So yea, selamat hari raya to everyone...while everyone was happily eating their lemang and rendang yesterday, i was on call...and it was one heck of a call...as if my pre-call bad day was a prelude to an even worse one during my call...Yap and i were in the OT the whole day clearing up the leftover cases from the day before...a laparotomy with bowel resection, an open cholecystectomy, an I & D, 2 perforated appendix...don't ask me why we took so long, but we just did...and halfway through had to go ICU coz one patient died..what did i tell you eh? at least one death per call...
And as if that wasn't enough, i had to settle the uro patients....and there was a liver abscess patient in sepsis who was unstable...and the nephro ppl totally set my nerves off...they sent 2 patients from their ward to our side for Tenchkoff catheter insertion the following day...and the HO on call informed me that one of the patient's femoral CVC was removed in the morning because there was pus discharge from the insertion site...which was fine...it should be removed...but the least the nephro ppl could do was to bloody reinsert one and bloody dialyse the patient before they sent the patient over...patient's potassium was 6.1 and he was supposed to be for operation the next day...really, what were they thinking? expecting the surgery MO on call to settle their crap? well, they chose a bloody wrong day and person to mess with...so i asked the HO to call the nephro MO to settle their own crap...seriously, i should write a complain letter to the Head of Nephrology Unit and Medical Department to tell them how irresponsible their bloody MOs are...since my big boss has been telling me that the medical MOs have been writing him a lot of 'love letters' regarding our surgical MOs...
We finally took a break at about 10pm plus for the first meal of the day...by then i was just so hungry and grumpy and ready to faint...thank God the OT call HO belanja us at Upper Star (coz i taught her how to do appendicectomy)...i had lamb chop...felt like the best lamb chop ever coz i was raving mad hungry...then we had to rush back to OT coz there was still another appendicectomy...which i asked Yap to teach the OT call HO coz i didn't think i was in the right state of mind to teach...and we were expecting a 25 year-old guy from Hospital Kota Marudu who had an MVA and his Hb dropped from 11.9 to 2...we thought it would be a miracle for him to survive the 2 hours plus journey to KK...
But arrived he did...the casualty MO in SMC called me about 2am to inform me that the patient has arrived...when i saw him, his BP was 84/47 mmHg with pulse rate of 130...pale as sheet...abdomen was distended and tense...they scanned him in Kota Marudu and saw free fluid in abdomen...so i called boss on call and informed him...he asked to post the patient immediately for exploratory laparotomy and proceed...the patient had 3 pints of packed cell from Kota Marudu, one of which was transfused on the way...2 of which we started transfusing while he was in the casualty enroute to OT...we crossmatched more blood but could only get 3 pints from SMC...but we couldn't wait longer...so we started surgery at 245am...the 3 pints blood we had were quickly consumed...
Big boss was called in...patient's right liver lobe, right kidney and adrenal were totally smashed and bleeding profusely...they removed the right lobe of his liver, his right kidney and adrenal...surgery took about 3 hours plus...i was scrubbed in initially but as the blood seem to be taking forever to materialize, so i had to unscrub...and produce blood magically...although it was post-fasting month and the blood banks are low on blood stock...so i had to ask the runner HO to go to Queen to get blood...they could only give us 6 more pints...and a DIVC cycle...they took about an hour to get the blood back to OT...and while then i was helping the GA side to put up the IV drips, give medications...and i was getting scolded from the GA specialist on call for not getting the blood fast enough...and i didn't like the way she was implying that the surgical team wasn't controlling the bleeding fast enough...
The thing was, i agree that the blood wasn't coming fast enough...and that we weren't fast enough in controlling the bleeding...but in case that specialist didn't notice, i'm not God...i can't just snap my fingers and 20 pints of blood would appear instantaneously....big boss is not God...he can't just lay his hands on the patient and heal the patient...considering that he did a right liver lobectomy, right nephrectomy and adrenalectomy in about 2 hours plus, that's quite amazing already...though i must commend that the GA specialist did well on her side to keep the patient alive...anyway, i guess it's God's will that this patient survived the operation...he had a total of 12-13 pints of packed cell transfusion, 1 DIVC cycle and another 6 units of fresh frozen plasma...
Patient was sent to ICU post-op...and until 8am this morning, no one called to inform me that the patient has died...so i assume he would live...big boss asked me in the OT during the operation if i still want to do surgery after this...i told him, if i were the GA MO, i would still be awake while the operation is being done...what i didn't say was the only difference is that as a surgical MO, i can be ordered around by the GA MO/specialist to produce blood magically, whereas as a GA MO, i can order the surgical MO/HO to do the impossible...sigh, i'm just so tired...and tomorrow i'm on call again...and ppl still watch Grey's Anatomy/House/ER and think being a doctor is so cool...hahahaha...
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