Jemputan Kenduri di Bidor, Perak
6 hours ago
medical doctors
These Tiny Tubes
October 18, 2020
Poking babies for some blood investigations is not that easy. First, we need to decide if poking them / to insert IV line (branula) is really needed. Then, of course we need to explain to mothers why we need to do that.
I always tell my patients (since housemanship phase) that our blood is like our identity. I think I have mentioned this in previous post too. We can check many things from few drops of blood. :) And I love the facts that we can do so.
In paeds, blood taking procedures are RARELY be done bedside (means most of the time, we will take the babies / kids to the procedure room) and we will ask the parents to stay outside of the procedure room, or simply stay in the patient's room. Why? I don't think people loves to see their kids crying with the pain initiated with poking them. Right? I have witnessed lots of mothers (usually) have tears flowing on their cheeks every time they hear their children crying in procedure room.
And to be honest, kids have really good memories - name it from their eyes and even from their body memories. Huhu. Every time we just hold to check their hands & foots for any possible veins, they usually will start crying. But some others are cool haha. Some will only cry once the needle is inside.
From left: EDTA tube for adults - EDTA tube for paeds - plain tube for adult - plain tube for paeds
EDTA tube - usually for full blood count, full blood picture
Plain tube - for renal profile, liver function test, serology etc.
Tricking the children with some videos are helpful to be honest. It helps to distract the kids. For babies, I discovered that playing some sleep lullaby can help to calm the babies. :)
I always asked my husband why on earth would he prefer Paediatrics compared to Medical Department. He said that both are busy departments, one handling general medicine for babies & children while the other one for adults. But, at least seeing cute babies sooth his mind to continue working. Lol. He handles kids better than me though we both are the youngest in the family.
And now, both of us are Paediatrics MO. Haha. Life is very funny sometimes.
Anyway, please pray together with us to be blessed with kids ya :)
I still remember I will ask your prayers when I was in medical school & housemanship. Hopefully, you will not mind to keep praying for me too.
May Allah bless your day :)
Cyberjaya
20201018
Open the Book, Seek Help.
October 11, 2020
Have you seen this book before? Hehe
This is a famous book in medical setting, especially in Paediatric Department. It is available in PDF form but most superiors prefer the juniors to have this book in pocket.
It is called Frank Shann.
A book consists of name of drugs and doses used. In Paediatrics, the dosages depend on the weight of the baby / children, hence you can see doctors start to open this book every time endorsing medications. Plus using calculator too.
For example, the most common drug used for fever / pain relief in kids.
Syrup Paracetamol 15mg/kg/dose 4-6H (max 4g/day)
Which means,
- the name of the drug: syrup Paracetamol (brand name can be like Panadol)
- the dose: 15mg/kg/dose. For example: a kid with weight 10kg, the dosage for him is 150mg.
- maximum dose if 4000mg/day
- 4-6H: means taken every 4-6hourly
- if taken every 6 hourly: the kid will consume 150mg x 4 times = 600mg (still below the maximum dose)
There are too much of information that health care workers need to remember. And again, it is really hard to know every single doses for every drugs in this world. So, this book makes it easier. Of course, it is helpful apart from calling the pharmacists and double confirm the dosage hehe.
Same goes in life.
Have we ever feel we had too much of things happening in our life?
We are human beings. We are not robots.
Even robots have the guidebook, so do we.
And what do humans have?
Yes.
Al-Quran.
Open the book, seek help. :)
Don't be ashamed.
This is simply a reminder for myself. Huhu.
Cyberjaya
201011
New Life, New Adventure
September 26, 2020
Assalamualaikum, hello guysss!
Hehe actually I am not really sure who's still reading this blog, but whoever you are, thank you for dropping by.
So, where should I start?
First and foremost, I just moved to Cyberjaya and work in a hospital in this area. I can say, it is so-called 'first class' hospital as it does not provide 3rd class beds so far that I know. Still struggling to adapt here though I have been working in this hospital for a month.
The environment is different.
The colleagues are different.
The system is totally different.
The approach is different.
The working 'politic' is different
Well, different hospitals have different styles. That is common.
I only know one person who used to work together with me in my previous hospital. And to be honest, the main reason I choose this hospital is because of the location - in between Perak & Johor so that we can take turn to go visit our family. Oh yaa, my husband is originally from Johor.
Luckily I choose to rent a unit of 2 bedrooms quite close to the hospital. About 10minutes journey. Quite a number of people suggested for me to rent around Seri Kembangan, Dengkil, Bangi, Puchong etc for a cheaper rent. But, I am from Perak, I am not used to drive 30-40minutes just to go to work, passing through highway with tolls and facing traffic jams.
"Dah kerja kat sini, kena la lalui. Itu lumrah."
Well, yeah I understand.
I tried to look for alternatives. It was either I spend money for lower rent (which was RM100 lower?) for cheaper place to stay but need to face those journeys... or I spend higher amount for somewhere closer.
I chose the latter.
But, I totally respect those who choose the former. :)
During the first few days, I can already feel the differences in living cost - where it was not easy to find a small kedai runcit, simple kedai makan etc. So I initially doubted my decision. However, after I went through my first oncall which was working at 8am today only to punch out at 5pm the next day... I finally relieved with my decision. Having microsleep while driving was totally not good. I was glad that my unit was not that far.
I honestly dislike oncall system. I had experienced oncall system when I was at early phase of housemanship (where the system was changed to shift system later). Staying awake for 36hours from 5-6am till at least 6pm the next day... I hate it. -_-' Some people maybe don't really mind oncall system but my body actually cannot take it.
I didn't get the department I choose. So that's another challenge. To make decisions for managements on something I don't have passion about... is really a challenge. People always say 'just try first, maybe you will develop your interest.' I tried. A month passed, still the feeling is not there. Haha.
Why are you pushing someone to do something they don't like?
But again, people will say, 'bersyukur lah kau masih ada kerja.'
Hahaha okay then, I rest my case.
Don't worry, I will still do my best. I will always try to do my best within my limit. :)
“Dan boleh jadi kamu tidak menyukai kepada sesuatu padahal ia baik bagi kamu, dan boleh jadi kamu menyukai sesuatu padahal ia buruk bagi kamu. Dan Allah mengetahui sedang kamu tidak mengetahui.” Al-Baqarah ayat 216
Last few days, I had a talk with a colleague who is currently in the same boat.
S: Perasan tak, Allah uji kita benda yang kita tak suka.
H: Kan... Lagi kita tak suka, lagi Allah bagi. Memang nak ajar kita kesabaran. Mungkin nak kita overcome perasaan tak suka tu.
And yeah, we are the chosen one to join the Covid team at quarantine centers in November-December. Alhamdulillah tak kena deployed ke Sabah. T_T
Doakan yaaa.
p/s: anyway, sorry for the negative vibe post. Haha I just need to rant it out first then I will be cool insyAllah.
Cyberjaya
200926
Karma by Muharikah | Book Review
June 11, 2020
Karma is the sequel of Stigma, written by the same author. This book was
bought during previous BBW, and I somehow know that there will be another
sequel (the last one) for this series, I decided to postpone reading it till
Dilema comes out :)
I can't imagine of waiting for Dilema after dealing with Karma.
Title: Stigma
Author: Muharikah
Pages: 419
Publisher: Iman Publication
Publication Date: March 2019
While Stigma introduced the main characters, Karma is more focus on the
relationships between Dr Iman & Dr Faris who got married together and how
they managed their relationship with their hidden history. Dr Iman as we all
know, is the boss in the ward that Dr Faris works in so it is undeniable that
Dr Iman has the dominant side of her as a leader. While Dr Faris is still
fighting with his struggle, unfortunately both of them were surprised with
sudden bad news - Dr Faris has a lymphoma! And turned out he is HIV positive
too. Dealing with both situations, we can see how both of them trying their
best to save the marriage, though I feel mixed feeling with the ending. T_T
Based on online dictionary,
"Karma - (in Hinduism and Buddhism) the sum of a person's actions in this and previous states of existence, viewed as deciding their fate in future existences." - https://www.lexico.com/en/definition/karma
I love the quote :)
1. "Let the husband lead the family."
I am attracted to this part, maybe because I am still new in this relationship
thingy, to be exact... approaching 10 months of marriage. Alhamdulillah. :)
I got the feeling when Faris' position is below Iman at the hospital, but
Faris is still Iman's husband to be respected. Point noted.
Well, if you guys have been reading the blog for a quite some time, I guess
you can see how independent I can be... especially with those solo travels.
Yeah, I can be dominant too. But, I think through out times, I prefer being
the follower. :D No matter how I am able to do something at home, I will try
my best to include my husband in the decision making so that nobody feels left
out. InsyAllah!
2. "Medical service is about human act and human touch."
This is also another reminder to me as a health care worker :)
I have love-hate feeling when attending patient as I can't help to feel
annoyed every time I met some kind of cases / patients like:
- accidents involving patients under 18, especially if they are not wearing helmet and do not even have license!
- accidents involving drunkens!
- patients who came in a worsened condition just because they ARE NOT COMPLIANT TO MEDICATIONS!
- patients who came at 3 o'clock in the morning for something they already have for months and years and they don't even bother to get it checked before.
- yada yada. Hahaha.
Banyak betul complaints. But, insyAllah for other cases, I am trying my best
to give the best with the best attitude :)
|
|
Aha... quite a number of cases that I have attended involving huge
stress or poor management of it that lead to suicidal attempt - taking
paracetamol in huge doses (for eg: telan Panadon 4 papan!), drinking
Paraquat (herbicides to control weeds). |
3. "Tidak ada karma dalam Islam."
"Yang ada adalah ketentuan dan takdir Allah yang telah diatur buat kepentingan
manusia itu sendiri. Setiap perkara yang Allah takdirkan, sudah pasti ada
kebaikannya, walaupun kita membencinya."
In this novel, Iman feels like she has done too much sins that Allah is
punishing her with lots of challenges. And I think this is the answer to the
challenges :)
4. Miracles
"Allah itu Maha Baik, kan kak? Setiap yang pergi, sudah pasti ada
pengganti."
Faris passed away. He did not the survive despite completing the chemotherapy
etc as the cancer has spread to the whole body. To be honest, this is such a
sad new especially after the patient has consistently compliant to all
appointments and medications - seems that the limit of our knowledge and
ability given by Allah.
But, to know a good news after the sad one... is so refreshing :)
|
|
Iman is pregnant! |
SM, Perak, Malaysia
200611
I was scrolling my Quora and came across this question. It is an interesting question if we are trying to answer it from perspective of healthcare workers like me vs riders.
To be honest, I don't have motorcycle license and have no skill to ride it as well. Haha.
And after working in the hospital,
I WILL THINK TWICE BEFORE RIDING ANY MOTORCYCLES. T___T
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| https://www.quora.com/Why-do-people-not-wear-a-helmet-while-riding-a-motorcycle |
-----------------------------------
**WARNING - THIS POST CONTAINS WOUND IMAGES**
Let me share with you a recent case I attended in the Emergency Department.
It was the morning of last day of Ramadhan, maybe around 4am. The patient was a 16-year-old boy, if I am not mistaken. He was referred from a klinik kesihatan that was 40km away, with the impression of: To Rule Out Skull Fracture.
Resources in Klinik Kesihatan can be limited, they can do chest xray, but not others. I've experienced a lot of referral to rule fractures from KK and to be honest, skills of doctors and medical assistants in KK are amazing. They are usually the primary team to stabilize patient in areas without hospital.
So, back to this case, he was brought in on a wheelchair, with lots of gauzes covering different parts of all four limbs. He could even walk from the wheelchair to the bed.
Usually, when we attend trauma cases, we use ATLS as guidance.
ATLS - advanced trauma life support.
The PDF itself is almost 500 pages! -_-'
Starting with A - airway + cervical
- Patient able to speak in full sentences, no gurgling or stridor, no foreign bodies in the mouth/ nose, not on cervical collar, range of movement of neck was full.
Proceed with B - breathing + ventilation
- Here, we usually use the acronym IPPA - which means Inspection, Percussion, Palpation, Auscultation
- I - breath spontaneous, not tachypneic, chest rise was equal bilaterally, no chest wound
- P - resonant percussion bilaterally
- P - no clavicle tenderness, no chest tenderness, chest spring negative, no subcutaneous emphysema / crepitus
- A - lung was clear, equal air entry
- Don't forget to check the oxygen saturation too (SpO2)
Then, C - circulation
- check other vital signs - blood pressure, pulse rate
- CCTVR - Color of skin, Capillary refill time (CRT), Temperature of extremities (is it warm/cold), pulse Volume, pulse Rate
- for this patient, it was all normal - pink, CRT <2s, warm peripheries, good pulse volume, pulse rate around 60-70.
- then, we checked the abdomen - soft, non tender, not distended, no abdominal wound.
After that, D - disability
- GCS was full E4 V5 M6, pupils 3mm/3mm equal reactive
Finally E - exposure / environment
- Here, we inspected the whole body from top to bottom, from front to the back.
- This boy has abrasion wound everywhere - shoulder, elbow, hand, shin, foot. But there was no swelling, no limb deformity, no limb tenderness, no limited range of joint movement (means, he can bend all joints normally) - so we don't expect any fractures here.
- There was no spinal tenderness / step deformity during log roll
- But the head was covered with bandage and we could see some blood stain. When we open the bandage, fuhhhhh there was jagged wound, quite big one! the skull was exposed. And there was no skin flap to cover back the skull.
- We gave him antibiotics and painkiller too.
- FAST scan done, no free fluid.
Something like this but smaller around 6cmx6cm size.
 |
| https://www.slideshare.net/vipinvenugopalnair/free-ld-flap-for-scalp-reconstruction-dr-vipin-v-nair |
Okayy, I know there are LOTS OF MEDICAL TERMS here haha. It is okayyyy, you don't have to understand everything. :D
To make it easy, generally we can say that this patient was stable clinically, vital signs was okay. Just, if there was no jagged wound on his scalp, he didn't even need to be referred to tertiary hospital.
Biasalah orang accident mesti akan calar balar sana-sini. Takde patah, kira alhamdulillah sangat dah. Tapi untuk dia ni, kulit kepala dah terbukak, tengkorak terdedah camtu. Nak jahit kulit kepala pun tak boleh.
We managed to request CT brain in view of the wound was big and skull was exposed - just to rule out any skull fracture or any possible bleeding in the brain (ICB - intracranial bleeding).
Alhamdulillah, turned out CT brain was okay - no ICB, no skull fracture.
So, what we did for his jagged wound - we referred him to Surgical Team so that they can refer the patient to Plastic Team. In big hospital, you can see lots of sub-specialty for Surgery - neurosurgery, plastic surgery, ear-nose-throat, hepatobiliary team etc. But, we don't have such sub-specialties here. There nearest one for that is HRPBI - Hospital Ipoh.
If the wound was a simple laceration like the one below, usually we can suture it ourselves..
| https://www.medicalimages.com/stock-photo-image-image9257585.html |
I feel sad for his father, he looked very tired and when the surgical team informed him that the patient will be transferred to Ipoh, we could see his 'pasrah' face. I believe the importance of parenting, but kids nowadays can be beyond control.
This is one kind of accident that actually can be avoided.
Why?
The boy is underage, without licence, without helmet, went out riding motorcycle with his friends around 12am, speed at least 80km/hour and the mechanism of accident was as I expected - he said "kawan main motor himpit-himpit, saya tak boleh control motor tu yang terbabas"
Rasa sedih bila jumpa kes macam ni.
And there were countless cases like this EVERY SINGLE DAY.
So, if you guys or your family members are motorcycle riders, do remind each other kay.
Always wear helmet.
200530
SM, Perak, Malaysia
Day 10 of May Photo Challenge - Self Care
I am Dreaming of...
May 5, 2020
... this pandemic to be over.
I am sure everyone hope for the same too.
It was a hard year, I can say. Beginning from end of January, when the team was given a briefing about the potential spread of Covid19 in Malaysia, then we were taught on how to properly don and doff our PPE. At that time, the cases were still low, there was no social distancing even in the hospital. When the cases increased in number, almost all seminars / teaching sessions / CME have been cancelled. In the middle of March, healthcare workers' leaves were freeze and most of us need to work and go to the health care center as usual.
It is already 2 months since I last met my parents too. I miss hugging them.
I miss the beach, so close yet so far.
I miss travelling.
I miss freedom of playing badminton at the courts with friends.
I miss going to body massage (which my body need it right now).
I miss eating out.
But, I believe everything surely happens for reasons.
I hope by the time this pandemic is over, we already learnt how to appreciate the health more. Always continue all the proper hygiene we have learnt through out the MCO. We will appreciate the moments we can spend with the families too. InsyAllah :)
Day 3 of May Photo A Day - Dreaming of...
SM, Perak, Malaysia
200505
Dalgona Coffee's Impact
May 2, 2020
I was working morning shift that day when my colleague passed over a pending night case. I That was my earliest day of returning to work after 2 weeks of quarantine as I became close contact to 2 positive Covid19 colleagues. Alhamdulillah my swabs turned out to be negative and I need to be non-symptomatic and complete 2 weeks of quarantine.
So, this young lady (Miss A) was in her 20s, with no underlying diseases, presented to us with palpitation and no other symptoms. Basically palpitation is an uncomfortable feeling that the heart is racing or the heart beats too fast. Same feeling when you are about to receive your exam results, or maybe when you see your crush walking around. :)
This same feeling is normal to me ever since I started working too. Haha. Nak masuk kerja selalu nervous sebab tak boleh nak expect much apa akan jadi sepanjang shift. So, I will always expect the worst situation so that I can get more prepared.
Okay, back to the patient.
Palpitation is normal is you feel it after a sprint or physical activities
It is also normal if you are stressed or anxious about anything.
Not to forget, if you drink alcohol or caffeine.
Why? your heart is pumping blood more frequently to the rest of the body to support it. :)
However, if you came to the hospital because of this, the health care staff will definitely need to rule out the emergency causes especially the heart problem. Along with palpitation, you definitely need to visit your doctor if you ALSO feel difficulty to breath / dizziness / collapse / fainting.
For this patient, some blood investigations will be taken - usually:
- full blood count (FBC) - we can see if there is any low hemoglobin, so it can be a sign that your body does not receive enough oygen.
- renal profile (RP) - to check your baseline for kidney function
- cardiac marker (in my hospital setting, we will take troponin I) - here, it can show if there is any problem with your cardiac (heart) muscles, maybe the muscles also do not receive enough oxygen and start to break down.
- electrocardiogram (ECG) is a must - this can show the rhythm of your heart, is the conduction of impulse okay or not
For Miss A, the blood results turned out to be normal and serial ECG was normal (improving sinus tachycardia, without ischemic changes going on)
Back to the history that we already taken at the beginning, she admitted that she drank lots of coffee during this Movement Control Order (MCO). She claimed that prior to this, she drink a cup of coffee as usual and she denied having this symptom.
To my surprise, during MCO, her caffeine intake was 4 TIMES DALGONA COFFEE A DAY!
If I use the viral Dalgona Coffee's recipe, it mentioned to use 2 sachet of Nescafe for one drink. So can you imagine how much sachets she drank a day? T_T
Diagnosis: Palpitation secondary to Caffeine
We re-accessed her after a while and decided to discharge her after she claimed her symptom is much improving and she looked very comfortable. We as well advised her to reduce caffeine intake and to come to ED urgently if she developed any other symptoms (especially chest pain / shortness of breath etc)
---------
I know that we are encouraged to give all out in everything we do, but please do not jeopardize our health. Okay?
SM, Perak, Malaysia
200502
The Thought That Counts
February 10, 2019
I've shared this on my Insta stories but I think I better make a single entry about it, for my own satisfaction and to show how life really is plus to acknowledge awesome people do exist :)
It was the day when I stayed alone in my ward, trying to handle between new cases to clerk and to approach so many "doktor, nak noted patient bed xx, complain bla bla bla...." Well, it is a good thing there are nurses who can update doctor what has been going in the ward because seriously you have no time to really check on every single patient the whole time. And this is obviously a government hospital, please don't expect one doctor and one nurse for one patient basis. No such thing, okay?
I am sorry because sometimes, there are patient's relatives who keep on complaining this and that in which they can obviously help with. T___T
On that day, I received a call from a colleague from another medical ward requesting for one houseman to accompany patient to send to HRPB, Ipoh for further intervention. In view of there was only one houseman in each Ward A and Ward B, 2 housemen in Ward C (in which I am in charge now), so of course we need to help with man power. One houseman to take care of 35-40 patient is doable but trust me, it is super tiring. After informing my MO about the request, she told me to stay with her in the ward instead and to send another colleague of mine to HRPBI.
I wish I was the one sending the patient, especially when I have completed my beds' carry out...haha
So, the day went on.... until 9.57pm, I finally done with clerking the last new case before planning to call the day off. After reviewing the patient with MO, she asked me to prepare to go home after settling the carry out for new cases. And finally it was 10pm, time to go home.
"Dr, patient bed xx tu GCS* drop, SpO2 pun tak boleh pick up, 80% je"
The patient was already on BiPAP (a device / machine to help with respiration) and I still remember my MO said to me to prepare with intubation if her GCS drop. Rushing to call my MO who was in ED with another new referral, she rushed back to the ward and intubate the patient. It was already 10.40pm when I was offering to manual bag the patient until the anesthesiology team arrived to connect the endotracheal tube with ventilator, meanwhile my on call colleague went to settle with the STAT blood for that patient.
Since my HO friend was working alone that night, I didn't feel good to leave him.
And phone kept on ringing, I suddenly remembered I was planning to have late dinner that night with friends. Staff nurse helped to cover while I picked up the phone. Trust me again, talking to a phone while you are bagging the patient is not something you should do. Family members can make viral of you.
Approaching 11.30pm, finally the anesth came and I passed over the tube to the MO and slowly I went to pick up my bag to leave. Suddenly, I saw my friends walking to the ward, planning to help.
I felt like crying, blessed to have these people. T_T
They even had my meal packed, in case I am too tired to eat outside that night.
I felt like crying, blessed to have these people. T_T
They even had my meal packed, in case I am too tired to eat outside that night.
*GCS - Glasgow Coma Scale - to rate one's level of consciousness for eye, verbal, movement response. If GCS less than 8, indicate for intubation.
Good people exist!
Alhamdulillah.
Alhamdulillah.
SM, Perak, Malaysia
190210
My 2018 in Alphabets
January 6, 2019
To be honest, I can say I seldom took random pictures last year and that's the main reason I can't afford to recall much stuffs that happened in my life the past one year. Been working in the hospital where most of the pictures in my gallery now are confidential work-related, I found it tiring to take out the phone just to take random photos. Haha.
"Jangan ambil gambar ye, ni kawasan hospital."
"Dalam wad tak boleh ambil gambar ye."
Actually, living in modern world, trust me medical staffs need to utilize the technology to make things work faster. Specialists, experts on the other side of world, MO in the other building, while housemen in the ward trying to survive with lesser experiences.... of course we need the technology much to reach the seniors. Most of the updates are discussed via the Whatsapps (especially with pictures and videos as prove)
Wah, such a long introduction.
 |
| First time. |
Anyway, I read two blog posts on this My 2018 in Alphabetical Orders (here and here) and would love to try one.
Amalina : This is not how my name is spelled as it is Amanina instead. But, I cringed much to listen to the viral Amalina song haha
Back to basics : Adulthood is complicated, with responsibilities some more. I believe taking my time and back to basics to understand stuffs make it simpler.
Craving : Craving for good food has been one of my top priorities on free time. I am still surviving to balance between work and my very own body needs. And don't you know, doctors sometimes need to live an unhealthy lifestyle despite counselling patients to do the opposite? Caffeine at night, eating dinner at 3am. Occasionally.
Doraemon's pockets : 'Poket Doraemon' is another name for lab coat's pockets. Haha we have many stuffs in the pockets, from pens, staplers, dawai kokot, scissors, laboratory forms, medication charts, phone, powerbank, rough papers and not to forget, blood samples.
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| My version of Doraemon's pocket - baru lepas exchange C&S bottle. |
Empty : Half filled glass vs half empty glass. I choose half filled glass, how about you?
Files : My 2018 has been filled with lots of files. Writing every single day but my handwriting doesn't improve much when I need to rush writing during round with specialists. Haha. Every single minute is precious!
Good job : I always tell this to myself after I encountered difficult task. "Good job, Nina. You did great and you've done your best."
Hospital : Hahaha. I am glad I didn't rent the hospital hostels. Why? The hospital is already like my second house. Spending at least 15-18hours a day in the hospital make me tired to even have a glimpse of hospital on my off day. Working in hospital is fun and doable, insyAllah. But I am still a human being who does feel tired.
Inconsistent : Urut dada je rasa bila jumpa patient macam ni, with inconsistent history. -_-' Kejap pernah kena stroke, kejap tak pernah. Kejap pernah operation, kejap tak pernah. Doctors are not magician and we instead need patients' help and good history to provide good treatment. And we hope people know that sakit kepala and pening kepala are 2 different things?
Jonah : This is a term to call someone who experience a hectic day with lots of admission or eventful days. "Jonah betul kau ni". On good side, working with 'jonah' colleague helps a lot to experience many new cases and new experiences. Otherwise, it can be you, the jonah one. Haha. Jonah is okay, but honestly tiring. Just look at doctors' postcall faces and you can judge their oncall nights. #personalexperience Hahaha.
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| First meal of the day at 11pm. |
Known case of: Usually, we presented the case with 'This is a 64 year old Malay gentleman, with known case of hypertension, diabetes mellitus, dyslipidemia. Currently presented with fever... bla bla bla. Otherwise, we use the word 'underlying' instead. My daily meal of conversation.
Let it out : Being a houseman, to feel stress is normal. The most important, let it out and I will try my best not to burden my heart with any bad feeling. Talk to someone I trust, let it go.
Marriage : Have thoughts and discussions on this in 2018, may Allah guide the way and make it real in 2019.
Nausea : Riding an ambulance is no joke, guys. T_T I thought I don't have motion sickness but to be in ambulance, rushing to get to other hospital is challenging.
Okay boss : Frequent way to reply the bosses :) Haha
Phone : I need a new phone. My phone is slowly deteriorating, from camera's quality to battery. Can you imagine from fully charged phone at 6.30am can drain to 0% at 11am? T_T Phone is life, like how I describe in the introduction.
Quality : Quality time with family is beautiful, especially when I just manage to spend few hours with them.
Red : I occasionally wear tudung with red flowers on top but I will try my best not to wear red to work. I know people said it is khurafat to think this way. But for me, in hospital, red symbolizes blood and emergency. I still wear red and pink blouses outside tho.
Sleep : Something I love to do, every where. I believe my family already get used to see me dozed off, in the car and even at family gatherings. "Eh, mana Nina, senyap je budak ni." "Tu ha, dah lelap dah dia." In medical, I will avoid driving home (balik kampung) after my night shift... well, can you imagine, even at the traffic light in front of the hospital, I accidentally dozed off while driving. Alhamdulillah for my safety so far.
Time : Time is very precious, I learn this the hard way in 2018.
Uncertainties : Embracing uncertainties was my motto for 2018 and alhamdulillah, I think I did a good job choosing it and it eventually guide my brain and heart to expect the unexpected :)
Vacation : In need of vacation stat.
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| In need of this. |
World : Dunia ni memang sementara. Witnessing death as daily routine make me numb to it and I hate that feeling.
X-ray : In case you come to the ward and hear people said 'SHOOTING' out loud... go run and protect your organs. X-ray is something common in hospital. If patient can walk or stable, the staffs will send the patient to the radiology department if any x-rays needed. Otherwise, we will call for portable x-rays which mean, the radiographer will come to the ward with portable x-ray machine to shoot one.
You : Thank you, good people for coming into my life and make my housemanship bearable. :)
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| Will share my wall of memories 2.0 later once it fills up with more sweet memories :D |
p/s - Now I miss random photos. T_T
Towards an adventurous 2019, fighting!
SM, Perak, Malaysia
190106
I Feel My Leg is Still There
September 14, 2018
I just feel like writing today.
This evening, when I was in the prayer room for Asar, I quietly listened to 'curahan hati' of a relative who is currently taking care of her father. She was actually sharing her thoughts to another random lady in the prayer room, just to lift up the burden in her chest, I guess.
Even though I am an Orthopaedics houseman and her father is actually in my ward, I am now in the peripheral team - which means my teammates and I are in-charge of all Ortho's patients in other wards in the hospital... so I don't know much about what is happening in the Ortho ward.
Okay, let's get back to that lady...
Her father was initially came with signs of inflammation of the right lower limb and our impression is necrotizing fasciitis. After further examination and discussion with the specialist, he ended up in the operation for wound debridement KIV BKA/AKA. BKA simply means below knee amputation while AKA means above knee amputation. BKA/AKA will only take place if the surgeon thinks it is better to do so and after approval of patient during the operation. Upon incision of the lower limb, there was A LOT OF pus discharge and slough - which means infection! The leg was really not in good condition and the infection was already ascending above knee. T_T
Only if you know how the slough / wound smells like.....
After explaining the intra-op finding and the surgeon explained the need to proceed with AKA, the patient was only keen for BKA at that moment. So, we proceed with that.
That was my first experience with BKA as a houseman.
Limb amputation - it sounds easy to say. But if I put myself in that patient's shoes, I can't imagine to see my leg is no longer there.
But, patient's general health is important as well. That limb can be a source of infection that can lead to sepsis / septic shock - many organs can lose their functions and eventually leading to death.
"Pakcik, saya minta maaf sangat-sangat. Tapi ibu jari kaki pakcik ni sebenarnya dah tak hidup. Kita kena keluarkan dia. Yang mati tak boleh bersama dengan yang hidup, kan pakcik?"
I still remember one of my MO's words towards another patient who came with gangrenous big toe, which means he need rays amputation of the great toe.
Yang mati tak boleh bersama dengan yang hidup, kan pakcik?
This sentence kept on playing in my brain.
Same goes to life. There are some things or people that are not meant for us or things that are actually harmful to us no matter how much we love them. This is when we need to remove them in our life, otherwise they will affect us, physically and mentally - eventually can destroy us.
It is hard to let go, but we need to try and live with the fact. And believe that it happens for reasons.
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I think I lose my writing skills much.
T_T
I miss blogging though.
SM, Perak, Malaysia
180914
180914
My Different Version of Eid
June 24, 2018
To be honest, 2018 is my very first year to celebrate the first day of Eid Fitri away from my family. I had expected this to happen this year, so, my heart was well prepared for that. 6 years staying abroad, alhamdulillah I managed to go home every single Eid Fitri :)
But, life changed. I have new responsibilities, new environment and I look forward for more changes in my life, insyAllah with an open heart.
Night of 1st Eid, I was on call at the labor room. It was uneventful, I mean the oncall was bearable with few admission - tolerable much. Well, who wants to get sick on the night of Eid, you tell me. -_-'
I had something I could not forget, two different cases that really caught my heart on how people perceive the hospital admissions.
1st case.
There was a lady, primigravida (first pregnancy) who came to Labour Room (LR) at 0200H (2am) with complaints of contraction pain and show. Upon further examination, the CTG (reflect baby's condition in the womb) looked reactive (means normal), the os was already 2cm and time contraction was 2x in 10 minutes that last about 30 seconds.
Based on my previous experiences, we will admit this patient to the ward for further observation - in view of:
- she came at 2am
- her house is quite far away from the hospital.
Even though she was just primigravida (the labour process is usually longer for primigravida), she could still deliver the baby ANY time!
But, she was really keen to go home instead of being admitted.
Well, I do understand she did not want to celebrate Raya at the hospital, but this was out of her control. If it is fated that her baby to be delivered on 1st Syawal, let s/he be. So, my MO allowed her to go home and asked her to come immediately to the hospital if the contraction pain becomes stronger or if there is any leaking liquor (air ketuban pecah) or if she feels any reduction of fetal movement.
2nd case.
After the previous lady left the LR, another lady, G7P6 (means she is currently pregnant of the 7th baby and already delivered 6 babies) referred from the Emergency Department for PV bleeding (per vaginal) with diagnosis of incomplete miscarriage.
Incomplete miscarriage means:
- the 'baby' or better to be called as product of conception - POC (hasil persenyawaan) is already out
- but some of the POC still remain in the womb
We need to evacuate the POC otherwise patient will continue have a lot of PV bleeding and abdominal pain.
Upon per speculum with the MO, we managed to remove the POC at the os and upon TAS (transabdominal ultrasound), the endometrium thickness (ET) was <10mm. Usually, we need to proceed with ERPOC procedure (evacuation of retained product of conception) if the POC cannot be removed from the os and if the ET >15mm.
In this patient's case, our final impression was complete miscarriage - she did not have to undergo the ERPOC. However, we admitted the patient for observation and told her if her bleeding is minimal, we can allow her home that morning. She agreed with that - 'saya ikut apa yang doktor rasa terbaik'.
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Here we can see how patients perceive admissions to the ward. Trust me, no doctors want to admit patients to the ward without reason. Most doctors care about the patients even though admissions will increase the workload. But, that are for patients' sake and our responsibility.
And to make the night more interesting, the first lady delivered her baby just few hours after she left. Luckily she managed to return to the hospital T___T.
Birth before arrival (BBA) to the hospital is another issue.
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On the day of Eid, I was in charge of post natal ward and guess what, the ward round ended at plus minus 7am! And the housemen managed to settle all documents for discharged patients as early as 10am! Wahaaaaa. The MOs were considerate enough to allow patients home very early so that patients can celebrate Eid with family. :)
My shift ended at 1pm and I decided to drive home immediately after that. Arrived my aunt's house at almost 4pm and I ended up sleeping for the rest of evening. T_T
Went to my uncle's house that night and I ended up with sleeping on the sofa.
The end of my first day of Eid. :D
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| 2nd day was better. :D |
Selamat Hari Raya everyone!
Although this maybe quite late, but I wish you have the memorable Eid :)
If you are reading this, please pray for my success for tomorrow's assessments. I will be leaving for another department very soon and hopefully I pass this O&G - Obstetric and Gynecology with good achievement. Ameen.
M, Perak, Malaysia
180624
Nasi Lemak RM2 and I
May 13, 2018
Stay back = 7am - 10pm
On call = 7am - 5pm, return to work at 10pm
Post call = go home at 1pm
So, the story was that I was post call one fine day, trying to get myself something to eat for breakfast. Luckily, they announced that Kak M was selling meals at the thumbprints / punch cards area. Since I was on call the day earlier, I didn't sleep much and I managed to get my work done (Prostin review, AM review etc) by 7 am.
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| Example of doctor's diet. |
I took a RM 10 note and even collecting orders from the nurses, volunteering myself to buy meals. Excitedly, I walked towards the side door to exit the ward, passing few beds occupied by patients. Just about to leave the ward, a patient gave a signal to me that she was in pain.
Pain in O&G (antenatal ward) mostly means contraction pain.
So, I returned to the procedure room to do vaginal examination (VE) to see how much her os already open. "Oh, nice, dah 5 cm ni Puan, kita hantar pergi labor room untuk bersalin ya."
After documenting the VE findings, I informed the nurses to prepare the patient and her file as the patient was going to be transferred out of the ward to the labor room. Upon leaving the counter, once again another patient claimed she felt leaking of liquor. I went back to the procedure room with that patient and was about to do per speculum to see if there was really liquor pooling in the vagina. Luckily, a MO, Dr. XYZ was there and volunteered to do it for me (thank you very much doctor!), so I prepared the documentation instead.
Then, Dr. XYZ decided to continue with morning rounds. Finished the round around 9am and proceed to carry out all plans like tracing investigation results, taking blood, doing discharge summary yada yada, it was already almost 12noon.
Good bye, nasi lemak.
See you when I see you.
:D
So many experiences with meals, to be honest.
Not to forget, I bought nasi kerabu at 9am and was only available to eat at about 8pm and found out that my nasi kerabu was not in the pantry. T___T I suspected the nasi kerabu was not in good condition anymore and people threw it away.
Another best moment was when akak PPK offered an extra patient's meal for me. Honestly, meals in my hospital are very good, especially the doctors' diet - available for me especially if my duty is in the labor room. Ayam masak sambal hijau, ayam masak merah, ayam masak kicap nyum nyum.
Cuma itu lah, masa nak makan properly tuuu. Hahaha.
That's the main reason I provide myself with something to eat on the go.
M, Perak, Malaysia
180513
Off and Food
April 21, 2018
Day 47+ of working and life is still bearable, alhamdulillah.
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| Laksa and rojak by the sea. |
I am such a happy young-at-heart kid every single time I have proper meal. :D
Honestly, I feel guilty to tell / ask patients to take care of their lifestyle (like to get well-enough sleep, eat proper food in good quantity, reduce stress in life) - when in fact, I am the one who are lacking of them. I am sorry.
Adoi.
Well, it is just me who are still adapting to find time to have meal in between work, plus feeling guilty to eat while other colleagues are doing their work. The hospital is small compared to any other hospitals but I still find the cafe to be far from the wards that I feel bad to leave to buy meals.
- "Eh, doktor, bila masa ada kat sini? Tak perasan pun... tu la, kecil sangat."
- "Ehhh, I think I saw you there, since when you are here?"
- "Tu la doktor, meh akak transfer lemak ni, baru la tak sejuk dalam OT"
- "Kau senang lah nak cari baju kat online shop tu, badan kurus."
- "Weh, lainnya muka kau dalam nametag."
- Doktor, makan roti je ke? Patut la kurus."
Honestly, these kind of reaction are new to me. T_T
Usually, on off days, I will prepare myself with enough stocks of breads, Gardenia will always be my preference haha. 6 tahun duduk Czech bukan main payah nak jumpa roti lembut. So, I will bring 1-2 packs to work plus plain water and air kotak. So, in case I don't eat proper meal, I have my backups :D (in which most of the time tak sempat nak makan pun hahaha)
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| Sunset in Lumut :D |
One good, valid reason to work here is the sea :)
My vitamin-sea. :D
Thank you Allah for this life plan. You surely know the best. Alhamdulillah.
M, Perak, Malaysia.
180421
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