A traumatic breech in labour for Me

Last oncall, I had a breech in labour. Didn't manage to send for emergency caesarean section. There's another two ongoing emergency caesarean section (Acute Pulmonary Oedema with severe PE unable TRO HELLP with platelet count of 33 and another emergency caesarean section for fetal bradycardia). This is my third vaginal breech delivery since I become a medical officer.

Not fun. Unexpectedly, patient is a primigravida (first time pregnant). Her os became full within 30 mins, from 4 cm to 10 cm. 10 cm is when your cervix is fully dilated and preparing for vaginal delivery. Somemore it is a footling breech (footling breech is when the presenting part of the baby is foot, instead of buttock). In assisted vaginal breech delivery, buttock presentation is easier and it is associated with lower risk.

Attended with a senior and specialist. Thank God that it went well, baby and mother are both safe. However, it is a traumatic one for me.

Really thankful for the teamwork, and the gazetting specialist who came just in time.

The next day during my postcall, I went and saw the mother. I thanked her for giving us the full cooperation during the labour. She was doing an excellent job.

The baby was extubated the next day, doing well too.

At some point, it was a very palpitating, stressful and traumatic event. My first two breech in labour went on smoothly, but this time it was a different experience.

That's what we are facing in  medical, not all came out to the show just like what is in the textbook.

26/8/2018 

Calm

During my last oncall, when I was in the emergency OT, the staff nurse broadcast the hymns from her handphone. She had a nice speaker. Nice songs: 10,000 reasons, As the deer panteth for the water and other songs. It was so calm while doing the emergency caesarean section. Baby delivered well :) Really happy and contented to see this gift of life.

It is great to attend deliveries. You will feel happy if the mother and baby are both doing well. However, in medical, sometimes things may go wrong with unexpected obstetric emergencies, complications and etc. Therefore, you must always be equipped.

In good times, you must celebrate life. In bad times or emergencies, you need to learn how to handle it. That is life.

:)

27/10/2018

All it takes to affect me is the only one that didn't do well

Today is my postcall day. Reaching home at about 11.30 am, took a bath and had my lunch. And, I went to sleep.

Last night, again the labour room heated up. It was burning. Having a full house patients in labour room and an emergency lower segment caesarean section as a grand opening for my on-call!

It was an eventful day. What affected me a lot was a young lady who is at her 27 weeks of pregnancy came in with bleeding. Initially it was thought just a bleeding from her cervical polyps (a growth over her cervix) but patient developed profused bleeding in labour room. I explained to her regarding her current condition and I told her that an emergency lower segment caesarean section is indicated in view of breech in labour unable to rule out abruptio placenta. After telling her regarding the outcome of the baby in view of the estimated fetal weight was only 1 kg, she cried. I almost cried too but I tried my best to hide it because there were still a lot of the things that I need to do before preparing the patient to the operation theatre. I noticed there were hoarseness in my voice when I further explained to her regarding the risk of the operation.

There is a saying, "You can do 99 things for someone and all they'll remember is the one thing you didn't do."

As for me, "I can have many mothers giving birth during my oncall and all it takes to affect me is the one that didn't do well." So random (^_^")

I had a few small babies last night. Intubated. Really hope these small little babies will do well in NICU.

To round-up, I have a few preterm labours, shoulder dystocia, vacuum-assisted delivery, OASIS (obstetric anal sphincter injuries), retained placenta, pregnant lady to rule out pulmonary embolism and the chaos ended with a lady with acute pulmonary oedema secondary to pre-eclampsia. Most of the events occurred at the same time. I am grateful for a great teamwork in labour room yesterday.

值班

我希望我不是医生，好想好想旅行。

Sick and On-call

Sick and on-call, with a case of placental abruption ongoing monitoring, waiting for delivery, the next thing that comes into my mind is to quit. However, I believe this thought is just a temporary one.

Thank my family members and my beloved one, for supporting me in any way. This proves that family is not an important thing, but it's everything.

Thank you for the little dear one, who strives so hard to make it through. I always look forward to the joy of seeing you at the very first sight and congratulate your mother. Sometimes, I can see her tears of joy too.

At the end of the day, I can see that life is so beautiful. Everything happens in His time. Thank you, Lord.

18/6/2018， 4.34 am.

她知道她活不了多久了，但她却感谢我

最伤心的是，你知到她活不了多久了，她却告诉你，“医生，谢谢你安排我去古晋。我好高兴，我可以得到化疗。我也想像其她人一样生活。” 从一个即将去做一个”治标不治本的化疗，” 非常年轻的患者说的。

下一个病人，与她两位女儿解释关于“Do Not Resuscitate。” 她们哭了，对不起。

值班，不在于做多久或晚间你是否能不能休息，重要的是妈妈和宝宝们平安无事，这就够了。别无所求。这是值班后的小小喜乐！

很多人说要坚持，要勇敢，不要放弃！但，几个人知道放弃需要更大的勇气呢？

人。。。算什么。。。

Sorrow is when your patient said, "Terima kasih sebab tolong aturkan saya ke Kuching untuk Chemo. Tau tak saya pun mau hidup macam orang biasa. Terima kasih doktor. Saya sangat happy." Basically a patient thanking me for arranging her trip to Kuching for chemotherapy. This is from a young lady, my patient, who is going to Kuching soon for her palliative chemotherapy.

Moving on to the next patient, talked to the two daughters, explaining about DNR (Do Not Resuscitate). Their eyes went watery and red. I am sorry.

On-call is not about how long you worked or how long you can sleep and rest during the night time. What matter most is during the post-call, all the mothers and babies are safe, that's enough. Nothing else I will ask for. This is post-call little happiness.

A lot of the people say that you must be brave enough not to give up. But how many of them understand that you need a greater courage to give up?

What....is mankind...

9/5/18, 2.39am

You do not Appreciate what you have, till it's Gone

It has been a year in O&G department, and I would say that I really enjoy the posting. I am now a permanent medical officer in O&G department. Still learning and striving.

It has always been my dream to take up surgery posting, ever since I was in 3rd year of medical school. However, after entering O&G department as my second posting, and surgical posting as my third posting, my dream changed. I want to do O&G.

I do not know why, regardless how tired I am, I will always be contented whenever I saw a newborn. Cuddled them in my arms, I felt so comforted. Every life is a miracle! The newborn is a miracle. They are so pure.

I realized that I lost my interest in surgery after my medical officer gave me a chance to do an appendicectomy. After taking out the appendix, I do not feel excited. Furthermore, as surgery field covers a wide range of different types of surgeries, I don't think I am so enthusiastic to try up all of it and to pursue all of them. Also, in the surgical ward, most of the post-major operation patient is still quite ill, they were placed in the back cubicle. Most of them are bed-ridden. Unlike in obstetrics, the patient comes in healthy, deliver the baby and go back home with a smile. Although, this might not be seen in all cases. There's always an exception. Post TAHBSO patient, after chemo/radiotherapy, we will still see them walking into the clinic for surveillance. But in Gynecology, it also depends on what cancer the patient has. Of course, like surgical, not all come with good prognosis. I am going to gynecology ward soon next month, I guess I will start seeing those palliative cases. It is something that clinical doctors can't avoid. It is somehow a daily routine to see life and death, in our career. However, I wish to see them less in obstetrics and gynecology field. On the other hand, I do see people who are very into all kind of surgeries, and they are very passionate about it. I think those are the one who will enjoy surgical posting more. They can even go to the hospital middle of the night just to learn. I salute them. As for me, I have other priorities :)

There's a saying, "You do not appreciate what you have, till it's gone." I experienced it! A few days ago, I was diagnosed with a benign medical condition whereby I was advised to change my department. The specialist offered to write a letter to my superior. However, boldly I told the specialist that I do not want to change department as O&G is what I love and I want to do in my life. I never know how much I like O&G till a few days ago. :) 

I always thought that the more senior you are, the less nervous you will be every time we do the emergency cases. I am wrong. I have seen that even the senior medical officer will get nervous too. All the cases are different and you never know what is adhere down there and you need to be careful. And of course, your speed is taken into account as well! Besides surgery only, you got to learn many more skills i.e. vacuum-assisted delivery, forceps, assisted breech delivery and etc. This comes with experiences. But then again, regardless of what, all I want to hear each time is the cry of the baby after baby out. It gives me a big relief!

Till now, I am very grateful to a medical officer who messaged me the day after I left O&G posting during my housemanship period, asking me if I am interested in O&G or not  =) She is no longer here. Hope she is doing great in her life now over there.