okay je tetiba tengok dah tak sedarkan diri, tak pernah ada sakit apa- apa pun sebelum ni. 

I was asked regarding how to do CPR in pregnant lady. 

3 mins CPR, still no signs of life. 

Update specialist oncall. 

Proceed with perimortem Caesarean section. 

Tetiba specialist punya kereta tak boleh start pula. Kaulah yang kena buat caesar dekat ED tu. Bagitau husband, just verbal consent, no time for signature semua, the golden hours is 5 minutes. 

From RCOG Maternal Collapse: 

The concept of perimortem caesarean section was introduced in 1986,61 along with the recommendation that it be initiated after 4 minutes of maternal cardiopulmonary arrest if resuscitation is ineffective, and be achieved within 5 minutes of collapse. The rationale for this timescale is that the pregnant woman becomes hypoxic more quickly than the nonpregnant woman, and irreversible brain damage can ensue within 4–6 minutes. The gravid uterus impairs venous return and reduces cardiac output secondary to aortocaval compression. Delivery of the fetus and placenta reduces oxygen consumption, improves venous return and cardiac output, facilitates chest compressions and makes ventilation easier. It also allows the heart to be compressed easily through the diaphragm against the chest wall by placing the hand behind the heart (with the diaphragm closed) and compressing it against the posterior aspect of the anterior chest wall. This improves cardiac output beyond that achieved with closed chest compressions

Once kita keluarkan baby, cardiac output mother will improve by 60 %, dengan kuasa Allah, mak boleh revive, hidup semula. The c-section tu kena buat while cpr ongoing. Bayangkan in that situation. 

Unfortunately, the patient passed away. 

And actually this is based from true story experienced by my MO masa dia kerja dekat district. He taught me, masa first time jumpa husband lagi kena tekankan, 

"Encik, encik bawa isteri encik ni dalam keadaan yang sangat sangat kritikal. Secara perubatan dia dah tak ada. Kita dah start tekan dada isteri, kita nak cuba bawa dia kembali hidup. Kita akan buat yang terbaik" 

 

Kena bagitau husband yang dia bawa isteri dah nyawa nyawa ikan dah, but dengan empathy. Pemilihan perkataan tu penting. 

"3 minit dah berlalu daripada kita start tekan dada isteri, tapi isteri masih tak menunjukan tanda-tanda hidup, jadi encik kita akan proceed dengan pembedahan untuk keluarkan bayi dan selamatkan isteri encik" 

 

Just verbal consent, dalam time ni husband pun akan angguk je apa-apa yang terbaik untuk isteri saya doktor. Not to forget, kena mention yang baby dah tak ada juga. Akhir sekali, 

"Encik, kita minta maaf, kita dah cuba yang terbaik. Kita dah tekan dada selama 1 jam, tapi kita tak dapat selamatkan isteri encik. Saya minta maaf ya. Harap encik bersabar" 

 

This all things kena document elok-elok. Obgyn is all about medico-legal. Benda yang kita tulis hari ini mungkin masuk dalam court 10 tahun nanti, siapa tahu? 

Okaylah, macam tulah assessment first aku. Nak kena prepare untuk assessment berikutnya and CME on this coming 16. 

Nanti- nanti:)