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Perak, Malaysia | Hradec Kralove, Czech

Neighbourhood

May 6, 2020


This was taken on the first day of PKPB. :)

The view look much fresher than before, I can say.


Day 4 of May Photo A Day - Neighbourhood
SM, Perak, Malaysia
200506

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

View From A Window

May 1, 2020


Since the MCO took place, my life rotated between the apartment and the hospital. I rarely go to the supermarkets as my husband will do most of the groceries shopping (usually after his post-night shift). Our schedule are shift based as people know. Most of times, the moment we leave the hospital is when the supermarket close. 

Still, we have food to cook and eat, alhamdulillah. And surprisingly, from the 1st day of Ramadhan till now, we managed to cook ourselves (our aim is not to order outside food hehe)

I miss the beach a lot too.

The view from our room :) pretty!


I am currently reading The Art of Letting God by Mizi Wahid. The book is not that thick, but I honestly took longer time to read. Not because the book is boring or what, but the contents are beautiful enough for me to take my own sweet time to enjoy. 

There is a part of the book sharing about "You Have What You Need"

Human is a creation that usually gets disappointed when we don't get what we want. Our aim is that the moment we ask for something, that something should be given. In this book, you can enjoy the idea that actually Allah has already given the 'ingredients' to get that something. 

For example, we want to excel in our studies. Of course we need some efforts to reach the destination. We are blessed with knowledge shared by older researchers or teachers that are contained in the books. That can be the ingredient for success. Books = knowledge. Others can be experiences, some skills that need to be polished from time to time. To be an adult as we are today, we need to grow as a baby to a kid, then to a teenager. We don't simple born and suddenly became an adult, right?

Life is a process.
Prayer is a process too. 

Even if we failed, we surely will learn something if we have tried our best. I love the lists in the book about what we should look forward to despite failure:
  1. A greater aptitude for patience
  2. A richer experience of life
  3. Personal growth
  4. A deeper sense of gratitude and satisfaction
  5. Strength to overcome future challenges
  6. Grit to get through the dry seasons
  7. Resilience during tough times


Keep on living and learning :)
Always see things from the good windows (read as perspectives), yea?


I am planning to join this photo challenge :) Wish me determination hehe
Till next post,
Happy Labour Day!
Byeeee.
Assalamualaikum.


Seri Manjung, Perak, Malaysia
200501

Terima Kasih, Nak.

April 30, 2020


Today morning, just before Subuh prayer, a patient came with complaint of generalised itchiness with periorbital edema (means - bengkak di sekitar mata) that made his eyes become so small, I barely can see.

HCW : dah berapa lama dah jadi macam ni pakcik?

Pakcik : masuk hari keempat ni, pakcik pun taktaw kat mana silapnya. Bangun-bangun tidur, terus jadi camtu, pastu pakcik pergi klinik, dia bagi ubat gatal, ubat allergik, ubat sapu. Tapi makin teruk pulak bengkak kat mata ni.

If you received medications like these (only tablets with label of symptoms), please kindly ask the clinic to write down the name at least. Is it piriton, prednisolone? It is tricky even for us to know the names of medications just from the tablets. 

Anaphylaxis - Wikipedia
Something like this. Wikipedia



Maybe there was some allergens on his bed, maybe some insects, or maybe some food he ate before. The patient denied any history of food allergy. Though he had some allergic to an analgesics - pain killer (unsure name), he denied any history of taking analgesics prior to symptoms.

At first I got confused if this is allergic reaction OR anaphylactic reaction (which the latter is worse), I quickly read back the notes shared by one of my favourite medical officer and found this.




Going through by systems:

Skin - yeah, pakcik got some itchiness all over body with periorbital edema.
Respiratory - he denied any problem with breathing - no shortness of breath / chest pain / wheezing etc. And the lung was okay, no wheezing (wheezing ni selalu jadi bila saluran nafas jadi sempit, macam orang kena serangan asma.
Gastrointestinal - he also denied any abdominal pain / vomit / diarrhea
Cardiovascular - no history of dizziness / shock / fainted
Neurological - none as well.



Diagnosis:
Allergic reaction secondary to ? cause.

Intravenous cannulation done, we decided to give these medications given:
- IV hydrocortisone 200mg stat
- IV piriton 10mg stat
- IV ranitidine 50mg stat

After discussing with senior about IM adrenaline, there is less harm than benefits to give... though this is allergic reaction (not anaphylactic) - so, IM adrenaline 0.5mg stat. 

We reaccessed patient about 30minutes later, the first thing he said "Nak, pakcik dah boleh nampak, terima kasih, nak." We can see the swelling around his eyes already improved much! He claimed the itchiness also had improved, hence we decided to allow him to go home with some medications.


A thing about this pakcik was he kept on smiling through out his visit in ED, soft spoken as well. Dah la mata tengah sepet, senyum senyum lagi la sepet pakcikkk. 

--------------

I always feel anxious to work night shift in Emergency Department. With this current Covid situation, staffs are distributed to many teams, hence, I need to survive on my own feet managing the Non Respiratory cases (green zone, yellow zone and red zone). Every single night shift, I will always pray for smooth shifts and the senior MOs working on respi team will not be annoyed to share their opinions for management. Alhamdulillah. the senior MOs, staff nurses, medical assistants are helping a lot and HO colleagues are good as well :)

Till next story :)
Salam Ramadhan semua.

SM, Perak, Malaysia
200430

Self Reflection from Ebit Lew's Beautiful Words

April 26, 2020




After reading these tweets on Twitter, I decided to read more about Ebit Lew. I know his name was famous ever since the Movement Control Order (MCO), when he directly go from one hospital to another to support the preparation for Covid Screening. There were lots of posts flowing on my Facebook timeline at that time, which amazed me a lot. He spent huge amount of money to help those in need. 

But, I don't really understand the current issue when he decided to take a break till MCO to be lifted later.

Otherwise, he is an impressive Muslim, who makes me reflect how much have I done for the community. I pray hard that Allah blessed me with my job's contributions as I am not that active in social contribution like him.  -_-'







Here, he mentioned a lot about prayers. Yeah, solat tiang agama kan? Simple but most of us take it for granted T_T. I realised as Muslims, we tend to get farther from Allah, especially when we are blessed with ease, happiness, success at that time. But we forget that all those rizq are from Him. 

Every speech of him are very eye and heart opening. Sometimes, we tend to search for others' mistakes forgetting that we are human too, so we also make mistakes. Here, we need to practice to see good in others. 

Hidup kerana Allah, do things for the sake of Allah. 

I need to always renew my intention every time I treat patient with this mindset. For Allah, for Allah, for Allah. 

May Allah bless him and us :)
Ameen!

Salam Ramadhan everyone.

SM, Perak, Malaysia
200426

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