Happy Posting

Happy posting. That is how I describe my current posting, pediatric posting. Don't know why, the kids make my day, everyday! It's been so long since I had this spirit to go to work, or I would say I am looking forward to go for work everyday, even my ON NIGHT shift or my PM shift (6 am - 9.30 pm). Thanks to 30 hours oncall system when I was in surgery last time, that nowadays it feels nothing to work for PM shift. Before this I felt like time is dragging slowly during my PM shift ^_^

1. Kids are innocent and cute. They are unwell when they are sick but they are super duper cute when they are well! A smile from them really melts my heart, over and over again.

2. The fun of getting the diagnosis. Thank to God that I have met a few superiors with kind heart and they are passionate. Sincerely I say, I didn't see much of these doctors nowadays. They are good inspiration for me. Moreover, they are willing to teach us, the house officers. As usual, you will get all version of ways of doing things/right procedures from seniors, friends but these MOs are willing to teach you the correct way of doing things. Some of them teach you how to get the diagnosis too. It is fun learning here.

I will treasure every moment that I have in Pediatric posting. o(^_^)o

Trying to make sense of what we are doing? - from Dr. Ch'ng LS (^_^)

Christmas present for baby E 

Promised lil R to give her this, because I have to poke her to set an IV line

A little explanation can solve a BIG problem

Jumping up from my bed, I was late. It was 5.40am already :( For the first time I took shower and dressed up within 10 mins, for the first time I drove to the hospital within 10 mins...I love to reach hospital early because I love to review the patient slowly :P But, too bad, this morning I have to review patients like a bullet train, no choice.

Yesterday a patient insisted to go back regardless of her baby high serum bilirubin. I was heated up as well by her request, but at last I chose to lower down my voice and talked slowly to her. Explained to her the consequences of high serum bilirubin.

Today, a patient refused for blood taking. I was having my lunch when one of my colleague told me that. As I walked back to the ward, I was thinking how to make the patient agree for us to take her baby's blood. At last, I showed her all her daughter's previous blood result and told her one by one the need of all the blood investigation and also why do we do the CXR for her baby. She is very keen to know each one of it, only for me to realize that our biggest problem is the lack of communication between patients and the doctors. And hence, I have decided to communicate with patients more after this, instead of history taking only, I will try to explain to them what I am doing, hopefully time is not my limitation. If it is my own child or family members, of course I wouldn't let u come and poke poke them and just go away :)

Another treasure I collected today ^_^ Hopefully, this two years of training will mould me into a good doctor. 

First few days in surgery with OnG fever...

(3rd July, 15) 1st day: 6am -11.15pm

Tired physically and mentally, missed O&G so much :( didn't review male parients for so long already.

Dear Heavenly Father, pls continue to lead me.....amen. 12.18am

(4th July, 15) 2nd day: 6am - 10.15pm

Workload still acceptable, just physically tired. Today I asked my friend, "Is the blood results for the patient with PV (per vaginal) bleeding?"

"Evelyn, we don't have PV bleeding patient, only PR (per rectal) bleeding..."

Still missing OnG.... Tiring.. Did burn dressing and at last the patient pass away. Sad. It's been 4 mths since I last did my CPR.

Dear Heavenly Father, pls continue to lead me and bless those who have been praying for me, Amen.

(5th July, 15) 3rd day

Extremly happy and grateful to be given an opportunity by Dr. L for the appendicectomy. She taught and guided well. She is really a good doctor/great surgeon. Thank you Lord.

But I am more happier, when I received a msg from a friend/ex-boss? Telling me to jia you, the Lord is with me ^_^

8th month of Housemanship (^_^)

I can't believe how time flies! Entering the month of Gawai, it will be the 8th month I am working as houseman(HO) in Sibu Hospital. As usual, I am doing the countdown, another 17 months to go! While waiting for the time to come, I promised myself to enjoy my housemanship years. Be positive! It is just 2 years of my whole life! And now, I am so happy to be in O&G department, it is just that I will be going to Gyne soon. As a normal human being, who loves the period of adaptation?

Two days ago, during my PM shift, I went in for an emergency EUA (Examination Under Anaesthesia) + Vaginal Wall Repair. Seriously, this is my first time entering this procedure in OT. I don't know, as for my surgeon, it is just a simple and minor procedure but as I never saw it before, I did not want to miss this opportunity. Thankfully, my surgeon is a very nice person. She taught me while she was doing the procedure, allowing me to feel this and that. I always believe that nothing is worth more than the experience that you gain during your training! Or else, you will never learn! Corrugated drain was inserted for this patient.

This morning, as usual, being a postcall HO, we will review the patients in postnatal
ward, discharging them if they are well. I came across this patient and today, her corrugated drain need to be removed. I am quite happy to have the opportunity to remove it under my MO supervision. My colleague was weird to see that I was contented to have an opportunity to do this small little procedure but as for me, if I do not know how to do this simple things or little procedure, how am I going to talk about those procedure such as Bilateral Tubal Ligation, Caesarean Section and etc. Obstetric is not all about doing caesar only (^_^) How about Ultrasound scan? Is it a black and white creature staring at me (^_^") This one I guess I need more practice.

Tiring working and oncall, but tiring doesn't mean that I am not enjoying it. Great to have one day off tomorrow! Happy Sunday....time to go to church! I am so sleepy by now, my panda eyes are getting worse. Miss my friends in medical school, especially my old housemates. Hope they are doing well in their respective hospitals. I wonder when are we going to plan our unplanned holidays :P as usual...

Primum non nocere

Primum non nocere means, "First, do no harm" in Latin.

Do you know what is CTG? It is a medium for the fetus (baby in mummy's womb) to communicate with you, doctors! Beside the ability for printing out the fetal heart rates on a graph paper, it also shows maternal's womb contraction and sometimes in some machine, mummy's heart rates also was shown.

I am still a houseman (HO), whatever that I did wrongly, my medical officer (MO) will have to answer in the morbidity and mortality review meeting, or even worst, in the perinatal mortality review meeting.

However, when your MO didn't blame you for your mistakes, that doesn't mean that I am right or I am ok with it. Tears dropped this morning when I was holding the patient's CTG. I need to be more competent and confident. Even though I am sure of something, at least, I have to inform my MOs.

Lesson learnt yesterday. Hopefully the baby is now in NICU, not another place.

手术室里的紧急时刻

当宝宝的头严重的卡在母腹中时，我几乎紧张得难以呼吸，其实对于所有在手术室里的同事们而言，那都是个令我们难以忘怀的午后。

          
           我是那场急性胎儿难产紧急下段剖腹产手术的第一助手。切口已经开了，但是宝宝的头依然严重的卡在母腹中。经过多次的推力尝试，医生始终没有办法找到胎儿的头部。刹那间，我的脑海中浮现了许多的想法：-

如果医生无法找到胎儿的头部怎么办？
如果我们寻求紧急协助，妇产专科医生能否及时赶到?
我今天是否能听到新生儿的哭啼声呢？

          我的心脏因紧张而剧烈的跳动着，因为面对这样的案例我没有太多的经验，我甚至紧张得在那冷冰冰的手术室里流下汗水。通常在剖腹产中，手术室里只会有儿科实习医生，但是今天儿科的 medical officer (MO) 也在手术室里。经过了接近10分钟的持续尝试，医生决定直接为孩子接生(即从拉出腿部接生而并非头部)。感谢主医生找到了胎儿的左脚，随着找出右脚...经过几次的扭转(因为胎儿被脐带缠绕了)，胎儿终于顺利的从母腹拿出。

          我真的好佩服 X 医生的医术，她简直令我目瞪口呆。最重要的是，我很钦佩她在危急之中的镇静。她并没有责骂任何人，只是冷静沉稳并且非常迅速的完成了她的工作。

          胎儿被取出之后并没有哭啼，胎儿被移交至儿科医生。但是，一会儿后我们听见了她的哭啼声，手术室里的所有人都松了一口气。X 医生开心的说:"好了，现在我们可以轻松一些来继续完成接下来的子宫及双侧输卵管结扎手术了。"

手术后，我告诉 X 医生:"我刚刚真的很害怕胎儿没有办法顺利的拿出。"

X 医生:"其实一开始我也非常紧张。" 

我:" 但是你刚才十分冷静啊!" 

X 医生:"如果我不冷静下来，更何况手术室里的其他人呢？" 带着一抹微笑，她便走开了。

那个傍晚，我到 Neonatal Intensive Care Unit (NICU) 看看那历经折腾的新生儿。胎儿的气管已经被插管了。得了meconium aspirated syndrome，在写这篇文章的我，希望现在那宝宝没事了。

The Emergency in Emergency OT

A breath holding moment for me, in fact for all who were in the operating theater (OT) that afternoon, when the baby's head was deeply engaged.

I was the first assistant for the emergency lower segment caesarean section case for acute fetal distress. Incision been made, baby's head was deeply engaged. Multiple attempts for per vaginal push were made but the surgeon still unable to grab and pull put the baby's head. Many things ran across my mind, what if:

-the surgeon failed to grab the baby's head?
-can the specialist make it on time if we call for help?
-can I hear the baby's cry today?

With a very little experience of mine, my heart was thumping with fear. I was sweating in a cool OT room. Most of the time, there was only a pediatric houseman (HO) there but this time around, I saw the pediatric medical officer (MO) was there too. Attempts been made for almost 10 mins and finally, the surgeon made the decision to deliver the baby via breech (means that pulling out the baby's leg first instead of the head). Thank God that the surgeon was able to locate the baby's left leg.... then the right leg. Baby was delivered with multiple twisting, due to the cord rounding the baby's body. I really admire this Dr. X's skills. Incredibly made me speechless. Above all, I saluted her calmness in time of emergency. She didn't scold anyone, she did everything calmly but very fast.

Once the baby was out, she didn't cry, she was handed to the pediatric MO. However, after a while, we heard the crying sound from outside. Everyone sighed in relieve. Then, the surgeon joyfully said, "Now, we can relax a bit and continue with the closing of the uterus and bilateral tubal ligation."

After the operation, I told her, "I was so scared just now if the baby couldn't be delivered."

Dr. X: Initially I was Uhm,,,ah,,err... already.

Me: But you are so calm just now!

Dr.X: If I was not calm, how about the rest of the people in the OT?

(With a smile, she walked away)



That evening, I went to NICU to see the baby. The baby was intubated. The impression was meconium aspirated syndrome. While writing this piece of sharing, I really hope that the baby is now ok.