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.

Randomly random

Sitting in front of my pinky laptop for an hour and a half already. Reading back my messages with Rev. X. Life is short, some people get to live longer, some people get to live for a while. Whatever it is, it is just the matter of who will sleep longer before the judgement day.

Amazingly, I already walked out of the shadow of my grandpa's death. Knowing well that I will be facing more terminally ill patients in future, I realized that I need to go numb as soon as possible. 

Just now while reading back my old posts for Rev. X, I found this message,

“There is no shame in what you are feeling. On the contrary, the fact that you can feel pain like this is your greatest strength. Suffering like this proves that you are still a man, this pain is part of human-

Then I don't want to be human.” -Harry Potter and the Order of Phoenix

Night is late, goodnight is the word.. ZZzzzz..

祢 是我永远的依靠

Singer: Edward Chen

每當我面對風浪 
祢總在我身旁
生命福份與我分享 
更深地渴望
每當有困境阻擋 
祢旨意不搖晃
使我心中滿有平安 
充滿無限希望

祢是我永遠的依靠 
堅守信心來宣告
我真實經歷祢全能的力量
唯有祢是我永遠的依靠
堅守信心來宣告 
當我來全心敬拜
神蹟就在不遠前方

The more knowledge, the more grief

I am now doing my evidence-based case write up on decompensated congestive heart failure. Basically I digged into some details regarding the causes, management and the prognosis. All the scary thought came to my mind, because my grandma is a potential candidate for heart failure, knowing all her medical history. As I read the journals, I was thinking, "What if...what if and what if...?"  (".)

Who can I share this with? Family members? Definitely not! My spiritual partner? Well, maybe later, if I have time...

At the same time, I kept praying to God, "Dear Heavenly Father, please strengthen my heart..."

Therefore, it is very true that, "For with much wisdom comes much sorrow, the more knowledge, the more grief." (Ecclesiastes 1:18)

Why Lord???? :'( Anyone of you can simply say that you can use your knowledge to help others, bla bla bla and bla bla bla... whatever...Dear Heavenly Father, please continue to guide my path and guard my heart.

Anyway, I am going to continue my case write up now, while listening to 依然爱着耶稣 by Edward Chen.