One Heck of an On Call

Assalammualaikum :)
Every month, I do 6 - 7 oncalls.
Ever since I started doing ICU calls in September, my boss gave me more ICU than OT calls to train me.
So this month, I had only one OT call.

Definition:

"ICU call: On Call and is in charge of the ICU for 24 hours.
OT call: On Call and is in charge of the Operating Theatre for 24 hours."

MOs doing OT call will be giving anaesthesia to all the emergency operations of the day. Operations might be done by several surgeons:

Ortho / Surgical / Obs Gynae but there will be only ONE anaesthetist.

And that single OT call of mine was yesterday; 26th Nov.
And it was such a buuusssyyy day, almost like 6 oncalls being combined into one.



I had an ECT (electro-convulsive therapy) in the morning.
Then EMLSCS for poor progress
Then bleeding PP type IV - under GA!
Then bleeding PP type II
Then WD Fornier's Gangrene - sent to ICU
Then EMLSCS for breech in labour
Then EMLSCS for poor progress
Then acute appendicitis.

My OT went on and on non-stop since 9am and it was already 4am by the time I discharge my acute appendicitis patient and I thought I can sleep until Subuh.

But suddenly at 6am, the staff nurse came knocking at my door and screamed "Doctor!! Ada fetal bradyy!!"

I literally jumped out of my bed, struggling to switch the lights on, open the door, take the phone the staff nurse brought me and listening to what the O&G MO has to say, put on my scrubs, put on my tudung, look for my glasses and shoes - all at the same time.

And as I am having active URTI at the moment, my throat was really hurting when I woke up I can't even talk properly.


Why the panic?

Fetal = unborn baby. Brady = slow.
"Fetal Brady" is the term we use to imply unborn babies with slow heart rates. When an unborn baby has slow heart rate, means the baby is in danger. BIG BIG danger and he/she has to be taken out ASAP or the baby might die in utero. See the reason to panic now?

I went out of my oncall room, didn't even care that I have not brushed my teeth or washed my face.
While preparing my GA drugs, I called Shangker breathlessly, asking him to stand by while I induce the patient; either GA or spinal.

When the patient arrived to OT, baby heart rate was 86bpm. Anything less than 110 beats per minute is low for a baby. And so, I had to GA the mother. Giving general anaesthesia to a pregnant woman is one of the things I fear the most in this field.

Anything can go wrong. And any mistake can cause the lives of two human beings and of course, lots and lots of paperwork ahead.

And in the morning, there was a CME session that I had to attend albeit being very tired and was dozing off midway until suddenly Dr R attacked me with a question: "Akmar! Which GABA receptor does Midazolam bind to?"
*criessss*

Nasib baik her mood was good this morning; x kena marah sebab cannot answer.
Finish lah coretan of one of my worst oncall day.

'til then!

-Because life is a test-

-AkMaR-
http://nur-akmar.blogspot.com

The Excitement in Organising

Assalammualaikum.

Anyone who has known me long enough from my high school years would have known that I like to organise events / gatherings / outings.
In high school, I organised a school trip to Genting Highland (yes I did, together with mother: the library teacher)
I organised a post-SPM informal outing to Port Dickson with my classmates, the first (and only) informal high school reunion and various extra-curricular activities in INTEC and IMU as well.
But I toned down in the UK. I was not actively involved in any student body in the UK as much as I thought I would. Mostly it was because I stayed in Preston, far from Manchester city. A little part of it was also because I needed to focus on my studies and at the same time I started dating my now husband 🙊 🙊 . Guess I wasn't that good of a multi-tasker.
While I was a house officer, I did even less organising. I was quite active in the houseman society but due to time and energy constraints, I did not organise many events.

In this hospital, I've participated actively in organising our latest project: The Organ Donation Awareness Week.
I was very excited that time. Contacting people for tshirts / look for buyers / went to the nearest shopping mall to ask permission to do a roadshow there and many others. But I have not really realised it yet.

And now, I am taking part in organising the Doctors Club Inaugural Annual Dinner.
And I get excited just by the thought of organising it.
I am in charge of the smoothness of the day, to contact a band to perform live music, and some other secret duties as well.
The dinner is less than a month from now.
There are so much to do but I am pretty sure we will all do well and will manage to pull this off.

Then only now I realised, I really like organising events.
The excitement and joy in me that was buried for the past 4 yrs just came out like a reservoir unable to contain the water in it anymore.

But I hope I will not lose my focus on the things I have to focus on; my husband and my career.

Just a short one today 🙃 🙃
I am oncall tomorrow - need to sleep early and get enough rest.


-Because life is a test-



-AkMaR-
http://nur-akmar.blogspot.com

Life As A House Officer. Part 3

Assalammualaikum :)

I went through
Part 1 - here and
Part 2 - here
Now let's go through my Obs Gynae posting.

Third Posting: Obs Gynae

This could have been the most emotional (and I was not the emotional one), loud, full of screaming ladies (doctors, patients and nurses) and medico-legally dangerous department.

I tagged the longest in this department; due to the high off-tag requirements.
We had to conduct 10 vaginal deliveries and episiotomies (a super hard task) and assisted in 5 emergency caesarean sections (among others).

Why was conducting 10 vaginal deliveries hard to achieve considering the high birth rate in Malaysia?
That was because during that exact period I was tagging with perhaps 8 other HOs - our hospital labour room was under renovation. We sent notices and diverted most of our patients to other nearest hospitals (and they hated us for it). We accepted only emergencies, and had to make patients sign disclaimer forms that they are aware of our "under renovation" status and will accept whatever shortcomings (which included less beds, no husband allowed during deliveries and no second class rooms).
The birth rate in the hospital dropped by more than half during those periods.
Hence for 8 HOs to get 10 deliveries per person (not to forget, we also had to fight for patients with the student midwives) was out of reach. They then reduced the requirement to 8 deliveries.
And I only managed to achieve them after about 3 weeks I think (or was it 4 weeks?)

The Constant Screaming

For some obvious reasons, the department is full of women. Women everywhere.
All the nurses were women. The patients were of course women too. I had only 2 male MOs at that time; the rest were women (which I think made these male MOs became womanly emotional too).
The labour room was always full of screaming women and nurses. The women screamed to get the baby out while the nurses screamed to "impart energy" to the woman to get the baby out. And when problem arises, we doctors are called and we join the screaming process too
😒 😒

"Berak!!!! Beraaaak!!"
"OK puan, satu dua tiga beraaaaakk!!!"
Then if when we had to vaccuum or go for emergency caesar, we shout "Vaccuuummm!!" or "Caesaaaarr!!"
If baby's shoulder stuck, we scream "Shoulder stuccckkk!!!"
If baby born flat (not crying), we shout "Baby flaaaaattt!!!"
If post delivery, the mother was still bleeding vaginally, the nurse will shout "Doktorrr! Patient ooozinggg!!"
Oh so much drama.

I think O&G was the only department that literally screaming for help is totally the norm, and happen pretty often.
Not only that, the MOs were shouting every where too.
"Houseman labour rooomm!!! Datang siniii!!!"
And the labour room housemen will come running, while the housemen in PAC will start peeping into labour room; being kepochi Why? Why? Who screwed up?

The Malignant Specialist

We term someone malignant when he or she is very destructive, hate-able and scary; just like a cancer.
And there was this one relatively new malignant specialist in the department.
Oh my God, mulut dia cabul gler. She can guiltlessly call us "Down Syndrome", "useless", "kau ni bodoh eh?", "kau ni belajar kt universiti longkang ke?!" and things like that. With her eyes glaring down (or up) at you, it felt as if they are going to pop out of her eye sockets.
She even said to a patient who didn't know she was pregnant: "Puan ni tak tengok cermin ke? Tak rasa ke u dah gemuk sikit?"
😑 😑 😵 😵

Outing postcall with Nisa during O&G time. Well, she was postcall. I wasn't!

Selit sikit gambar atas ni 👆 👆
Since I was already in my 3rd, and Nisa in her 4th posting, ktorg dh pandai cari masa untuk pergi makan 😬 😬

The Brutal Miscarriages

After about 2 months in Obstetrics, I then went on to the Gynaecology part of the posting.
Gynaecology deals with women health, rather than maternal health.
And God, I saw so many miscarriages so brutally happened. And they were nothing like in the television.
Contrary to the Obstetrics part; the Gynaecology part was so not dramatic; even when there should be some.

The news of miscarriage was broken to the ladies almost inhumanely.
And I talked about that before, in my post titled "I am sorry I can't save your baby".
I'm sorry, we doctors sometimes can be very savage.

After 4 months of drama and emotions and shoutings (no, I did not cry in this posting), I went on to General Surgery. Where bed sores, sacral sores, abscesses and CPRs became almost daily. *cries blood*


-Because life is a test-



-AkMaR-
http://nur-akmar.blogspot.com

Life as a House Officer. Part 2:: Medical Posting

Assalammualaikum =)

Let's pick up from where I left off. Read the Part 1 here.
The horrible morrible Medical posting.

Second Posting: Medical

Well, this was hellish and exhausting.
I lost 5kg within the first 2 months, effortlessly. I was the skinniest, slimmest and already someone's wife.
My tagging period in Medical was hell.
I hated some of the seniors in my department at that time, especially the leader. Leaders arrange our timetables. And she, shamelessly gave two days of holiday per week to herself and her friends because they "have to do 24-hour shift" while we taggers get no off day.

In the general medical ward, there were 34 beds and they are almost always full. She put 3 taggers in each ward with only one non-tagger (who was also the most junior one). Of course, things get very messy. Where were all the other non-taggers? In the dengue ward, obviously, the less busy ward compared to gen medical, and in ED - it is busy too there, I know but they get 2 days off per week? Such a heartless woman the leader was. I don't care if she reads this post. She already knows I don't like her.

Even though I was second posting at that time and some of the other taggers were 4th posting, it was still hell-ish.
It was like the blind leading the blind.
I had to be in the ward before 6am, and can only leave the hospital most of the time after 11pm.
I drove in auto-pilot mode. I only realised that I reached my destination, completely forgotten how I arrive there. If Akmal was driving, I'd be sleeping in the car; even though our house was only 10minutes away.

To off tag, we have to present a case during morning passover and we also have to pass a viva by Dr. Kang (the Specialist in charge of house officers). I passed the viva, but I couldn't present during morning passover because the passover was only once a week.

To present, we need to clerk (in layman term: interview) the patient, manage and then discuss our management. That is what it mean to "present a case".
I prepared hard for this one case to present during passover; a pulmonary TB case. A very very difficult one. But I was so determined to present it even though I know I will be questioned like crazy and I wouldn't have the answer to most of the questions.
But I was so desperate to off tag. I went home past 12midnight that day.
And on the next morning that I planned to present, the morning passover got cancelled 😭 😭
I cried a bucket. I started crying non stop in front of Nisa in the room because she asked me, "Kau OK ke?"
I missed the morning rounds because I was crying in the room.
Because that means I will have to hold for another week and prepare one more case to present to off tag.

But Allah heard me.
HE helped me BIG time. On the day that the passover got canceled, I received another case.
A considerably simpler one. A HIV positive patient with chronic diarrhoea.
And I went through the case with a specialist already.
And the next morning, Dr Kang decided to hold yesterday's canceled morning passover. Hence I got the opportunity to present this HIV with chronic diarrhoea patient!
And to make it more blissful, Dr Kang was the only specialist present during that morning passover (or rather during my presentation time). The other specialists came in late while the scariest ones (Dr M and Dr M; the two iron consultant ladies in Medical) were absent.
Hence I was questioned only by Dr Kang. And as sarcastic as he is, he is also very kind hearted and practical. He didn't bury me in the dung. And with that, I managed to off tag. Finished my 2 weeks tagging period.
Yes, two weeks only. But it felt like forever.

The rest of the 4 months were not without its own sufferings.
During 4 months of Orthopaedics posting, I inserted not even 10 branulas on my own.
In Medical, I had to insert 10 branulas per day.

Makan-makan at the end of the posting.

I could not fathom how Akmal went through Medical as a first poster.
He was in it, all on his own - we weren't married at that time.
He didn't have anyone to care for his food. Well sometimes I took his shirts to laundry and iron them for him.
But that's about it. But also perhaps it was a blessing in disguise. He didn't have a wife he had to take care of during his first posting. I was a fiance but I go back to my parents', my food were taken care of by my parents and he didn't have to worry about me.
He gave his undivided attention to his work.

In Medical posting too that I made some good friends; as "we were in this together". Lembab sama-sama, kena marah sama-sama, balik lambat sama-sama and stuff.
But in Medical too that I met nasty people. People who while working long shift (the most important person of the day), can still sleep in the room in the afternoon. At first I thought she was being super-efficient. But it turns out she was neglecting her job!
Also met selfish shameless leader. Also met "I deserve your utmost respect, and you should treat me like the biggest boss" kind of boss.

Staff nurse ni nama dia Alex. Was in 7C night shift that time. Scared me off 😱😱

What was good about Medical posting then?
One thing for sure....my learning curve went up exponentially. And my confidence too.
I had to face so many things in Medical that once I graduated from that department, I felt so much better and matured, and experienced.
Come what may, I can face them. If I survived Medical, I can survive anything.

Which brought me to my third posting: the ever emotional department Obstetrics and Gynaecology.

-Because life is a test-

This was our Medical farewell makan-makan. Held AFTER I left the department though because we didn't have time to organise it WHILE we were in the department!

-AkMaR-
http://nur-akmar.blogspot.com

Life as a House Officer. Part 1

Assalammualaikum :)

Yea I know.
This is a very belated post.
9 months since I've completed my housemanship (baru 9 bulan; belum setahun jagung pun jadi MO-nye)
But I still feel like writing about it.

Those 2 years; were hell in heaven.
More heaven than hell yah.

Let's start at the very beginning.

Program Transformasi Minda (PTM)
My career with the public service started off with a 5 day course in Ibis Hotel C180 - which was right in front of my hse 😒 😒. Gone were my dream of going for a course in a beautiful far away hotel.
But that was a blessing actually; for I managed to ask my brother to send me my sportshoes (we have that PE session every morning!), and some colouring materials for our group project.

The course gathered new house officers from several hospitals around Klang Valley; Hospital Serdang, Hospital Klang and I can't remember one more; I think there was one more hospital involved. Was it Ampang?

The PTM was where we learn about naik pangkat, SKT, hrmis, Piagam Pelanggan, Budaya Korporat, tindakan tatatertib, dressing codes and basically everything goverment worker stuff. People say it is the brain-washing program. Well, perhaps it was. But it wasn't as brain-washing as the Kem Bina Negara I went to before 😅 😅
Most of the content went down the drain actually. I didn't remember much of it except for the dress codes and the tindakan tatatertib.
And as usual of course, a group project at the end; a play.

There you go, my team mates doing our fair share of colouring.
Using the markers and crayons I got my brothers to send me from
home

The Introduction/Orientation
We then had another 5 day orientation in the hospital level. This one introduces us to the anatomy of the hospital, how to get our parking passes, how to ask for the 10% staff discount in the hospital cafe, who were the HO leaders of each department and stuff.

In a life span of a house officer, he will have to go through 6 postings; Orthopaedics, Medical, Obs Gynae, Surgical, Paediatrics, Emergency Dept / Anaesthesia / Primary Care / Psychiatry (not arranged in order).
The newbies who are going in for their first postings are called, well, "first posters".
Then they go on to become "second posters", "third posters" and so on until they are the "sixth posters".

First Posting: Orthopaedics
I was blessed to be assigned to Orthopaedics first.
There were about 4 or 5 final posters (first posters look at them like saints) in Ortho at that time.
Let's see if I can still name them. They were Angeline, Edmund, Faizal, Firdaus, Ganesan (not final poster at that time but very very reliable). They were really helpful and kind hearted.
Orthopaedics is dubbed as one of the most chillax department hence if a final poster is placed there; it is heaven for them. Like totally. Which is why I think these seniors were very nice - they were not pressured, they themselves were calm. Thus, come what may, come whatever trouble this first poster face, they can help.
As for me, it wasn't. First posters will never feel any department is a chill one.

I cried for the first time in Orthopaedics. I got scolded so much by Mr P for grinning when he was bashing me during the morning passover. Really I didn't mean to grin. I just didn't know what facial expression to make. I was so terrified at that time, to the point that I grinned. And it only fired him up even more.
Oh God.
But to be fair, he smiled like a sweety pie to me during my last posting and even said "Hi!"

And at the end of my first posting, I got married 😬 😬

My last day in Ortho. It was a clinic day and my MO let me off early because I had wedding preparations to do!

I think I'd better stop here for this post.
It will get too long if I put the stories of my second posting: Medical here as well.
The department itself bore too much of agony for me. Of course, there were fun bits as well.

Let's start writing part 2 in a while.

-Because life is a test-

Oww yeaahh.. This was the preparation I was talking about! I went to a spa for my pre-wedding preparation.
The first but unfortunately also the only spa experience for me as of now. 

-AkMaR-
http://nur-akmar.blogspot.com

K-Drama:: Hospital Ship Medical Scenes

Assalammualaikum :)

I've just finished watching Hospital Ship, one of the latest korean drama.

The korean drama part, memang daebak!
I've always loved Ha Ji Won.

But the medical part, crappy sangat!
So I sort of lost respect to her acting 😒

I can't stop being annoyed with every medical scenes.

Doctors and White Coats
Tak habis habissss doctors and white coats.
I guess it's because they cannot portray a doctor easier than a person wearing white coat.
But to the extent that the doctor HAS to wear white coat even to go out buy food?
Beh tahan.

A lot of people don't understand just how hot wearing the white coat is.
And that it is a big infection risk as well.

In the UK, doctors don't wear white coats anymore.
In Malaysia, most of the medical officers do not need to wear white coats; only the house officers.
So yes, doctors are still doctors even without the symbolic white coat.

I hope there will be a Korean drama that will portray doctors without white coats.

Doctors and Specialties

Dr Song Eun-Jae (Ha Ji Won) is a general surgeon.
But in this drama, she even performed a major limb replantation surgery (Orthopaedic surgery), Caesarean section (O&G surgery), liver transplant surgery (Hepatobiliary surgery), attempted cardio-thoracic surgery - and the funniest part; checked the GA machine (Harrghh! This is an anaesthetist job!) prior to surgery 😅 😂

Hancus, all the doctors are doing everyone's job as if it is their specialities.
It is acceptable if they are doing it in situations of emergency.
However it is not acceptable that they endangers peoples' lives by doing that.
She performed a C-sec to a mother with cord-prolapse! That is a major major O&G emergency.
Bukan senang nk GA kan pregnant ladies, and the baby need to be taken out ASAP; and at the same time stop major bleeding.

Scenes like this will only make the society more confused.

OK.
Dh la, stop babbling for now.
Nak pergi masak.

-Because life is a test-

-AkMaR-
http://nur-akmar.blogspot.com

What I Dislike Abt This Small Town

Assalammualaikum.

When I was in IMU, I had this one Korean friend.

His name was Park Sang Hyun (I remember his name well because of Park Ji Sung 😝 😝)

I asked him what is the thing he misses the most about Korea.
To my surprise, his answer was not the food, the culture, the weather, or even his family.
His answer was: THE INTERNET.
The internet in Korea, according to him was super fast.
And I can imagine that.

Here, in this not-so-tiny town in Johor, I dont even have proper access to the internet.
Heck, my housing area is not even on Google Map!
If I search for my own current location on Google Map - I will be in the middle of a rubber plantation.
I cannot subscribe to Telekom for even a landline, let alone getting Streamyx or Unifi here.

Thank God I am using Webe Mobile, the coverage is pretty strong near here.
But only intermittently.
Sometimes the coverage is very strong, I could watch episodes of Korean drama on my phone.
But sometimes the coverage is very weak until the person on the other end of the line claims my voice sounds like I am drowning in deep water.

For house internet, I subscribed to Webe Broadband.
It cost me RM59 for 30GB worth of internet.
But we usually finished the quota by 20th of every month - or earlier.
This month, I ran out of my 30GB quota already hence I am using a super slow internet now. And it's only the 14th.
I can't even test my internet speed on speedtest.net
Even the test itself takes super long to load.

Imagine trying to write, preview and then publish this post.
Hence pardon me if there are grammatical/spelling errors.
I can't read and re-read them before publishing them.
It just takes too much of my time.

Hence, I'm going to end this post here.
And suddenly I wonder, how is Park Sang Hyun doing now?
Last I remembered, he fell in love with this one chinese girl from Klang and was contemplating whether to confess or not 😍 😍

-Because life is a test-

See, even this speedtest.netpage is taking forever to load 😭 😭

-AkMaR-
http://nur-akmar.blogspot.com

Budak Bandar Again

Assalammualaikum.

This week is my KL week.
Since I have been transferred to Johor, Akmal and I take turn to go balik kampung.
And I purposely chose this weekend because Syaira is going to be in KL too and Alia is going back to Bahau next week.

Syaira, Alia and I were mates since our first posting in Orthopaedics.

So janji jumpa in KLCC since it is the easiest place to get to for Alia.

Public Transport
And to my excitement, dah maju rupanya Balakong ni!
We already have an MRT station 5km away from my mum's!

Excited naik MRT and LRT from Balakong to Pasar Seni then to KLCC.
The trip from Balakong to KLCC cost RM5.20 per person per way.
So for the two of us; it cost us RM20.80 in total.

The MRT memang cantik, and cold and bigger than the LRT.
The stations are bigger, and cleaner and of course, newer.

The Reunion
Our rendezvous point was the KLCC Concourse level surau.
Sampai2 je Alia and Syaira were attending to their babies.

And our next point was: the nappy changing room *palm face*

U take that one, I take this one

Wash wash, wash wash

Nasib xde yg berak busuk. If not, pengsan Auntie Akmar

It never crossed my mind to step foot into a nappy changing room.
To my surprise, memang cantik and well equipped nappy room in KLCC.
There is a mini playground, a few baby stations and a sink with water tap and soaps + a hot water dispenser.

Syaira's eldest; Safiyya was playing in the playground with some new friends so she got really upset when Syaira wanted to leave the nappy room after cleaning baby Ruqaiyyah.

She sulked the whole way to Madam Kwan's.
In fact she was still sulking while choosing food in Madam Kwan's.

And soon enough, Alia's baby Aqil pulak ngamuk2 sebab penat + lapar susu.

Alia's baby Aqil tengah mengamuk

Memang muka sedih betul lah

Syaira's Safiyya pun merajuk at the same time.

Anyway, we survived the session well.
Baby Aqil also feels happy enough that he wanted to play with Akmal - for a short while.

Baby Aqil refused to look at the cam

The whole team; with our empty plates.

And the girlsss!!

Kenapa post ni title "Budak Bandar Again"?
Because I felt so cosmopolitan-ite; taking MRT and LRT to KLCC, trying out cosmetics in the store, bought a Hazelnut Americano from The Coffee Bean.
Rasa terperuk gler dduk kt bandar kcik in Johor 😂
Just that kali ni I didn't sit in a coffee shop, using my Mac looking swag.

And ooohh!! 11.11 sale is comingg!!

-Because life is a test-

-AkMaR-
http://nur-akmar.blogspot.com

Dah jadi MO daahhh

Assalammualaikum all :)

I have not been fair to this blog, eh?
My last post was in April!

Just a quick update then.

I've managed to successfully completed my dreadful years of housemanship in a tertiary centre in Klang Valley; albeit being extended for two months (bloody Paeds)!
After floating for about 5 weeks in Anaest Dept, I was transferred to a smaller hospital in Johor in April 2017.

This hospital I am working in now is a small hospital; however it is fully equipped with operating theatres and has many departments.
We can usually gauge how established is the hospital by seeing how many departments it have, how many specialists are there in every department and whether it has operation theatres or not.

Alhamdulillah, I was assigned to the Anaesthesiology Department; the department of my choice.
Hubby was placed in the Orthopaedics Dept - which I found out later turns out to be the nemesis of Anaesth dept 💆🏻

Since I was already trained in anaesth for almost 6 months; my tagging period as an Anaest MO was expedited.
I tagged 12 hrs for 2 weeks, followed by about one month 24hrs tagging and then started my solo OT call.

My scariest moment of solo OT call as of now was a cannot intubate, cannot ventilate situation for a cord prolapse EMLSCS patient.
I almost died of heart attack and my hands were shaking throughout the whole operation.
When Dr R came in she shouted and screamed at me for not putting the patient on the ramp position before I attempt intubation.
I was actually quite disappointed on that day because I had two seniors with me in the same OT but no one came to my rescue.
I believe my failed intubation was due to my inexperience.
Thankfully the mother and baby survived.

For those who don't know, "cannot intubate, cannot ventilate" situation is a nightmare for any doctor. We have to declare a crisis in those times. It means at that time, the patient is already not breathing (either because of our drugs or due to ongoing disease) and we cannot secure the airway and help with ventilation.
If the situation prolongs, the oxygen in the patient will slowly be used up and he/she will die of lack-of-oxygen.
It is equivalent to choking someone to death!

Anyway, in August (4 months in the dept) I started tagging in ICU.
After two weeks I finally started my first solo ICU call.

I love doing what I am doing now.
Having said that, I remembered what I wrote during my first month as a house officer - The First Month of Life.
I loved my job back then too :)


-Because life is a test-

-AkMaR-
http://nur-akmar.blogspot.com

My First CSE

Assalammualaikum

Sorry I've been lazy and not updating my blog as frequently as I wanted to.

Today is a special day.
My first attempt at CSE (Combined Spinal) anaesthesia and I nailed it!

I did it under Dr R's observation and I was extremely nervous.
Thank God my hands did not shake as much as they did when I first attempted spinal anaesthesia under her supervision - she was assessing my competency at that time.

I know this is too much of a jump - I have not talked about my relocation, my current department and all.
I am quiet in a rush now, couldn't afford to write much.

But since today is a special day - my first CSE attempt - hence I feel very compelled to type them out.
Enough to say I am now an Anaesth MO in a small district hospital in Johor.

Yes, Johor.


Hiks.

'til then!

-Because life is a test-


-AkMaR-
http://nur-akmar.blogspot.com

My first CVL

Assalammualaikum!

It is already very late now - 11.19pm
I have a flight to catch tomorrow morning yeay! I'm going Sarawak for Fatin's wedding :D
Fatin married a BBC - British Born Chinese weewitt

But because today is one of those special days in my career, I decided I need to pen them down (or type, in my case)

So today, I was put on ICU duty, instead of GOT due to the lack of manpower in ICU.
And today also was my first time inserting a Central Venous Line (CVL)!
To non medical people, a CVL is a catheter (maybe "tube" sounds more familiar) that we insert into the body so that the tip of the catheter will lie in a patient's heart.
Yes, heart. The right atrium to be exact.
And we have to be careful to put into the vein, instead of the artery.

So today I inserted a CVL through a patient's internal jugular vein (that is the vein in our neck) - via US technique. 😆 😆

I know the older generations in medical would have laughed that I am so proud with this one CVL - they have inserted numerous during their HO years. I got my first only after I become an MO.

But, so what?
At least I have inserted one.
And this will certainly help me in future :)

So thanks Farid, for guiding me thru the insertion of CVL.
And Danny for being there, as an amateur as well hence I kept telling myself all the mistakes I did, are for me and him to learn 😀 😀

And I dont mind mentioning their names here - they don't even know the existence of this blog.

This is the check xray of the patient. We need this to ensure that the tip of our catheter is
nicely placed in the right atrium, not too low neither too high.

Til then!
Oh and I'll try to blog about my 48hrs Kuching trip :)


-Because life is a test-


 -AkMaR-
 http://nur-akmar.blogspot.com

Book Review: Have A Little Faith

Assalammualaikum.

I've always loved Mitch Albom's work.
I feel that they are always very inspiring, funny and resonates well with our real lives.
And they are usually expensive - relatively, compared to other thicker books.

In every bookfair, I will always look for Albom's books.
I'll buy them if they aren't too expensive.
And during the last Big Bad Wolf book fair in Mines, I managed to get hold of one; titled Have A Little Faith - which cost me RM12.
Not too bad.

This book is well written, and it teaches a lot of life values.
However, it is so very Jewish and Judaism-ish.

Albom's previous works are stories about his dying professor Morrie and his last words and life lessons. This book talks about his Rabbi - affectionately known as "the Reb" whom he knew from when he was a little boy but only recently reconnected with, when the Reb asked Albom to write his eulogy.
Let me give you a little bit of spoiler - it spans for more than 8 years, this book.
He describes how he grew closer and fonder of the Rabbi, the very being he was so afraid of and always avoided when he was young.

He described how well mannered, patient, peaceful, determined and kind hearted his Rabbi was.
The Man of God - that's how he always describe this man.
And I really really admired this Rabbi character - and I silently wish we have more Islamic preachers with these characteristics.
He keeps track of people in his congregation, made phone calls to the respective families when he heard of any weddings / child birth / deaths within, if he cannot attend the function.
He does house visits until he was too old to do so.
And he was well educated as well.

I like it that he MAKES phone calls, a rather dying trend of our society nowadays.
We WhatsApp, message, emails - which are actually not real conversations.
We can misunderstood and hid emotions with written conversations. We can always add "Haha" at the end of any sentence, to make it sound better, even if the sentence before might break our or the receiver's heart.
But when you call, you can hear the person's laughter, sorrow or even silence when the person at the end of the line tried to swallow her tears.

And anyone who have read my blog long enough will have noticed - I hate Zionism.
I hate them for oppressing and occupying the Palestinian lands illegally - and they hide behind the name "Israel" - which also equals to Jewish.
But not all Jews are Zionists though.
And the main character of this book is the Reb - someone of a different religion with me.
Someone of the religion that the Zionists hide behind.
Anyway, this sentence of mine can be politically challenged - lets put that aside for now.

The writer also talked about Pastor Henry Covington.
A determined, dedicated Christian pastor who was involved with lots of crime during his younger days - including drugs and was also jailed for some time.
And he formed and became the pastor of the My Brothers Keeper's Church - and has turned a new leaf. He described the man very well, and I believe Pastor Covington IS a miracle and a living proof  of what determination and faith can bring into a person's life.

Albom managed to make me fall in love with the characters, but of course, not the religions.
Most of the teachings are the same anyway, the Abrahamic religions.
Hence there was no reason for me to fall in love with the religions.

I hesitated though during the process of reading the book.
It took me more than one week, not because of the hesitations but rather due to the limited time I had.
And I thought of stopping myself from reading this book as it was too Jewish.
Will it benefit me more if read a more Islamic book instead?
Will this put me in the danger of Shirk?
I kept my mind open though - I am reading this book for the sake of reading it, and I already buy it anyway.
I will not let the book shakes my faith in whatever way.
And of course, it didn't.

I was very much absorbed into the story half way thru the book.
In fact, it taught me a lot about life and perseverance and having and keeping that strong faith.
And I am glad I did not stop reading it - just because I am scared it might make me turn my back towards Islam or, what will other people say if they know I read these kinds of books?
I was quite disappointed - oh why is Albom, the writer I admired is a Jew? I can accept him being a Christian or Hindu or Taoist. But Jewish?

But, come to think of it again, that was silly ain't it?
To think that my faith can be shattered from reading a non-fiction, non-biased book?
How thin was my faith?
If anything, after reading this book I felt my faith towards Islam just grew stronger.
I now have a better and more imaginable character to adopt into my life.
And I look forward to Albom's other works.

Let me end with a quote from the Reb

“Mitch, that's what faith is. If they spit in your face, you say it must be raining. But you still come back tomorrow.” 

-Because life is a test-

 -AkMaR-
 http://nur-akmar.blogspot.com

Anaesthesia MO

Assalammualaikum.

Today I was scolded, or rather cynically told off by an anaesthetist.
She came in while I was looking at my phone during the surgery.
Perhaps she wasn't pleased with it - but to be fair I wasn't looking at my phone the whole time.
She came during that time I was looking at my phone, answering texts.
My luck.

It was an expected long operation - at least 5 hours.
Hence the anaesthesia practitioner MUST be present and continually monitor the patient.
I WAS monitoring the patient.
But I am still very junior in this field, there are still many things I don't know although I admit I should have studied more these past few weeks.

She then started quizzing me.
How do we calculate the fluids requirement for this patient?
Do I know the difference btw fluid maintenance, fluid deficits and fluid loss?
How do we calculate?
Fortunately, very fortunately, I still have my HO-time notebook in my pocket.
And I could produce a very good well-calculated fluid regimen for her.
She complimented me for it, thank God.
But she wasn't happy that I did not calculate it before she comes in.
Hmm, some of my seniors will always skip this part hence I don't routinely calculate them - perhaps now I have to start practicing the good practice, and not just the routinely done ones.

The next question was on perioperative monitoring.
What do we monitor in long operations?
I could answer but I could not really tell the indications behind it - eg temperature monitoring.
Why is it so pertinent for us to monitor the temperature in a long-standing op?
I know we have to avoid hypothermia, but why?
I know hypothermia reduces metabolic rate and sort of slow down our body, but I can't provide a proper answer for that question.

Well later on I found out that there is this thing called the Lethal Triad: coagulopathy / hypothermia / metabolic acidosis.
Hypothermia leads to coagulopathy and met.acidosis which will in turn aggravate the met.acidosis and coagulopathy.

She then said something about Anaesth is a difficult field, people always think we sit idly during operations, but actually, it is very difficult. She said I should read more, and not just sit down looking at my phone - right to my face.
And she walked off.

I felt so bad.
I felt so guilty
I felt like a disappointment.
My mood was so low the whole day. I did not dare to look her in the eye after that.
She was so nice to every other MOs - perhaps I have not gained her trust.
And from what happened today, it will be harder for me to prove myself.
I do not hate her. I brought this upon myself.

To make things worse, I woke up late this morning and was rushing to work.
Hence I accidentally wore sandals to work - instead of a proper pair of shoes.
And I have to go out to the wards and do pre-operative assessment for patients having their op tomorrow.
That made me feel even less professional - going around the hospital with sandals.
And I left my stethoscope in the car - which really, added salt onto the wound.

So now, I am sitting down and reading about anaesthesia concern on the types of operations I'll be doing tomorrow - the ENT list.

I hope I'll do better tomorrow.
And will regain the confidence I lost this morning.

-Because life is a test-

 -AkMaR-
 http://nur-akmar.blogspot.com

The not-so-wise tooth

Assalammualaikum.

People call the human third molar as the wisdom tooth.
It really is, a misnomer - as it is no wiser than my other teeth.
In fact, I think it is even more brainless than the others.
Why bother come out when you don't have space to - and make my life miserable past 5 yrs and now worse past one week.

Too Expensive to Bother

So I had this wisdom tooth that started to appear some time before I continued my degree in the UK.
In UK, I think it was infected TWICE - within 3 years time.
I THINK it was infected, because I did not go to see any dentist there.
You see, somehow dental health is not included in the NHS free service (at least that's what people tell me)
Hence each visit to the dentist will cost about £20 - 30 - and thats more than RM100 - for a simple check-up, excluding the procedures or medication.
Thus I kept the pain to myself, gobbled down Paracetamol and it went away.
The first summer break in Malaysia, I skipped going to the dentist.
When the infection happened the 2nd time in the UK, I swore to myself that I will make it a point to visit the dentist in Malaysia when I get home.
And I did.
I just can't remember what the dentist did. I think she gave me an appointment date that I was not able to keep.

And then it wasn't so painful anymore.
Only some time it started throbbing and will usually go away after I brush my teeth so hard that my gum bled.

Too Busy to Bother

Then during my houseman year, it got infected again.
Not having time nor the luxury to go to the dentist, I kept the pain to myself again.
Earlier this year, it got infected again.
It was so painful and I was blessed to meet this one nice senior dentist in the hospital, that I asked for her help. She asked me to come to the clinic any time I can make it.

The first time I went, she said my wisdom tooth was impacted and inflamed.
But not infected - hence she prescribed me only Chlorhexidine mouthwash - no antibiotics.
She also kindly asked her junior to do scaling for me. My God, it was soo "ngilu".
And then she asked me to come when it is not painful anymore.
I felt like crying - how can the pain go away if you are giving me only mouthwash?
I felt the pain was different from the pain I had before.

But it did go away.
One week later, I showed up again at her clinic.
She had another quick look and asked me to set an appointment with the dental assistant, at a time convenient for me.
She will have to extract the tooth, if it is a simple procedure, I will get a 1 day MC.
If it's a complicated one, I'll need 3 days MC, as it will my face bengkak.

So I had to postpone the procedure until I completed my housemanship.
I won't be able to get a 3 day MC during my housemanship - it is just difficult.

Finally Free-er

So, I had the extraction done last Monday 27.2.17
She had a look and was saying things like "opening flaps", "making incisions", "gutters" and stuff - and she looked at me like I understood what she was saying. Oh come on, I'm a medical doctor, not a dentist.
I know what those words mean but I can't imagine the procedure.
But anyway, I simply nodded.
I felt so much in debt with her - and she's so nice that I do not wish to trouble her.

Oh, The Pain

The extraction itself was horrific.
It wasn't painful but the sounds of the machine all scared me.
She was being very considerate and kept asking if I was in pain.
She injected a very generous amount of local anaesthesia that I didn't feel any pain at all - just some pressure.
But it turns out that my not-so-wise tooth was very big and angled in such a way that she can't simply pull it out even after cutting the gum open, making a flap and gutter and whatnot that I heard her saying to her junior while exploring in my oral cavity while I quietly trembled in fear.

She had to call the Oral Surgeon to come and help but the surgeon was preoccupied at that time.
When you're in this line long enough, you know that when people started seeking help, things are not going as smooth as you hoped. Well, not to scare you lot but it's the truth.
Be reminded though, informing the superior and asking for help from the superior are two different things.

In the end, she had to break my tooth before pulling it out.
Sounds gory eh?
Imagine hearing the grinding machine, working it's way in your mouth.
And my jaw was so tired of keeping my mouth open, I wished someone can just help hold my jaws open. The bigger the better - clearer field for the dentist.

So after pulling the little demon out, she had to suture the flaps back.
And I got a 3 day MC.
My appointment was at 9.30am - post breakfast.
I finished everything - including taking the meds from the pharmacy at about 1pm.
And I went straight home and sleep.
It got so painful as the local anaesthesia effect is slowly fading.
And the oral painkiller needed time to take effect.
I skipped lunch and by the time Akmal comes home that night, I was famished.

The Recovery

The next day, I had porridge for all my 3 meals and I was so much on top of the pain.
I took painkillers on time and ate only soft food.
I was so pain-free and was certain can do the procedure again, if needed.
On my last day of MC, I started eating macaroni, and all was well.

Only on Thursday, the first day I started working - that the pain kicked in like crazy.
I was so much in pain I felt like crying all the time.
The throbbing pain comes and goes.
When it comes, I felt like punching my face hard, right on the spot near my jaw where the tooth was so that it gets numb.
I practically lived off Paracetamol, Ponstan and Ibuprofen on Thursday, Friday, Saturday and Sunday.
I asked Akmal to have a look at it a few times, and I made him explore around using a cotton bud which I really regretted after that as it worsen the pain and I had to push my cheek on my palm so hard against my pillow to sleep that night.
Last night it was unbearably painful that I had to skip dinner (but I had Manhattan Fish Market for lunch haaaaaa haaaa 😂😂 ).

And today was my appointment day to remove the sutures.
The day I've been waiting for since Thursday.
I did not want to go earlier since I did not want to be a burden.
I have used my privilege as a doctor enough, going straight to the clinic without having a proper referral letters and being able to call the clinic and change appointment dates to suit my schedule, and even had all the staff in the clinic calling me "Doctor" as I pass by - "Doktor, kumur mulut sini" / "Doktor, sakit lagi tak?" etc etc
I didn't want to be a crybaby hence I waited for this day.

The Shame of the Broccoli

And it turns out, the gutter or the socket where my tooth sat was very deep.
And I had food particles stuck there.
And bacteria were happily feasting on them - hence the pain.
The dentist flushed the socket using syringe and taught me how to do it myself.
And they found some small pieces of broccoli in there (I was so embarrassed at that time - I had it during lunch ytd) 😳 😳 😳 😳
"Doktor makan broccoli yeeee" - said the dental assistant.
Hilang ayu oi.
But I did really gargle as hard, if I can describe it that way, as I can after every meal.

Anyway, now the pain is improving although it is still there.
If anyone were to slap my face now, I'll throw that person out of the window for the pain of the slap will cause more than skin damage to me.

Okay, that's enough for now.
I hope when I re-read this post in a year time, I will remember how painful it was.

And see, I wrote a 1000 words essay on "Removing My Teeth"
I hope this didn't bore you!

p/s: I know the wisdom tooth and the wise tooth ARE different.

-Because life is a test-

There. The size comparison of my teeth vs left index finger

-AkMaR-
http://nur-akmar.blogspot.com

Korean Dramas and Their InfluenceS

Assalammualaikum.

I'm not proud of it but I have to admit that I am a fan of Korean dramas.
I must say, it has taken my free time away. I used to use them to read books.
This Halyu wave first came to Malaysia in 2004 I think.
I was form 3 at that time. The first few K-dramas were Full House, Stairways to Heaven and Winter Sonata.
I remembered SIGNING a contract with Mama - I get 3 hours of TV time per day but if I don't do well in my PMR trial, I will be left with only 1 hour.

Those 3 hours were for:
2 -3 pm Korean Drama at 8TV. Jewel in The Palace was aired at this time.
6 - 7pm Cantonese Drama on TV3
7 - 8pm Cantonese Drama on either TV2 or TV3; whichever more interesting. Later on, 8TV started airing Korean drama during this slot.

I did manage to keep my 3 hour TV time that year ✌

Korean dramas have their own attractions - those good looking actors and actresses are definitely their biggest magnet but they also have good scripts and storyline.
The plot - although sometimes predictable, is good and always some form of lessons in it.

The Theme

Each drama has its own theme and the story is made up revolving around this theme.
Descendants of The Sun - soldiers
Goblin -  supernatural world within our world
Jewel in The Palace - herbs, medicine and the kitchen of the palace

And each theme has substance.
Although they sometimes don't make sense eg the drama Emergency Couple where they made intern doctors working in the ED as the theme (I can assure you we don't have time to brawl over petty things in the hospital cafe if we're in our ED shift) but they are not vague either.
They showed the hours spent in the kitchen / military training / lectures and stuff.

The Script and Acting

Efforts are also put in to make the scripts real
The dialogues were carefully strung together.
And the actors actresses were convincing when they said it (of course, not ALL of them).

The Cons?

But let's face it.
The story itself is unreal.
How can they have so much time, to always hang out in a cafe (each drama will have its own cafe sponsor hence ALL the cafe scenes will be in that cafe, dal.komm cafe for instance - it appears million times in Goblin / DOTS )

The actresses don't do dieting - they eat everything from fried chicken delivery in the middle of the night to soju and BBQ chicken in the middle of the day - yet they are all so slim and thin and some were even muscular.

They are always doing exciting things. They are not even glued to the screen, watching K-dramas.
I always think, is this how life is in Korea?
They have time to go grab coffee en route to work?
They ride buses and tubes to work - only the rich has cars.
They walk around the beautiful parks.
They cry at the Han River banks at night when they are sad?

But how come I don't get to do that?
How come I am just so lazy to go out of the house to have a nice and peaceful tea time at the nearest cafe?
I rather stay at home - and watch Korean dramas, and watch them do all the things I wish I can do. The irony 😒

Anyway, I think I have to reduce my TV time now.
I have more than 3 hours per day of TV time nowadays, on my off days - which is really not good.

But then, with the increasing price of everything won't it be cheaper to just stay at home?
I pay a certain amount for my internet bills, no matter how many hours I stream every day.

Oh well
Til then,

-Because life is a test-

 -AkMaR- http://nur-akmar.blogspot.com

Apple Support

Assalammualaikum.
So yesterday I talked about my silly blunder - deleting 80GB of my files
Saying "silly" makes it sounds cute.
It isn't really.
I really feel stupid and angry and disappointed at myself for losing 7 years worth of files.

So yesterday I set up an appointment time for Apple to call me back for technical help.
I made it at 7pm and completely forgotten about it.
Today, on the dot at 7pm - I received a call from a Singaporean number.
Then only I remembered it must be from Apple.
Once I picked it up, a computer generated voice greeted me - Press 1 if I would like to speak to their technician or Press 2 if I would like to reschedule the call.
Convenient eh?

So I chose 1.
And the call was directed to another operator that says something like I am in a queue and will be entertained shortly.
I have been wondering since yesterday - who will I be talking to?
American? Or Asian? Or better, Malaysian?
Will I be charged for this call?
When I first saw the Singaporean number, I was relieved and disappointed at the same time.
Relieved because it will be an Asian person talking to me but disappointed - why isn't their call centre in Malaysia??

Anyway to my surprise - the person on the other end of the line was an American man (from the accent)
And throughout the phone call, he was being really nice and understanding.
It's been a long time since I speak purely English - I've been mixing Malay and English + Chinese a lot in Malaysia (and proud of it).
This man's choice of words were very pleasing and professional.
He kept saying "Aaah yes, I understand", or "It must be hard on you" "Oh yes I did that once as well and felt really bad myself" bla bla bla.
I can only think that he must have undergone a really good customer service training.
He might not mean what he said (Yes, they are mostly very superficial) but it is very comforting to hear.

I kept comparing him to the many many Malaysian telephonists I've spoken to.
Although Malaysian telephonists are helpful, they are not generally friendly and understanding.
They are almost robotic, and sometimes even challenging or laughed at us.

At the end of the conversation, he was trying to tell me that he can't help recover my files - he very aptly put in a sentence - "Well this is a very good lesson and experience for you. Next time you will know exactly what to do and have the power to decide how you want it to be done"
So customer-servicey kan?

OK lah, that's all for now.
I have to come to terms that I will not be able to recover my 80GB worth of files.
To be honest, I do not know what I lost yet.
I think I must have lost all my travelling pictures.
As for documents, I will feel the pinch when I need them later.


-Because life is a test-

-AkMaR-
http://nur-akmar.blogspot.com

That blunder

Assalammualaikum.

Just a quick update.
Recently (about a month ago), I had a major problem with the internal HD storage space in my Macbook.
I was left with only about 2GB space.
Naturally, I fiddled around and rediscover iCloud.
I've always had this uneasy feeling with online storage - I feel as if I risk exposing everything to the public if I were to store my files online. Hence I've never really explored iCloud.

But this time I was desperate.
I need the storage and my external HD wasn't working well.
So when I activated iCloud in my Macbook, it automatically transferred all my files into iCloud.
Then I found out that I only get 5GB of storage in iCloud for free. It won't be enough anyway. If I want more storage, I'll have to buy them.

Naturally, I did not want to pay.
Little did I know, it actually did not "copy" my files from Macbook to iCloud, it "moves" them.
For those of you who are used to these terms, you'll know what I meant.
It means I only have one copy of the files.
And I - like a fool - deleted those folders from iCloud (I thought there were two copies! One in iCloud and the other in the local drive!)
And suddenly I have 80GB of free storage left.
80 GB!

It took me a while to really understand what was going on.
I deleted 80GB worth of files and folders.
It was everything in my medical school years.
My eBooks, my lecture notes, my pictures, my working documents, every single thing.
I am now left with only songs and some pictures going 2014 backward (I kept them in a different folder).

I downloaded various types of file recovery apps, but they couldn't help.
Until about 3 days ago, I re-re-discover iCloud.
And realised to my horror that, I did not delete my files from my computer.
I deleted them from iCloud! I should have used iCloud to recover them.
And iCloud allows recovery of deleted files up to 30days from the day we deleted them.
But I could only recover ONE eBook - my Lippincotts Pharmacology eBook :(

And now, I have been spamming the iCloud support page to ask them if they can help me recover files deleted past the 30 day grace period.
Wish me luck!


-Because life is a test-

-AkMaR-
http://nur-akmar.blogspot.com

Completing Housemanship

Assalamualaikum.
So I finally completed my housemanship last week, albeit being 2 months later than scheduled.
Wednesday 15th Feb was my last day.

For those who don't know, doctors in Malaysia have to first complete a 2-year training program before they can be a fully certified doctor.
Within these 2 years, we rotate through 6 departments; 4 months each. If you're deemed competent you'll complete within 4 months and move to the next dept.
If not, they'll extend your rotation for 2 months and u can only be extended twice before being asked to transfer hospital for a final assessment.
And during these 2 years, we are called HO (house officer).
After completing the training, we are called MO (medical officer).
I need to remind though, a house officer is still a doctor.

So how did my last day as an HO differ from my first day as a MO?

Well superficially, I brought a more fancy sling bag.
On Wed I brought backpack but on Thursday I brought my leather-like sling bag.

But apart from that, it did not differ much

I worked in the Emergency Dept for one day as a MO.
The next day, my appeal to float in Anaesthesiology Dept was approved :D
Hence since then, I am an Anaesth MO.

I used the word "float".
That is the term used for us who have finished our housemanship and is waiting to be transferred out.
In some hospitals, we can choose which dept will we like to float in. My place, however, doesn't seem to be that flexible. We must float where they want us to.

Most and especially HOs in Klang Valley will be transferred out of Klang Valley once they complete their HO ship.
I applied for Melaka, however, I am placed in Johor grrr..
I've since sent an appeal letter to KKM to be posted in Malacca and is still waiting for the reply.


-Because life is a test-


-AkMaR-
http://nur-akmar.blogspot.com