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C.O.D
April 9, 2019
"COD is no longer 'cash on delivery' when I become a houseman...
May Allah bless and grant you Jannah, ameen." - Hanis, 5th April 2019
Basically, death is not uncommon in Surgical department as well.
Most of them are patients with advanced cancer that already metastasis to vital organs especially lungs. Not to forget, victims of MVA (motor vehicle accident) with ICB (intracranial bleeding) - bleeding in brain. I witnessed a lot of cases in which we ended up issuing Death-In-Line (DIL) and Do-No-Resuscitate (DNR) after discussing with the family members regarding poor prognosis or deterioration of patients.
To those who are clueless what is actually COD in medical line - it is a short form of cause of death. It is not easy to come out with diagnosis for a living patient and to be honest, it is even difficult to come out with cause of death as well. Superiors always remind us, be careful with what we are dealing with, document everything we have done and do everything that we have documented.
There are few criteria before we can pronounce the death of patient.
- check the vital signs - usually heart rate, blood pressure, SpO2 will be unrecordable - means cannot be detected anymore
- check the glucometer (level of glucose in blood) - if too low, can be the cause of death as well
- check the pupils - usually fixed, dilated
- check lungs and heart sound - none... a bit tricky with patient supported with ventilator and we can still see lung expanding with transmitted sound on stethoscope
- check cardiac monitor - usually it will show a straight line (asystole) - print it out.
Usually if CPR is commenced to save patients life, it is only be done for up to 30 minutes. After prolonged shortage of oxygen, most of organs will slowly shutting down, especially brain. It is uncommon to go beyond that, taking note of resuscitators conditions as well. Commencing CPR is very tiring, pregnant lady should never do that. 15minutes of CPR = at least 165kcal of energy.
Ya Allah, guide me to Your light, ameen!
SM, Perak, Malaysia
190409
The Baju Kurung Girl
March 24, 2019
I adore girls with baju kurung in the hospitals, as I can't tolerate the heat much to wear baju kurung at work. The only time I wear baju kurung is when I have the shortest working hours which is normal shift (7am - 5pm), otherwise I will wear trousers with blouses instead :)
One of the thing I wish not to happen on the day I wear baju kurung is "dr, patient bed xx collapse / asystole" (in which I hope will not occur on any day pun actually)
Because it seems so hard to climb up patients' beds to do chest compression. ??
Doing CPR can drain much energy and I pray patients will have fast recovery and discharge very soon. Ameen!
Tempting Veins
March 23, 2019
I am currently in my 4th posting, to be specific I am now in Surgical department. Wahh, time surely flies very fast. It was just a year ago when I started my housemanship and now it is already my 2nd year. I've been trying to update my experiences here, but after quite a while not updating stuffs in my own blog, it feels awkward. Haha.
But, I planned to update a glimpse of my daily life in short posts regularly. I don't have much time to really make posts with something like "3 life lessons I learned from...." T_T in which the one I really miss to create.
Honestly, working as a house officer need energy - mentally and physically. I am sure being medical officers and specialists require more energy, just... being a house officer is my level for now.
Why the bulging veins?
I don't realized I have them actually. But, whenever I encountered patients with difficult blood taking, I automatically look at my own hands, only then I realized them. Suddenly I wish all patients have these bulging veins, just to avoid the need to prick the patients more than once just because it is hard to do so.
And actually, after working for more than a year, I can say that blood taking needs experiences, good instinct and sensation from our fingers. Sometimes, doctors can't really see the veins but we can feel them with fingers.
Such veins are more visible in people with less fat, patients who are not edematous (no water retention in body) and people who workout a lot.
And most doctors have bulging veins, thanks to frequent CPR we need to do, maybe some retraction done during operation... ohh, maybe fundal pressure to help delivering the baby in C-section? Hehe
-_-'
Just a random post, I guess?
I miss blogging, but I think I lost that magical blogging touch. T_T
2018 Best Nine
February 11, 2019
I was scrolling my own blog and suddenly my eyes found my featured post - 2017 Best Nine. Maybe it is too late to share my 2018 Best Nine now, but who cares though. :)
I didn't expect I only posted 13 pictures in 2018. Such a drop in number.
Sunset is always one of the thing I will look for especially after I went through any interesting oncall. And the beach with sunset are the best pair to enjoy myself with.
Somewhere in Pos Kuala Mu.
This place is actually in Sungai Siput, but not that close to my house though. If I am not mistaken, we took at least 1 hour plus to get there and it is actually quite close to the border of Perak - Kelantan. The place is getting famous but not that mainstream yet. :)
Somehow, I am glad that I didn't take any part time job during the phase of waiting for job. I did some online stuffs to get money too, but most of my expenses that time were from the saving I had while in Czech.
So, I was unemployed at that time and I must say I had the best few months of my life, exploring Malaysia with my parents. Not just that, I am thankful to have that chance to appreciate meeting and gathering with my relatives in which I don't have the privilege and opportunity much to do so now.
Umrah with my parents.
My favourite flower - tulips :)
This is the background picture of my Whatsapp chat anyway.
The day I requested to go to this viewpoint and for the first time in my life I saw the scared face of Emak. -_-' hehe, kesian mak kena layan anak buat benda2 gayat macam ni. Still remember when I said to her I would love to visit Macau Tower later and to see Macau for the highest point, she agreed even though she mentioned in the first place that she will only stay around the lift. But to my surprise, she accompanied me around the tower anyway.
Emak is always the best!
I didn't expect I only posted 13 pictures in 2018. Such a drop in number.
Completed my tour in Malaysia with Sabah as the last state I went to. Alhamdulillah, finally in February 2018, I managed to go to every state in Malaysia. I always love road trip, although seems like I can't help to sleep in the car nowadays... I can't imagine how my next road trip will be, in view of I haven't drive long distance for quite some time.
But, let's embrace the uncertainty. Too many places in my head, I will catch up on them when the time comes :) with the plus one too, ameen.
Not many people know about this, but I actually went to Macau last year, during my end of posting leave. It was a last minute plan obviously, bought the tickets maybe 2-3 weeks before departure. Don't care much about the price as I need to appreciate the short holidays that I have and spend them with my parents.
Macau is a beautiful, small city. Not sure to call it a country or not. Is it belong to China or is it independent? Some said the first one, some other said the latter. Can't afford to write entries on the trip though. I wish I could.
But Macau is lovely to check it out :D
And I miss hiking now. Hehe.
Towards many more memories in this 2019. And surprisingly I started to snap more random pictures lately. Hope I can share more stuffs in the blog too. :)
SM, Perak, Malaysia
190211
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.
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| 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
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