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Vampire at Night
December 19, 2019
I saw this post in my draft, just the picture below.
I bet this post was drafted when I was in medical posting (at least a year ago).
Usually only in medical posting, we have huge number of bloods to be taken before 6am for a night shift houseman. Honestly, the process of blood taking is not that long (it can be as short as 1minute) ONLY IF:
- the patient is cooperative,
- the patient does not have any chronic kidney disease / on chemotherapy,
- the patient is not obese,
- the patient is not dehydrated,
- the patient is not a kid or elderly,
- the person doing the blood taking has good experiences.
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| Add caption |
The are two ways to take blood - from venous and from artery (in Malay, we call artery as nadi - the pulsating one).
For difficult blood taking, somehow taking blood from artery will be the best way instead. Just, I believe it is painful compared to via venous, but only arterial blood can give the best result to see the good is our oxygenation in our blood system.
Few problems you can encounter during blood taking (venipuncture) / branula insertion:
1. Delicate / running veins
- Usually these can be seen in elderly
- Our veins are elastic - the moment a needle is inserted into the vein, our vein will hold the needle in place (like... hugging the needle) - there will be no way for blood to escape - like a seal.
- But for elderly, their veins are less elastic --> hence, blood will slowly go out in from the hole in between needle and vein, leading to hematoma.
2. Neonates
- I believe many of us have seen the current issue about blood taking in baby.
- It is difficult to be honest - you need steady hands and at least one assistant. Usually taking blood from neonates without assistance is doable, if you cover the other limbs nicely and know how to retract the skin well to properly expose the veins beneath.
- But, to insert branula to a baby can never be done alone. Trust me, I have tried once, the branula was successfully inserted (just the way for blood taking is done), but the secure the branula will be another issue. Assistant is obviously needed to secure the branula on the baby's hands.
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| Gebu gebas |
3. Advanced kidney problem
- Especially patients on regular dialysis.
- In these patients, the blood vessels will slowly constrict (smaller diameter) --> hence the difficulties.
- They also will have one side of upper limb with fistula / prepared for future fistula, so we lost chance to take blood from one limb.
- Don't ever poke patient on the same side of limb with fistula - we are going to risk the pathway for him to do dialysis later by introducing injury / infection.
There are lots of more actually, you can further read about difficult blood taking here. I believe I have encounter almost all difficulties as shared in the link.
Not to mention, other situations to be taken into account - like, patients pergi mandi/solat/toilet, nak kejut patient dulu untuk bangun tidur, nanti ha terkejut tiba-tiba kena cucuk.
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| blood taking trolley |
I must say, blood taking / branula insertion is surely painful. But, reminds ourselves that blood is like our identity, it reflects the condition of our body - is the water enough? is the kidney / liver okay? is the blood sending good amount of oxygen? is there any infection - is it bacterial / viral?
So many things can be checked from the blood. Blood is precious. But don't worry much if you think doctors are taking lots of blood, we at least have around 4500 - 5500ml of blood in our body and usually the maximum amount taken daily is maybe 10ml - it is like 0.2% only hehe :)
20191219
SM, Perak
Latest Me.
December 18, 2019
Oh my, my last entry was in August, that was at least 4 months ago. There were obviously multiple life events happened in between those gaps, and I am looking forward for all the future uncertainties. :)
1. I am a wife :)
Alhamdulillah, on 16th of August, I became a wife to my husband, Haziq. The marriage life is going okay so far, alhamdulillah, still trying to understand each other's differences and preferences. I realized it is definitely true when people said you will never know someone until you get married to him/her. You wake up in the morning with him by your side and finish the day with him too - on good (non-night-shift) days. So, basically you can observe each other's liking at every minute of life if both of you are on off days.
To have a doctor as my husband is a blessing in disguise. Alhamdulillah.
Previously, I have no idea how to live my life talking about medicine at home, in the car, etc - practically everywhere and almost every time, like breathing medicine. But, right now, I am very glad to have someone who can genuinely listen to what I am sharing about - all the struggles of working, all the happiness achieving success at work, all the sadness of unable to revive patients, the lethargy, the hunger yada-yada.
Thank you for being there, my understanding husband. :) May Allah bless us with mutual understanding and love, always.
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| Source - https://www.marriage.com/quotes |
2. I move to a new house :)
It is an apartment, people said it is bit pricey for monthly rent but we both agreed this is the best bet we can get with the price - a lovely 3 bedrooms apartment, on a good level, with nice view plus fully furnished IKEA furniture and we basically the first one to rent the unit - so you can imagine how brand new and fresh items we are dealing with. :)
I am sure all of us agree that a comfy, lovely home is what we are looking for after a hectic working day :) Hehe.
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| View from the apartment. |
A room is specially allocated for our activity like studying, ironing etc.
Another room is the guest room - especially if the family members are coming for overnight trip :)
While we use the master bedroom.
Since the kitchen is kinda fully equipped as well, we have a target to cook at least 2-3 times a week. Sounds so lazy but that is the best plan we can try to do. Our schedules are quite tight, working at the hospital for at least 10-14 hours a day and coming home with lethargy - we can't afford for frequent home cooked meals.
Trust me, the moment we returned home at 10pm-11pm after working the whole day since 7/10am, we feel too tired even to stand properly. However, we are trying our best to at least complete these three things - 1) make sure our solah is done, 2) eat dinner/supper and 3) take bath.
3. I am in my final posting :)
Reading my old post about starting my housemanship, I feel grateful to see how far I have become. 3 months more towards the end of housemanship and there will be another battle of being a doctor.
Anyway, my final posting is emergency medicine (ED - emergency department). :D
I chose this department anyway, instead of anesthesiology, just because I would love to learn how to be a good front liner and to practice and develop more confidence to deal with emergencies.
Anyway, my final posting is emergency medicine (ED - emergency department). :D
I chose this department anyway, instead of anesthesiology, just because I would love to learn how to be a good front liner and to practice and develop more confidence to deal with emergencies.
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| During moulage in ED. |
ED can also be called as ETD (emergency & trauma), A&E (accident and emergency) or ER (emergency room) - this place witnessed hundreds of patients coming everyday (at least for minor specialist hospital) and of course it can reach up to thousands for state hospital.
So far, I am enjoying and appreciating all moments in ED because this is basically the place I can practice to give a plan as a MO. There are too many things to learn in ED - doctor skills, knowledge, empathy, how to improve patience, how to break bad news etc.
And this is the place I feel 'stupid' when encounter patients from departments that I've left quite long time ago. Since I just finished my Paeds posting, the knowledge is quite fresh in my brain and the skill of blood taking / branula insertion is still okay. Alhamdulillah. But when it comes to other departments stuffs, it takes me a while to come down to few differential diagnosis.
Still, I can't really tolerate patient who come to ED at 3am, with complaint of headache since 1 previous hour. We gave tablet Paracetamol (equivalent to Panadol) and the symptom resolved. The reason for this headache was the patient sleep late at night. T__T. Boleh tak rasa nak nangis? Kecemasan ialah untuk kes-kes cemas. T_T. Even if you have persistent headache and it is affecting your life very much (like taking frequent MC), you can go to outpatient department (OPD) or any klinik kesihatan for further management. Usually they will try to investigate the reason, make future plans and most importantly, you can continue follow up with them.
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All in all, I guess 2019 is amazing so far alhamdulillah. It has all the adrenaline rush, happiness, tears and smile. Adorable 2019.
* Moulage (French: casting/moulding) is the art of applying mock injuries for the purpose of training emergency response teams and other medical and military personnel.And this is the place I feel 'stupid' when encounter patients from departments that I've left quite long time ago. Since I just finished my Paeds posting, the knowledge is quite fresh in my brain and the skill of blood taking / branula insertion is still okay. Alhamdulillah. But when it comes to other departments stuffs, it takes me a while to come down to few differential diagnosis.
Still, I can't really tolerate patient who come to ED at 3am, with complaint of headache since 1 previous hour. We gave tablet Paracetamol (equivalent to Panadol) and the symptom resolved. The reason for this headache was the patient sleep late at night. T__T. Boleh tak rasa nak nangis? Kecemasan ialah untuk kes-kes cemas. T_T. Even if you have persistent headache and it is affecting your life very much (like taking frequent MC), you can go to outpatient department (OPD) or any klinik kesihatan for further management. Usually they will try to investigate the reason, make future plans and most importantly, you can continue follow up with them.
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All in all, I guess 2019 is amazing so far alhamdulillah. It has all the adrenaline rush, happiness, tears and smile. Adorable 2019.
20191218
SM, Perak
Just Because It is August | 2.0 :)
August 4, 2019
I realized I tend to reflect myself more in this month, I mean August. And yeah, August this year gonna be a step to another level in my life, insyAllah. :)
p/s - pray for me yea and kindly share tips for a good marriage if you have any :)
JUST BECAUSE IT IS AUGUST :)
PRIORITIES
To be honest, I regularly read my own posts and reflect how I used to be before and how am I currently. Obviously, life changed me a lot, from working experiences dealing with different kinds of patients, appreciating life when dealing of newborns and oldies etc. Nowadays, I am struggling to put my thoughts into words as I think I haven't properly reflect myself the past one year plus. And I miss to do so, very much.
Just a recap of what I have go through so far - so that the future me will further appreciate how my life have turn myself into a better person, insyAllah.
1. I am already in my 5th posting, Alhamdulillah.
It means I have been in this housemanship for more than a year. To be honest, I still feel afraid to think about dealing with people's life. Recently, my new head of department asked this popular question to us, the new comers in Paediatrics - "Why do you choose to be a doctor?" Seriously, this is a very general question, yet can be quite tricky to answer. I bet different doctors have different reasons for this and there are simply no right or wrong answers. You can help people by being a doctor and you can still help people by not being a doctor.
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| Attending newborn. |
After a while, I realised for me it is actually medicine that chose me and Allah led my way towards medicine. It was hard at the beginning to have the passion as this job is physically and mentally challenging.
But, after few initial weeks of working, I can feel the satisfaction of being a doctor, despite I am still learning my best to be the good and safe doctor. It started with when the patient admitted to ward for some symptoms and I need to figure out what actually happened to the patient based on his/her clinical symptoms, trying to correlate with the physical examinations with the help of imagings (like ultrasounds / x-rays / CT scan ets) plus blood investigation then come out with a diagnosis and try to manage the disease with some plans.
The best feeling is when I would be the one discharging the patient after giving treatment and the patient got better and well. I really love the feeling when the patient does not have the symptoms anymore and when I can see clinically he is getting better - having appetite to eat, able to move around, able to smile and have better conversations with family members.
2. I am getting married soon, insyAllah.
We knew each other for a year plus, have been working together as well. Many colleagues were surprised about this as we don't really show our relationship to others, only those who are close to us knew about it. And I feel glad when the close friends keep on supporting us and still keep the info to themselves. :)
I feel so blessed when Allah gives me the opportunity to have this feeling and may Allah lead our hearts, together, towards the right path till the end, till Jannah, insyAllah ameen.
My parents were very excited to know about this, so do his... and for me parents' blessings are one of the most important thing I consider for a relationship. I love how he approached me, it was sweet, simple and direct, not leaving me with uncertainties :). The exact moment when I seriously considering to proceed was when he went to meet my parents and when he said something like this to me - "I would love to know more about you and to have you as my life partner, my best friend, my companion, my wife, the mother to our children, my partner in crime, my travel mate."
Thank you Allah for sending him into my life and please guide us towards a happy and blessed marriage.
3. #kemasrumahwithhani
I just discover this FB group - #kemasrumahwithhani recently and I totally fall in love with all the posts. My brain wants to live a minimalist life but my heart keep on buying stuffs that I thought I will use. It was difficult to de-clutter stuffs without the guilty or sentimental feeling but some things I need to let go as I don't want to be a hoarder. Alhamdulillah, I can currently control myself not to buy random stuffs, hehe.
Try to explore the group, we can get ideas on how to organize our stuffs - even like how to fold the clothes, how to dry clothes in rainy seasons, how to easily clean the kitchen, how to deep clean the washing machine, how to do food preparation, how to decide when to keep or let go of our stuffs and etc. :)
p/s - pray for me yea and kindly share tips for a good marriage if you have any :)
SM, Perak, Malaysia
190104
Recaps of Pangkor Run 1.0
June 24, 2019
16/6/2019 - Pangkor Island, Perak
To my surprise, there are lots of running events being organised around my working area - Manjung. Or maybe it is because currently I don't have much issue with logistic - like I can drive around to almost anywhere haha. So, after meeting few friends with common interest which is to join running events, we decided to give a try with this Pangkor Run.
I were very excited to imagine myself running along the beach and yeah, it was one of the nicest feeling ever! :D
Anyway, I feel like I gradually losing my writing skills, so, bear with this one yea. :)
15th June 2019
Most of us were on postnight shift that day. It was quite an eventful night shift the previous day - with non-stop cases referred from Emergency Department and of course no sleep achieved that night hahaha. We were basically berkampung in ED attending new cases.
Went home around 10am, took our breakfast, did few pending stuffs here and there then... suddenly it was already 1pm. Actually we planned to take a ferry to Pangkor around 3pm. Unfortunately, the three of us overslept and woke up almost 5pm. We rushed to pack our bags, aimed for 6pm's ferry from Marina Island.
How to get to Pangkor from the mainland?
Only via ferries. I heard they want to redevelop the airport but later I guess.
You can take ferries either from Marina Jetty or Lumut Jetty.
It's been a while since I took the ferry from Lumut, so, not sure much about the rate and schedule. But if from Marina Jetty, here are the schedule and rate - much expensive but you can get to Pangkor at shortest time compared to Lumut :)
You can park your car around the jetty with RM15/day.
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| Ferry Schedule |
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| Ferry Rates |
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| Here is the ambulance boat - to transport patient from Pangkor Island to Hospital Manjung - for any emergencies that need further management in bigger center. There is a Klinik Kesihatan there, in Pangkor anyway. :) |
We checked in Puteri Bayu Beach Resort that night, booked a room for girls and another room for boys. Rate was RM100 for each room, with 2x breakfast each.
16th June 2019
Woke up around 5.30am, as the run will start around 6.30am. To be honest, this was the first event that really start the run on time, lol. Actually, even 5 minutes earlier. Run was okay but my pace was just acceptable. Hahaha.
Dah lama tak lari, memang haru la pace nya.
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| 5 of us. Another one was having AGE-_-' |
After the run and taking pictures here and there, the girls decided to enjoy the beach and the view. Since the hotel was connected to the beach, we didn't have to take any taxi / walk far though. :)
The view was amazing. I have not much memories of Pangkor since the last time I went to Pangkor was ages ago! Even, I have been working in Manjung for 1 year plus, yet, I didn't have the chance to go there within this 1 year haha.
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| Loving the wave :D |
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| Nak berenang, tapi segan :D |
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| The water was really cold :D But, still mesmerizing! |
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| The girls :D |
The journey was short yet sweet.
Looking forward for more running events together with them! :)
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| Let's go home :) |
I've completed my 4th posting in housemanship :)
Pray for my next one, guys!
It will be either Paediatrics or Emergency department hehe
190624
SS, Perak, Malaysia
MVA
May 13, 2019
My oncall last night was calm, alhamdulillah.... until 5am. I received an update from my colleague that he was going to ED for a new referral - intraabdominal injury, a condition in which I feel challenging to attend other than brain injury.
MVA - motor vehicle accident.
I am not sure about the exact history, but this patient, Uncle L was riding a motorcycle and accidentally hit the tree. We are not sure about the mechanism much but it must be a very serious accident as the patient came to ED unconsciously. Blood pressure started to drop, which may indicate some bleeding was going on.
He successfully underwent emergency operation (exploratory laparotomy + splenectomy) which mean, we cut open the abdomen to find out what was going on inside. There was at least a kidney dish filled with blood clot and approximately more than 3L of blood loss. And the spleen was totally injured and need to be removed. Few segments of liver were contused as well.
Anyway, do you guys know how much blood the heart pumps out every minute? 5L/min!
And he lost more than half of blood in the body. So many blood transfusions going on this morning, my friend became runner to fetch blood between blood bank and operation theater. At least 3 large bore branula were in situ - one for packed cells, one for cryoprecipitate & fresh frozen plasma, one for IV drip.
He was still in critical phase and admitted to ICU post operation.
And actually there was another patient at the red zone this morning, he was also unconscious, lying flat just beside the patient we were preparing to transfer to operation theater just now.
Informed by my friend, he already passed away this morning, in his baju melayu and kain pelekat after finishing his Subuh prayer and he was being hit and run. Arrived in ED with no pulse, cardiac monitor showed asytole (no heart rhythm), I've been told CPR was commenced and the team was unable to revive the patient.
May Allah bless you pakcik T_T
MVA of Uncle L and pakcik was not related, anyway.
Becoming numb and numb T_T
SS, Perak, Malaysia
190512
Evanescent Life
May 4, 2019
"Everything in this universe is evanescent.
Because it is evanescent, it is also precious.
Spend this precious moment wisely and beautifully."
- The Things You Can See Only When You Slow Down
This view is enough to make me smile to the ears :D
Wonder if there are people who're still blogging their heart out? :)
SM, Perak, Malaysia
190504
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