Friendship

We were strangers, on a crazy adventure,

Never knowing, we will meet at a crossroad,

Never knowing, what we'd have go through.

And here we are,

In your hardship,

You are looking for a new life,

In my ordinary days,

I am still in search of the past.

And at the crossroad,

You guided and helped the inexperienced me,

In my mistake, you stood up for damage control,

At times, you motivated and inspired me,

When I lost hope,

You were there to remind me.

We talked, we cried and we laughed,

You welcomed me into your journey,

I found someone there,

I see the journey of the most important lady in my life.

And there we are,

Had a little smell of the river,

A blow by the cool evening breeze,

Listened to the whisper of the heart,

Walking down the riverside.

Love is beauty, love is pure,

Love pays no mind to desolation,

It flows like a river through the soul. 

How does a moment last forever?

How can a story never die?

In this precious and priceless moment, 

Somehow, our time and place, stand still.

5th July, 2019 at 2235H

the little Angel left us

2 months ago. I saw a patient in labour room, she was in tears worrying about her pregnancy. She was told by the private doctor that her baby stopped growing. After my assessment, she needs a frequent follow up under us and she may need imminent delivery at any point of time. Her baby stopped growing for the past 2 weeks. Detailed scan done by 3 specialists showed a grossly normal baby.

It didn't last for even a week, she underwent an emergency operation. On the next day, I was shocked to receive a phone call from a group of friends, telling me that both couples were crying. I was on my way back from lunch, rushed to SCN (where their baby was admitted), I was taken back by the news. The baby is likely to be Patau Syndrome.

I straightaway went and met the patient. She was in tears, and for the very first time, I cried as well in front of my patient. I couldn't hold my tears. My heart was torn. After arranging them to a special room behind, I left. I still need to go to the combine clinic. On and off, I still burst into tears. I was seeing the combine clinic patients asking how are they doing but inside my heart there was an indescribable feelings. My heart is aching.

Days passed, everyday I would pay her and the baby a visit even when she was transferred to the NICU (neonatal ICU). She was there spending her time with the baby. I could see her eyes swollen, very swollen. She must be crying everyday. During my oncall, when the ward was not busy, I will go and visit her and have a chat with her. I always believe that companion is better than all those comforting words.

There's one Saturday afternoon when I planned to go to a church activity, but I ended up in hospital because I was late for the church activity. To my surprise, the baby was intubated. Things didn't seem alright. Not long after that, she left us.

I remembered when I was oncall, whenever I was free(usually about 2-3 am), I will spend time with the baby in NICU. I can see that she was so lonely. I talked to her. She was strong, she survived long enough for her condition. She is an angel, that I will never ever forget. I wish to see her again in heaven. The sadness is indescribable, and I believed the mother had so much more to bear. It is not easy. I won’t ask her to walk out of the dark shadow, but I prayed that she will move on with the scar.

Most of the time people will blame the mother for what has happened to the baby. And that is the most common question asked by patients. I told the her, it wasn’t her fault that the baby ended up with Patau Syndrome.

p/s: permission granted from the patient for this post

Every baby is a Gift

I was oncall on 5th October 2018. We have one patient with second trimester loss (means that the mother gave birth to a dead baby at early stage of her pregnancy). The baby might be few hundreds grams only and they are born dead.

The patient was only at her 18-20 weeks of pregnancy when she delivered the baby. One of my gazetting specialist came to the hospital for a medicolegal case examination and she got to know that the patient had already delivered the baby.

She asked me: "..., normally where did they put the fetus(baby) ya?"
Without thinking any further, I answered: "Likely in the yellow plastic bag".

I feel weird towards the question that she asked. However, I never think about that. For adults, when they passed away, we have the metal coffin-like place to put/transport the corpse temporarily, but how about the fetus(baby) which is only 300 grams?

So I went and found out that the corpse of the baby will be put into a proper box and will be transported to the mortuary. Not in the yellow plastic.

I updated the specialist via whatsapp.

She replied: Every baby is a gift.

Some baby might not make it to live in this world. Some might passed away early due to chromosomal or structural abnormalities. But, they are still a gift. Every baby is a gift and we should handle them well.

Friends for a season

I was in-charged of antenatal ward for the past 4 months.

There were one group of patients who were admitted to the ward for placenta praevia. Placenta praevia is a condition whereby the placenta is located at the lower segment and at some degree, it will obstruct the birth canal. Hence, patients have to undergo caesarean section. Those patient will be admitted to the ward at the later period of pregnancy. This is because, due to the low lying placenta, they can developed per vaginal bleeding anytime which can lead to torrential bleed. This can cost them a life. Therefore, they are to be managed as inpatient.

There were one group of patients with placenta praevia. Although they were admitted at different time, they became good friends. One by one, they were sent off to caesarean section, according to their times. Those who haven't deliver will go and visit those who already delivered. They always kept each other updated via the whatsapp group. One day, one of the patient with placenta praevia major with underlying one previous scar went off for caesarean section. The surgery was complicated with a few issues but in the end, all went well. She had a caesarean hysterectomy, this will be the patient that I will never forget, S.A.B. My senior and I were there throughout the caesarean section, Bakri Balloon insertion till caesarean hysterectomy. Her friends in the ward were worried because they didn't receive any messages from the her since she who went off in the morning. So they started to ask the doctors what happened to their friend.

I had another 3 more patients, pre-eclampsia patients. They became good friends as well. 3 of them were induced at about 34-37 weeks. They delivered about the same time. Normally when i walked in and out from the antenatal ward, i can see one placenta praevia geng and one pre-eclampsia geng. Their bonding were quite strong. Good thing, at least they became friends and have companion. At least, they were not so boring when they were in the ward.

All of them were very polite.

All delivered before I left the antenatal ward.

I guess, they are friends for a season! Haha...

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.