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.

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