You probably have gone over the edge when....

You probably have gone over the edge when...

1. you start regressing into your childhood and play an improved version of 'let's play dress up' on FB...yup, i've recently started playing Cocogirl on FB...yes, i used to be quite tomboyish...but if there was one (girly) thing i loved when growing up (besides going for ballet lessons) was dressing up my barbie...

2. you don't give a damn about your exam anymore when it's less than 2 weeks to your exam...especially when you used to be someone who'd cry a river if you get anything less than an A...in fact, you now wish you'd fail your exam so you have a valid reason to call it quits...

3. you think that indulging in no. 1 would be a good career move than the living hell you have to go through daily...yes, at this very moment, i wish i could just walk away from this hell i'm in and move on with my life...

Sigh...it's been almost a month since i last type a post...or has it been more? i don't know...when in hell, one loses track of time...i don't revel in bitching...and i hate the idea that more often than not, when i'm typing a post, i'm bitching about my life...it's just not healthy...i wish that i could type happy/inspiring/touching/optimistic post...instead of lamenting about how i work like a dog on a daily basis, indefinitely...some would call me ungrateful...and maybe i am...but i really thank God everyday for His daily miracles for getting me through each day of living hell...without Him, it would have been much worse...but i'm only human...a self-centred, self-preserving, selfish creature...who wants a good life, who doesn't want to suffer so much, who longs for a family of her own...but my work life is such a black comedy that ppl laugh at my predicament and console themselves saying, "thank God my life isn't as bad as hers"...and the most common word used to console me and my colleagues is 'pity'....i'm sure they meant 'pathetic' but i guess most ppl still have manners...

I don't know how long more i have to live...but somehow wasting my next 3 years in this living nightmare doesn't seem worth it...Oh Lord, please, i know my suffering is nowhere close to what Jesus had to suffer (and i did bring this upon myself)...but i don't know how much longer i can go through this...if You're willing, please give me a way out...if it's Your will that i have to go through this living hell, then please make it more bearable...thank You, Lord...Amen...

Defying Gravity...

Thursday was a mixture of drama and miracle...some idiot decided to create Everests out of anthills...and i was the unwitting scapegoat...suddenly i just felt like i've had enough of all this stupidity...all this politics and hypocrisy...can't help thinking that i should stir up trouble so that i have an excuse to quit...

And i woke up on Friday morning from a dream...which normally would have sent shivers down my spine and caused me to wake up screaming, crying and soaked in sweat...i dreamt that i failed my exam...instead i actually felt relieved and happy...i felt that it was a good sign...if i failed my exam then i have a good reason to quit...yea, screw it!! i'm outta here...

And then i opened my FB and saw a friend's link with one of the song from WICKED: the musical...it's the song by Elphaba, "Defying Gravity"...when she started to fly...and i could relate to Elphie...how she was such a nice and loving person but was used by the establishment and when she rebelled, they outcast her and labelled her 'wicked'....when i first watched the musical and heard Rachel Tucker sang this song at Apollo Victoria Theatre, tears were flowing down from my eyes...it was so touching and inspiring....

And i listened to it again...this time, the rock version by Kerry Ellis...thought it was great for dancing...the energy and spirit were so inspiring...and i checked out the lyrics...the song lyrics and the lyrics from the musical are slightly different...but both versions still made my spirit want to break free...anyway, sharing the Kerry Ellis rock version here (though i think Rachel Tucker is a better Elphaba):

http://www.youtube.com/watch?v=4P-cMh4QjYA&feature=fvst

And here are the lyrics:

Something has changed within me
Something is not the same
I'm through with playing by
The rules of someone else's game
Too late for second guessing
Too late to go back to sleep
It's time to trust my instincts
Close my eyes and leap

It's time to try defying gravity
Kiss me goodbye, I'm defying gravity
And you can't bring me down
Mmm-mmm

I'm through accepting limits
Cos someone says they're so
Some things I cannot change
But til I try I'll never know
Too long I've been afraid of
Losing love I guess I've lost
Well if that's love it comes at
Much too high a cost

I'd sooner buy defying gravity
I'm way up high, I'm defying gravity
Kiss me goodbye, I'm defying gravity
And you won't bring me down

Unlimited
My future is unlimited
And I just had a vision
Almost like a prophecy
I know
It sounds truly crazy
And, true, the vision's hazy
But I can see it
I can feel it
I swear I'll be so high
yeah yeah

So if you care to find me
Look to the western sky
As someone told me lately
Everyone deserves a chance to fly
And if I'm flying solo
At least I'm flying free
To those who ground me
Take a message back from me
ah yeah

It's time to try defying gravity
I'm way up high, I'm defying gravity
Kiss me goodbye, I'm defying gravity
And you won't bring me
You won't bring me down

Here's to standing up for your rights/faith/beliefs/convictions!!! time to break free and defy gravity!!!

The Return to CF...and a dysmenorrhoea-induced vasovagal attack...

I went to the USM’s CF yesterday…after a long long long time…since I left USM and started working in Sabah, I’ve never visited KB again till I came back here for Masters…and I’ve been wanting to check out the CF for the last 5 months plus...of course the first 4 months were quite impossible coz I was in HUSM…then I started my rotation in HKB and I’ve been meaning to go but somehow everytime Wednesdays 730pm come I’ll forget that I was supposed to go to CF…so yesterday I reminded myself the whole day that I had a date with God that evening…

And horrible me actually didn’t feel like going when the time has almost arrived…but I went anyway…and I’m glad I did…the CF is held at the Murni hall now…and we just sat on the floor on mats…we had praise and worship session like old times…and most of the songs we used to sing back then…and being in the Murni hall…brought back so much nostalgia…I was so moved during the worship session that tears were free-flowing…after all these years, I’m back where it all started…the place where I really found God…and how our hide-and-seek relationship really started…one where I kept hiding and He kept seeking and have always found me and brought me back to Him…

It’s been 5 years since I graduated…and I’ve stray away from Him uncountable times…just like Israel…and yet He has always brought me back to Him…and I’m just so amazed at how far He has brought me through…just like the line from the song “Through It All” that goes: “You’ll never let me go, through it all”…then we had a speaker from FES who gave us guides for bible study…sitting on the floor for almost an hour gave me such a butt ache and back ache that I realized I’m no longer as young as I used to be…

So I woke up this morning feeling a lot better…I’ve been down with a flu since Monday…went to work ready for my 4 consecutive calls in a row…we had clinic in the morning…my boss admitted 2 patients…one for I & D, another for T & S…was planning to do them after lunch…and thank God the flap case was postponed…coz then it would have been a longer day for me…anyway, just about half an hour before clinic ended, I had a bad attack of menstrual cramps…today was my 4^th day of menses…it has been happening on and off lately but the pain usually is self-resolving after about 10-15 minutes…

But after clinic, the pain was still there and seemed to be worsening…I thought I’d take a quick drive to get lunch and come back to the hospital to continue my work…walking to the car park was a challenge…but I managed…then halfway driving to Chinatown, I felt a vasovagal attack coming…I guess the severe dysmenorrhoea must have induced the vasovagal attack…and I have had history of vasovagal attacks during recovery from flu…short of total blackout, I had all the symptoms of turning cold and clammy, lips as pale as sheet, nauseous, hands trembling with tingling sensation, upper and lower limbs turning into jelly…I was praying that I would make it to some roadside where I could park before I totally blackout and crash into something….

Thank God I managed to find somewhere to park by the roadside…I thought resting a while until the wave has passed would help…but the pain and all the symptoms only got worse…the pain was so bad that I felt like defecating…so I had to go to a budget hotel which was just opposite the road where I parked to use the toilet…I was in the toilet for a good while…of course with defecation the pain was still there…so in the end I had to ask for help from the hotel people to send me back to the hospital…I didn’t think I could drive back there on my own without risking an accident which would only made matters worse…

So the nice couple drove me to the hospital…dropped me at the casualty, went to park my car and returned my car keys…I wanted to offer them cab money since they drove my car but the guy said he’ll get his friends to pick them up…really thank God for kind strangers…so I went into the triage, telling the staff there that I was a doctor who works in the hospital and I’m sick…they didn’t even bother to take my blood pressure at the triage…they sent me to the yellow zone and left me there to die…ok, so I’m being dramatic…I’m sure no one ever dies of pain-induced vasovagal attack…but from previous history, whenever I had vasovagal attacks, my blood pressure drops to as low as 60/30mmHg…and I need IV drips to go in fast to bring my BP back to normal…

Of course since they left me lying there for so long, by the time I called a student nurse to check my BP, it was 100/62 mmHg…I supposed my body has compensated…but the pain was still unbearable…I think I can imagine 1/10^th of a contraction pain now…and I’m definitely going for epidural childbirth…my menstrual cramps lasted probably an hour plus and I really thought I would die…while in pain, I called Kean Khang to see if he was in the hospital…coz I didn’t know how long more till the casualty MO would come to help me…and I needed pain relief real bad…thank God he was PM shift and he was free…

By the time he came to casualty, the casualty MO had just attended to me…so I told her I need drips and pain killers…and I’ll be fine…so Kean Khang tried to set an IV line on my right hand but failed…thank God the nursing coordinator managed to set a line on my left hand…coz all my veins were constricted and collapsed…usually, my veins are very prominent…then Kean Khang smuggled a dose of dynastat from OT for me…after that, my pain was gone and so were the other symptoms…of course the 2 pints drip helped too…in the end, I had to ask my colleague to take my call today…I really felt drained after the ordeal…I think I need to rest today so I can continue to be on call the next 3 days…very kind of my colleague to agree to help…

I felt really alone in my pain earlier…I cried out to the Lord to take the pain away but the pain only became worse…at that time I really wished I had someone beside me to hold my hand and tell me that everything was going to be alright…but I don’t have that someone…and I couldn’t hear God telling me that…but I was very grateful for Kean Khang…his presence made me felt less alone…and I felt that I still have friends who will come to my rescue when I need help…God bless him…and the kind couple who helped send me to the hospital…

Locked-in syndrome...again...and birthdays...

This week was a mixture of good and bad...more good though...which i'm very thankful for...i wasn't on call during the weekdays...so i had time to go to church to practice keyboard after work...Suet Lai asked me to play the keyboard for her during this Friday's worship...since i suck big time at playing, i needed more practice...also, this week Alisa (with Anthony and Darrien) and Chiew Ping came to USM for their stats course...so it was good to have more friends around...

So one of the days when i went to church to practice keyboard, i got locked in again when i was trying to come out of the church...church was on the first floor...so after i was done locking up and went down the stairs...there was a door and a grill downstairs....and i couldn't open the door despite unlocking it...it was bloody stuck...Alisa was outside and i asked her to open the grill to help me unlock the door from the outside...but she said the grill was locked...i was quite alarmed as i remembered i didn't lock the grill..

As i was panicking in the dark (coz i turned off the light at the stairway), suddenly the lights went on...and i heard doors being closed and locked...then suddenly a man's voice asked, "tak boleh buka pintu?" i was quite shocked that there was another person in the unit...i found out later that apparently there's someone staying up at the 2nd floor...so i said, "tak boleh" in my most despaired tone...and he said, "cuba pusing ke atas"...so i turned the handle upwards and voila!! the door opened...thank God for that man...coz if it wasn't for him i would have been locked in for quite sometime...again...but really, how would i know that i had to turn the handle upward to open a door? that's just not normal...

On Thursday, i had to be delivery girl for my boss and seniors in OT coz they just couldn't bear to eat the OT food anymore...i had to drop my ward work to go buy food for them...really, back in KK, my bosses would wait for us MOs to go for lunch together...and if anyone went to ta pau, it was when the person is free and didn't have ward work pending...sigh, i guess i've really been spoilt in KK...i guess this is the price to pay for having sold my soul to the devil...i actually had a very naughty thought while buying them food...i wanted to put a lot of chilli and sambal in their soup...but my conscience won in the end...

Thursday was also Khalil's birthday...and i have yet to listen to his new album 15...although the package from HK is sitting at home in KL waiting for me to open it...So Friday i played keyboard at church...i played as if all the week's practice didn't mean anything...coz it was still bad playing...so i had to turn down the keyboard's volume so as not to injure any musical ears...came home and slept for 3 hours...then a bunch of us went for dinner at 4 Seasons...and then after that went for dessert at Red Bean Cafe...gosh...weekend has become feasting days for me...since i hardly get proper meals during the weekdays...

So now it's early Saturday morning...and i'm on call later...and i'm wide awake coz i slept earlier in the afternoon...dang!!! it's also Joe's birthday today...sent him a birthday wish msg which he replied with a virtual kiss, hahaha..felt bad that i'm not in KL to celebrate his birthday with him...since he actually came back from Penang to celebrate my birthday with me...i should have asked for this weekend off and gone back to KL...but it's my fault really...i actually didn't remember that it's Joe's birthday today :P...such a horrible friend i am....oh well, good friends will understand that even though we're not near each other, our thoughts and prayers are always with them....Happy Birthday Khalil and Joe!!!

Worst nightmare...and a miracle...

Ok, so i've been in KB for about a month now...and i've finally been able to move into my new room over the weekend...i've been squatting at suet lai's room all this while...really thank God she didn't chase me out...but i really felt that i was overstaying my welcome...so was really glad when i could move into my new place...

While staying at suet lai's place, i've managed to have my first encounter with the notoriously noxious Paederus dermatitis...for 5 years i was in uni during undergrad i've managed to escape those bloody insects and 2 weeks into my stay in KB this time round the Paederus got to me...and of all places it had to be the underarm...so damn painful...and later on so itchy...i was so worried it was going to spread when the blisters broke...but thank God it didn't spread...and my skin is healing quite well...still itchy...and hyperpigmented...but i'll survive...

Today i got to come back from work early (early means before the sunsets)...so i went to do some grocery shopping and went back to my 2 day-old room...one minute i went into my room to put my bag (with my phone, house and car keys in it), the next minute i took my grocery bag to the kitchen and closed the room door behind me...after unloading my grocery, i went back to my room only to find my door has decided to lock me out...there was a latch behind the door and it must have latched on when i closed the door...how in the world that happened is beyond me....

I tried not to panic...i banged and banged against the door...without any success...then i just couldn't take it anymore...i just broke down and cried and cried...and asked God what did i do wrong? why is this happening to me? do i even need this? is my life not shitty enough already? i'm already so tired...and i'm locked out of my room and in my house...and my housemate isn't around...and i couldn't get any help from anyone...tell me if you wouldn't feel helpless in such a situation...

I was walking around the hall helplessly trying to look for something strong enough to break the latch...finally settled for my newly bought 5kg dynamo detergent bottle...banged and banged with all my strength while asking God to have mercy and give me a miracle...i really had no one to turn to anymore...so after about 20 minutes of banging, the door miraculously opened...thank God for His mercy...but i think i was still pissed that what happened happened...such an ungrateful daughter i am...and my hands and arms were shaking for quite some time after that...

All the really really long hours at work i can still endure...but to come home and get locked out of my room with no means of getting out of the house and no means to call anyone for help? i don't think i can take too much of such unneccesary stress...i'm just glad this ordeal is over...i don't know if i can take another one my way...but Lord, if You plan to, then You'll have to make sure You get me out of it...coz i can't do it on my own...

The longest 2 days in my life...and more to come...

So the bunch of us started working on Wednesday morning...went to the hospital at 730am...it was our elective OT day...so day 1 of life in the department we get thrown into the furnace...we had a free fibular flap...saw 2 cleft lip repairs...assisted one frontalis advancement...and then scrubbed in for the flap as well...the flap started at 1030am...we only finished at 330am Thursday morning...and had to send the patient to ICU...had to made sure the transfer was uneventful so that the flap won't be compromised...and no, that wasn't the end of it yet...

There was a wound debridement and escharotomy in the emergency OT so us taggers had to stay back to assist and observed...and it ended about 6am plus...by the time we got out of OT and got home it was past 630am...so i only had time to bathe and brush my teeth and it was off to work again...i managed to sleep for like an hour during the escharotomy...but i really had problem keeping my eyes open during the briefing by our head of department...and there was a free flap which was postpone from yesterday which initially was cancelled...but then after lunch we got a msg saying it was on again...groan!!!!

So we went into OT...the latissimus dorsi free flap for foot reconstruction started at about 3pm...and we managed to get out of OT by 1030pm...woohoo!!! that was a miracle...at least Cinderella managed to get home before 12 midnight...really thank God for that...wanted to go to church this morning (in Kelantan we go to church on Fridays instead of Sundays coz Fridays are off days and Sundays are working days)...but when i woke up it was 1030am...hehe, church was halfway through...Suet Lai said don't worry...God will forgive me...He understands that i'm too tired...i just hope this won't be a regular thing coz i really want to start going to church again every week coz i haven't been doing that back in KK...

Oh well, at least today i got to rest a bit...managed to study a bit too...though half of the stuffs i read i couldn't understand...hopefully i'll be able to study enough to pass my 1st year exam...so many things to read...so little time...although it's really tiring to be in OT for long hours, but i actually like the things i'm observing and learning...so i guess it's not too bad...hopefully i can pull through these 4 years...gonna need lots of prayers and miracles...and probably won't be updating my blog as often...then again, since it's my only outlet, i may have more input...hehe...

Yes, i know the patient needs blood...but i can't produce blood magically...

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...

Today is the first time i ever felt like quitting...for real...

I got transferred to a new rotation after i got back from a great holiday...i've always hated that unit even as a HO...you know how when you come back from a real high to a real low? that's like a great height to fall from...and today is the first time i ever felt like quitting..for real..one of our patient, a 15 year-old girl with history of cancer was admitted for ascites...we drained out about 1.5L from her abdomen 2 days ago...she felt better....this afternoon, when i was about to do my pm round, the nurse informed my HO that the patient's blood pressure dropped drastically...so the HO told me and we went to check on the patient...

So i gave her fluids...and do the necessary investigations...she looked quite drowsy and ill...i told my colleague who in turn told my consultant (who happened to come for pm round)...i thought he'd come to see the patient...but he didn't...my colleague came to help but as she was on call, she had to go to OT for a case...so i was resuscitating the patient with the help of the nurses and 2 HOs...we put in a central venous line...put in a urinary catheter to monitor her urine...tapped her abdomen coz it was so grossly distended and tense...by the time we did all these, it was after 6pm...

I was about to go home and wanted to have a last look at the patient to make sure she was ok...that was when i noticed she suddenly became unresponsive and looked like she was having a tonic fit... had to intubate her immediately...but of course, since this was in the ward, immediately took like forever...and the on call HO in-charge of my patient was an ultra-imbecile...thank God the other 2 on call HOs who were helping me were capable...i think Murphy's law was at work today...whatever that could go wrong, did...

I was in the ward till 830pm plus...we did CPR 3 times for the patient...shocked her twice...overloaded her...she went into acute renal failure...i just couldn't save her...she couldn't even live to celebrate Hari Raya tomorrow...i didn't watch her die...i left the hospital after ICU called to transfer her...i thought she would make it...or at least i prayed she would...but one of the on call HO msged me after i got home that she passed away...

I'm just so angry at the whole thing...at myself, at the bloody imbecile HO, at my boss, at my colleague...i shouldn't have to stay to settle patients after office hour when there're on call MOs...and i shouldn't have to be angry at stupid HOs even though they are stupid...i shouldn't have to be angry at my boss for not caring for his own patients...and i shouldn't have to be angry at my colleague because she left me alone to resuscitate this patient...but i'm angry at myself for feeling all these... i shouldn't even care...patients die anyway...in 2 days, none of the ppl involved in the situation would remember the patient...but it will haunt me...for a while...

I need to get a new job...where i won't have to see patients die...cause patients' death...maybe i really should go to NZ and become a seasonal fruit-picker/packer...or maybe i should become a wedding planner...at least i'll make ppl happy...instead of killing ppl...

I'm leaving...on a jetplane...and still having bad call...

I'm on call today...in Queen...my last call before i leave for NZ tomorrow...and so far i've been picking up messes...while creating mess myself...i think my boss on call must be cursing me now...in the morning, medical referred an 80 year-old man to rule out intra-abdominal injury...so i asked why did they think he was having that...the MO told me he had a fall...i thought, hmmm..did he fall from like 10 feet or something? and if he did, why would he end up in medical ward in the first place?

They got an ultrasound abdomen for the uncle, and the radiology MO informed me that the uncle had free fluid in the abdomen most likely due to splenic laceration...so ok, i went to see and was quite appalled by the course of events that ended the uncle in medical ward...he was actually referred for anaemia for investigation...they missed the crucial information that he was actually hit with a plank on his abdomen...right...so called boss on call...she asked to transfer patient over to surgical...for splenectomy..so yea, 1st mess picked up...

Then medical referred another 20 year-old guy for acute abdomen...they think he was having typhoid...his abdomen was very distended...ultrasound showed free fluid with sediments..so possible perforated bowel...called boss again...she asked to tap to see what fluid comes out...but i couldn't see anything when i scanned the guy's abdomen with the kuno scan in the medical ward...so i just poked at the right iliac fossa...aspirated a lot of air...then got some small intestinal fluid came out...looked like liquid faeces...so i thought ok...so it's bowel contents...so sent patient to surgical for laparotomy...then i told boss and he said that i poked through the bowels...shit!!!! so 2nd mess picked up...and er..created as well...now i hope his wasn't a negative laparotomy...

Medical also referred another 77 year-old aunty for rectal mass...the specific referral was for surgery to do proctoscopy...excuse me, but since when only surgical MOs are capable of doing proctoscopy? and the medical gastro team is capable of doing a colonoscopy, taking biopsy and getting the HPE result all by themselves all this while...since when are they no longer able to do so... forcing them to turn to the surgical team for proctoscopy? my my...how things have changes...oh, but i didn't pick this patient up yet...waiting for the HPE after the gastro team performs the colonoscopy and obtains the biopsy...

Then i saw another patient in the casualty (i actually saw a lot more but this one is the most interesting by far)...49 year-old aunty who presented with 5 days history of progressive abdominal distension and absolute constipation...no history to suggest colorectal or gynae malignancy...the only signs of malignancy was that she was quite wasted and pale...per rectal revealed an anterior mass externally compressing the rectum...so we did a per speculum and vaginal examination... we found a cervical mass...so called boss on call again...and she asked to refer gynae to take over first and surgery team will review the patient in their ward...poor aunty...

Oh well...come tomorrow, i'll be leaving on a jetplane...for a break i so badly needed...NZ, here i come..."i'm leaving, on a jetplane, wish i don't have to be back again, oh babe, i love to go" (sang to the tune of 'leaving on a jetplane')....my life is in a mess and it's time for some time off for personal reflection and soul-searching...hahaha...i always think that a trip would do that for me... but after i come back from every trip, i still feel lost and "un-searched"...sigh...may this restless wanderer finds rest some day....

Malaysian efficiency...

Thursday wasn't too good a call...had to do op till 4am...at least Friday would be less hectic...since it's the fasting month and we did not have our regular Friday lunch, i thought it best to go to JPJ and get my licence translated to English so i could drive while we were in NZ...of course i forgot that true to Malaysian efficiency, all government offices and counters are closed for a long Friday lunch break...it doesn't matter that most of them would not be eating...crap! so i had to sleep in the car while i waited till 2pm...

Cam told me it only took her 15 mins to get her licence translated...what she didn't tell me was that i had to photocopy my IC and driver's licence...so i went to get my number and waited...i also asked the guy at the enquiry counter as to what i needed to get my licence translated...he said i only needed a photocopy of my IC...so i had to walk a good 2 mins to another place to get my IC copied...for rm1!!! and when it was my turn, the girl at the counter told me that i needed a copy of my driver's licence too...really, post call doctors should carry a sign that says "kindly do not piss off a post-call doctor, or else..."...

I thought of a lot of nasty comments i wanted to make but i'm an implosive customer...so i had to waste another 2 mins and a total of rm2 plus i had to pay rm10 for a bloody translation which i could probably do better...but at least they did only take 15 mins to do the translation...which i could have done in 2 mins...that my friends, is Malaysian efficiency...indeed, Malaysia Boleh!!!

'Truly amazing'....

I haven't been HO-bitching for a while...was trying to break bad habits...unfortunately, i was on call with a 'truly amazing' HO recently...i just had to blog it down so i won't forget about the things that happened during that call...so apparently it was this particular HO's first OT call...boss has always been telling me he thought this HO (let's call him B) was a little weird...and he definitely was no brightest brick in the block....but i actually got to know how thick his skull was during that call...

We had 3 operations that day...2 appendicectomies and 1 PGU repair...thank God only 1 op required my 2nd MO to come in...or else he might have died of MI or stroke if he saw the things B did while he's scrubbed...i think my BP increased by at least 20% that day...so the 1st appendicectomy...it was as if B had never scrubbed up in his entire life...coz he doesn't even know how to put on the OT gown...the nurse had to instruct him how to do it...then after he gloved up, he put his hands below his waist...anything below waist is considered not sterile...the nurse told him off once...and twice...and thrice...and he kept doing it....

And during the op, he isn't helpful at all...doesn't retract where i need to see...even though i already placed the retractor where i want it for him to hold, he'd still manage to move the retractor out of place...it was quite frustrating....and he would put his free arm behind his back...much to the astonishment of my scrub nurse...who told him time and again that the back is also non-sterile area...he didn't just do this for the 1st appendicectomy...he was doing the same things again during the 2nd appendicectomy...i mean really....even a cat/dog can be trained to obey commands when told or showed enough times....

The icing on the cake was when he was helping me drape for the PGU repair patient...usually we'd drop the sterile towel so that we won't come into contact with non-sterile environment...but no, our hero B did a graceful arabesque and nicely placed the sterile towel over the patient's top while gently brushing the GA HO's head (who is a guy) with his hand....my eyes totally popped out...i just couldn't help but to yell at him and asked him to change his bloody glove coz he still had that clueless look on his face as if i was yelling at him for no reason....it was actually damn funny to watch it happen...except that i couldn't laugh at that time coz patient's life was in hand...if any of the 3 patients had post-op wound infection, we'd know where the germs came from...

By the time we were closing the patient's wound, i've had enough of B that i asked him to please unscrub...i actually asked him if there was anything wrong with him...he answered that he was not feeling well...but i don't think that's an acceptable reason for being totally thick-skulled and plain stupid...after that, the urology consultant came in for a cystoscopy and asked the OT call HO to scrub in...i called the runner to go in instead...to spare the consultant the risk of MI or stroke...

I just pray he won't be my OT call HO again anytime soon....he's Siang Lin's OT call HO today...will see what Siang Lin has to comment about B....Lord help us all...

Banged my car...again...and got my new laptop...

I was post call on Friday...had quite a bad call on Thursday...finished OT about 4am...thought i'd get some sleep...but no...some guy had to get drunk and get into an accident...so had to see him at about 5am plus...and i didn't really sleep well while waiting for the case coz the stupid alarm in the MO call room was blaring again...urghh!!!!

So went to see the patient in casualty...then waited for boss to come see the patient...good thing didn't have to go in for laparotomy...so went back to sleep for about half hour before i had to get up and do morning rounds...then was in elective OT the whole morning...kept dozing off...after OT, still had afternoon rounds....by the time we were done, it was 5pm plus...

Had to send a colleague home coz her car couldn't start that morning...so was ok while driving her home...coz had someone to talk to...after sending her home, was caught in the jam...so i was dozing off...tried so hard to keep awake till i get home...but just couldn't...i must have dozed off before i hit the brake so i banged into the car in front of me...totally woke me up alright...i was like shit! shit! shit!! my car's bonnet and front bumper totally crumpled...but fortunately the other car was a Kembara and nothing happened to the back of the car...the lady came out and asked me what happened? i was like...really sorry but i fell asleep...she looked so shocked...

Anyway, rest assured i was quite awake the rest of the way home...i was so tired...and so emotionally distraught...i didn't know whether to laugh or cry at my misfortune...i just wanted to sleep...so in the end i cried myself to sleep...was awakened by a phone call...it was the delivery guy...delivering my new laptop....so i gave him the directions to my place...

I was quite happy earlier when i got a msg telling me my dell laptop would be delivered to me on Friday....but that was before my accident...so when i opened my new laptop, i wasn't as excited as i should have been...but it was still a consolation...my new purple dell laptop...:)...thanks for the gift...:)

Spent the whole day sleeping after i came back from morning round today...boss called about lunch time...i guess he found out that i banged my car again...i guess he empathizes with my misfortune since he banged his car last Saturday as well...he asked if i needed any assistance...i was like, er no need lah..my car still can run...just that it's deformed...i was thinking he doesn't even have his own car now, how exactly is he going to assist me? hehe...

Ok, gonna meddle with my new gadget...it's so cool...it had a facial recognition feature that recognizes my face for fast log in....hehehe...will put up some pics soon...

A dead phone on my Queen call...

So i was on Queen call yesterday...and it was also our OT day...and only boss was around...coz big boss and the other boss were not around...so boss was pissed and frustrated...and one of our case got cancelled coz the patient's blood pressure was sky high...although we've started her on 2 types of antihypertensives...and her blood pressure in the ward was quite acceptable...

Anyway, halfway through OT, my phone totally died..the keypads were not functioning so i couldn't switch on my phone...and it's quite the worst thing to happen when you're on Queen call...coz then all the referrals can't reach you...thank God for boss though...he offered to lend me his old phone...well, it's an old nokia with polyphonic ringtones...but hey, beggars can't be choosers...meanwhile, i asked the 1st call to take my calls for referrals...

We finished OT early so we were going to his place to get his phone and then off to lunch...but then we saw the 2nd call going to emergency OT for a perforated viscus...and since the 1st call was in Queen covering for me, i had to go into OT...so no lunch for me...and the case turned out to be a perforated jejunum...patient went to ICU post op...and now we have 2 patients with Bogota bag who are in sepsis...and boss emphasized to everyone that i was in both operations...

Anyway, boss brought his phone and charger for me...so i could resume my Queen call...but it's still quite inconvenient coz most of my numbers are in my phone...so i had to guess who were calling and who were messaging me...thank God i had a relatively good call although i stayed in the hospital last night...

I don't know if these are signs...but ever since i joined surgery department, a series of unfortunate events have befallen me...really, i just hope things won't get any worse...

The trouble i went through for Khalil...

Today was supposed to be a good day...coz it was the day i bought Khalil's concert ticket...boss actually allowed me to go off for a while after lunch to get the ticket...so i was happily driving to the place which sold Khalil's concert ticket...had a little trouble finding the place...so i had to take a big detour to get back to the place...on the way, while i was turning into the main road, i banged into a truck in front of me...i wasn't paying attention to the truck in front coz i was looking at the oncoming cars...anyway, i didn't see any cars so i thought can go lor...then bang!!! apparently the truck in front hasn't turn out...dang!!! the front of my car was quite totalled...thank God nothing happened to me... i didn't even feel the impact...i only heard the sound...as if it was from another car...

Got a good scolding from the truck owner...despite my profuse apologies and pledge that i would pay for his truck's damage...all the while i was thinking my car suffered worse damage than his truck...but well, it was my fault for driving straight into his truck...he even took photos of my car...and i...so scared i'd run off on him...so after i gave him my number (and address) and paid rm100 as deposit for the guy's truck damage, i drove my wrecked car to Tembok Besar...the travel agency which was selling Khalil's concert ticket...managed to find it...only to find out that the nearest seat i could get was the 13th row from the stage...

My heart sank...i was hoping that they'd be selling vvip tickets as well...that's like the first 5 rows from the stage...i would have been willing to pay more for the vvip seats...but those weren't on sale..crap!!! and since i didn't have cash and the agency didn't accept debit card, i had to walk a good 5 mins to the nearest ATM to withdraw money...so finally i bought my Khalil's concert ticket...i should be over the moon...but the occasion has been marred by an unfortunate accident...

Now i'll be rm2000 poorer after my car is fixed..more since i have to pay for the truck's damage as well...and i'll be crippled without a car for the next few days...and i'm on call in Queen on Friday...the mechanic said my car can only be ready on Saturday...sigh...i know i shouldn't complain...since it's my own fault..and i should really thank God that i wasn't hurt physically...i guess i'd be consoled a little if by some miracle i managed to get my hands on a vvip ticket....and perhaps a chance to be at his celebration party (like when i was at Khalil's concert in Taiwan)...yea, i know...wishful thinking... but a girl can hope yea?

What a start to a day....

Some days you wake up and feel ready to face the world...and as soon as you step out into the world, disasters start to happen...today is one of those days for me...for the record, days like these happen more often than not lately...for me at least...

Well, for consolation at least Sunday was a good day...i went to church after morning round...and i got the "Kathleen, how are you? haven't seen you for a LONG time...been busy?" line from the usher...sigh, yea i know i know...i've been doing some MIA...and i was asleep most part of the sermon...and so was the guy sitting next to me...anyway, after church Flora, Becky, Christine (and baby) and i went for lunch...then Becky and i went to watch Alice in Wonderland...any Johnny Depp movie would be a good movie...but Anne Hathaway looked quite weird as the White Queen...had a good nap after i went home...and had a good jap dinner with Elaine, Siang Lin and Suet Lai...came home and studied a little...while chatting...hehe...well, i can multitask...

So this morning i woke up as usual to prepare to go to work...i'm on call today....i was just reversing my car and turning when i drove up the curb...and what do you know? my left front tyre burst...it was pretty funny...but i wasn't really in the mood to laugh...coz i needed to get to work in time and there was no way i could have changed the tyre and drove to work, in time...so i had to call Yap to come pick me up...so paiseh had to inconvenient him...so i messaged boss to tell him i would be a little late for work...when i reached the ward, he was just coming out from it....he saw me and shook his head and said, "i already expected something would happen this morning"....dang! talk about making an impression with the boss...

Oh well, i can't help it if my luck is in the dumps lately...but thank God for dependable friends...Pang is really God-sent...coz i saw him in ICU while we were doing round there...and he agreed to help me change my tyre since he wasn't on call today...God bless him....well, at least thus far my call has been quiet...if things get any worse, i'd be wishing for pivalsher to shrink myself so i can hide from the world...but for now, i wouldn't mind watching Hatter do the futtenwacken....i need cheering up....

Maybe i'm being paranoid...but i can't help feeling that there's an unseen force in charge of unforeseen circumstances who has decided to play major pranks in my life...really, 2 burst tyres within a month? not forgetting all the disasters with the OT lists...oh, Lord...have mercy on me...

Down....

Today started out fine....Elaine called during lunch and we planned to go for karaoke session after i finish work...today we had OT from 2-8pm....so i'd be only free after 8pm...but i was quite geared up for our 'tuition' session since it has been very long since we had one....

So i was in OT till about almost 6pm...i told boss i'd go do round....when i went to the ward, the HO told me there was an elective admission...the patient was one of the few patients that i was supposed to call to cancel her op on Monday...coz we have to put in the cancer patients since their cases are more urgent...her op was laparoscopic cholecystectomy for cholelithiasis...and she had been asymptomatic for the last 6 months...

Anyway, her op had been cancelled 3 times before...once was becoz she didn't stop her aspirin a week prior to the op date...of course this was probably the fault on our side for failing to inform her to do so...but i did try to call this patient for the last few days to inform her not to get admitted....however, the phone number written in the major OT book was not in service...and i didn't manage to check her old notes for other contact numbers that i may call...ok, that was my fault lah... but she didn't have to scold me like as if i was the one who decided to cancel her op...i tried explaining and apologizing to her but she just kept raising her voice and scolding me...so i told her i'll ask my boss to talk to her when he has finish his op....

I brought boss to see her after we finished seeing some patients who needed new interventions... she didn't even dare to raise her voice a bit...although still can see that she was pissed lah...stupid woman...just coz i'm a lady...and happen to look young...then she thinks she can bully and scold me...but she didn't dare to scold boss coz he's a guy...boss was saying that i looked too small, that's why kena bully...one of the disadvantages of looking young and being short...urgh!!! Chinese people can be such bitches sometimes...

I totally lost my mood for karaoke already....was just about to call Elaine when she called...she said she was out for dinner with Flora and Agnes...and Agnes' car window got smashed...and Flora's backpack was stolen from the car...talk about having bad days...how can everyone around me is having a bad day as well? i supposed compared to Flora and Agnes, mine wasn't too bad already...so i guess i shouldn't complain too much...so i just told Elaine that we just cancel our plan...and i came home and had dinner alone...at times like this, i really wished i had someone to complain to...oh well, at least i have this blog as my outlet...

It's quite frustrating that we have to cancel our cases as now our OT time has been lessen due to the lack of OTs thanks to the rut we're in...i supposed i understand the patient's anger and indignity...if i were in her shoes i'd be damn pissed off as well...but it's not like i was being rude to her...all the while when she was scolding me, i never once raised my voice back at her...if it was other people, sure they don't give her face and scold back de...

Sigh...and there's another Chinese patient that i couldn't contact for Wednesday op..also need to cancel him...die lah...sure kena marah again...why do i always have to be the one who gets scolded? life sucks....:(

What a Chinese New Year and Valentine's Day...

So this Chinese New Year and Valentine's Day was quite a good reflection of the inadequacy of my social life...and i ended up spending it in the hospital anyway, despite the fact that i was back in KL... there i was, hoping to have a good rest from anything remotely medical when i'm back in KL, but i guess you can't run away from your calling huh?

(Maybe i'm getting delusional, but someone up there might not want me to post this...i finished the damn post only to find out i couldn't publish it coz the net was down...so now i have to restart from here...bugger!!)


We were having reunion dinner at my cousin's house...and i was just about to start enjoying my dinner when my aunty called me to check on my grandma...it appeared that she was choking...so i went and saw her turning blue...i was like shit!!! this isn't happening...short of cricothyroidotomy, we tried every non-invasive technique i could remember to try to dislodge the obstructed food particles but she only seemed to turn bluer by the second...thankfully, she started gasping...but she was having stridor which meant she was still pretty obstructed...so we had no choice but to bring her to the nearest medical centre which is a private one...

At the private medical centre, the locum doctor managed to suck out some huge slices of mushroom and she seemed to be breathing better...but her saturation was still fluctuating...the doctor was convinced that my granny had another stroke which caused her to choke...but knowing my granny, she was just stuffing food in her mouth and trying to swallow mushrooms in whole (she already has some dysphagia problem to begin with after her last stroke)...the doctor was planning for intubation in case her saturation dropped further but they couldn't put in an IV line for granny...initially i refrained myself from interfering but i wasn't about to let granny get hypoxic brain damage just coz some private medical centre nurses and locum doctor couldn't get IV access for granny...so i managed to put in an IV line on her leg before they managed to waste more IV brannulas and charge us for them...

But i wasn't really convinced that granny had another stroke and that she required intubation...her GCS was still about 11/15...and after they put in a Ryle's tube and suctioned her gastric contents, she vomited out another huge slice of mushroom and ta-da....no more obstruction...phew!!! my cousin Sam must have been praying fervently...thank God for His mercy...the doctor then said he was referring us to either another private hospital or a semi-government one for CT brain...so we opted for the semi-govenment hospital since the particular stint at this private medical centre has set us back RM600...

And the ambulance service cost us another RM150...so we reached the hospital about 1030pm...apparently if one of your relative is a medical staff, you get better and faster service...but between you and i, that's bollocks!!! to settle registration, blood investigations, CXR, ECG and CT brain, they took about 5 hours before granny was admitted...there were at least 5 doctors in the resuscitation hall (not sure if they had to run between that and the acute room next door) and about 5-6 patients...i supposed i should just shut up and never to complain about Queen anymore...coz considering that we have less doctors and a whole lot more patients in our casualty at each shift, we are doing a damn good job already...

While we were enduring the gruelling wait, i was watching "Casanova" on tv...Heath Ledger made a fine Casanova...how's that for an original Valentine's day activity huh? hahahaha....so finally granny was sent up to the geriartric ward at 13th floor at about 330am...they were treating her as aspiration pneumonia...so after settling down, i stayed to accompany granny till the others return during the day...it was like doing my 6th consecutive EOD...except that it was a little worse...coz i didn't have a bed to sleep in...and my 'patient' woke up every hour...really felt like asking for dormicum or alprazolam...but i made it to sunrise...and waited till noon before my parents came to relieve me...i was quite hungry and grouchy by then...

Spending the night at the hospital was the last thing on my mind when i came home for my CNY break... but i guess God always have other plans for us...anyway, granny has enough grandchildren to rotate as caregiver for her...you don't need to be a medical staff to be a caregiver...you just need to have plenty of love and compassion...which i think is much lacking among the ward staffs...and i need whatever little break i have to survive another stretch of EODs for God-knows how long...

Anyhow, Happy Chinese New Year and Valentine's Day...oh well, it's just another Sunday...(dang!! i'm sounding more and more jaded)

Questions, Questions, Questions....

Have you ever felt the saying 'what goes around comes around' ring true in your life? i started my new year 2 years ago by becoming single after saying goodbye to my boyfriend of almost 5 years... this year, i'm starting my new year by still being single, but has just been spurned by a guy i have supposedly dated recently...for less than 5 months....actually it's less than 3 months...

How is it that when you know that 2 ppl are just not meant to be together, you still managed to get involved in an unsanctioned, doomed-to-fail kind of relationship? i supposed you need to be a super loser, super pushover and super doormat....

How can someone be so into you initially and quickly lose interest and becomes cold? i dunno... perhaps men are just generally jerks and assholes...

Is there a difference between feeling wanted and feeling loved? i think there is...but sometimes you just can't seem to decide which of it that you want and everything kind of becomes messy...

Have you ever vow to yourself after your last relationship that you won't allow yourself to cry becoz of a man anymore? and somehow, you still end up crying becoz of a man? i guess some of us never really learn from mistakes huh?

Have you ever find yourself falling for guys your mother told you exactly not to? i guess you always do stupid things like that in the hopes of proving your mom wrong huh? maybe it's a self-worth issue thingy...

Which is greater love? A love so magnanimous that you're willing to let go of that love if it means less pain/better future for the one you love? Or a love that is willing to fight through the pains and obstacles that come along its way? i think i have yet to meet a guy who would do the latter for me... i guess all my previous guys have been incredibly magnanimous huh?

Have you ever read the book that goes by the title of 'he's just not so into you'...or something like that? don't even remember who the author is...but i just realized i don't really need to read that book...coz i'm damn good at reading those subliminal messages that men send out when they're just not so into you anymore...

What do you do when your guy doesn't want you anymore? do you blame yourself? do you hate him for causing you pain? do you beg him to take you back and promise you'll be better? here's my 2-cent worth...don't blame yourself coz most of the time, it's not your fault...and he's not worth you putting in so much emotion as to hate him...and don't bother begging him to take you back... have some self-dignity....

Why is it when you know you're getting yourself involved in a doomed-to-fail relationship, you still hold on to your hopeless romanticism and hope against hope that somehow things will work out? i guess some of us had fairy-tale and romance overdose when we were younger...

I still have so many questions...and yet, it is probably useless to keep asking questions we don't really have answers for when things go wrong...i supposed i should really thank God for His timing... He knew i was heading for doom but He loved me so much that He didn't allow me to continue in doom...and He knew i'd be too cowardly to break free so He put it in the guy to do it...

Anyway, thanks for the good memories...though they're short-lived...thanks for being the brave one to put an end to a doomed-to-fail relationship...though i shouldn't have allowed it to start in the first place...i hope you'll be happy with your new girl...and hopefully i'll be happy with my new guy...if that ever happens...oh well, que sera sera...

The Grim Reaper strikes OT...

Yesterday's OT call began disastrously...up till yesterday, i have managed to avoid a DOT (death on table)...it's not something i brag about to anyone but i was always grateful that no patient has died on table when i was giving gas...but my bosses have always told me that you're never truly a GA MO until you have a DOT...so yesterday was my last OT call as a GA MO...

I started my call with a neuro case...not exactly the best omen...aunty was 63 years-old...ASA 3 with DM, HPT and CRF requiring occasional dialysis...apparently she had chronic subdural haemorrhage which caused her to have left hemiparesis...GCS full...they posted for burrhole and drainage...the MO said, it's a very simple op...and i have done many burrhole and drainage...there was no reason for me not to accept and proceed with the case...

So aunty arrived in OT at about 930am...i assessed her...she was talking and smiling to me..she could answer my questions with full comprehension...i guess she didn't know as well that her last conversation would be with me, the GA MO...so i put her under, intubation was uneventful....the neuro MO started the op at about 945am...BP was stable throughout...but she was steadily bleeding...only had 1 pint of blood...about an hour and a half into the op, her BP suddenly dropped to about 80/40mmHg...good thing i had the right mind of setting another large bore brannula for her before the op started...so i started running gelafundin and warmed up her 1 pint blood...after 2 readings of low BP, her BP picked up with fluids...

When aunty's BP dropped, the neuro MO asked to call her senior for help...so another neuro MO came in...and they decided to convert to craniotromy...about 10 mins into the craniotomy, aunty's ETCO2 dropped drastically...fell from 30 to 15 then to 7 then to 2...and then her saturation became undetectable...i thought her ETT dislodged to i checked but her ETT was in place, the tubings weren't disconnected, and the ventilator was giving good tidal volume...i called my boss and he came immediately...i told him blood loss was probably 800-1000ml...initially BP responded to fluid...but after her ETCO2 dropped, her BP became unrecordable and she became bradycardic... we started running the 1 pint blood and asked the nurse to trace the other GXM she had from the ward...

Boss asked to set arterial line so i was feeling for her dorsalis pedis pulse...could feel it feebly initially, then suddenly i couldn't feel the pulse anymore and boss said, patient went into asystole...shit!! so we asked the surgeons to stop and proceeded with CPR...gave all the necessary drugs...even defibbed her when she went into VF...but after more than 1 hour of resuscitation she was not revived...i felt so horrible when i had to explain to aunty's daughters that their mother was dead...

I didn't cry though this time...i think the shock hadn't really set in...boss said it was probably pulmonary embolism...the sudden drastic drop in ETCO2 strongly suggested that...it's such a rare operative complication...but it had to occur to this aunty during my call...i can't help feeling responsible for her death...if i hadn't accepted her case and proceeded with the case, she would probably be still alive...perhaps it was a jinx...not that i'm particularly superstitious...but perhaps if it wasn't me who was on call yesterday, then aunty would not have been my 1st DOT...but i couldn't have known in advance yea? yet the ugly truth is...aunty's dead...and i'll never forget her last smile...

The Grim Reaper Calls...

I was on call last night...not exactly the worst call in my life or anything..but lately my calls have been that crappy, i no longer bother to compare...my calls are making me feel more like a grim reaper than a doctor...patients just keep dying...i know people keep telling me i'll get used to it after a while...but it still gets to me every single time...

The day started out fine..as usual the action only starts after office hours...whole day i was practically jobless...and then after 5pm, the phone calls start coming...there was a medical patient who was having massive continuous lower GI bleed who was referred to surgery for surgical intervention... needed an ICU bed for stabilization before op...i was reminded of the acquired haemophilia uncle who had the same problem...he died eventually...thankfully not during my call...anyway, since they insisted that patient was stable for transfer and the surgical team will go in that night itself, i accepted the patient...meanwhile, my burn uncle was oozing blood-stained fluid from all 4 limbs and trunk... post wound debridement yesterday afternoon....losing fluid and blood faster than we can replace...blood pressure was low...initially started on single inotrope...then had to add another one...

GI bleed uncle came at 7pm...already on IV dopamine maximum dose...BP quite stable after running in fluid and blood...but blood was practically pouring out from his anus...i was humbled by the fact that 2 gastro specialists actually escorted this patient to ICU...well, i expected an MO to escort coz i didn't want to risk a patient like that with just an HO escort...but 2 gastro specialists is a bit too royal a treatment...i was actually having dinner in the MO room when i heard the voice of someone who always puts a smile on my face...his presence somehow made my stress more bearable...and to think he actually got the arterial line for the GI bleed uncle (you know how arterial line insertion is my bane), i'm forever indebted...yup, just about the only bright spot in my otherwise bleak and dark call...

So anyhow, i was resuscitating the patient...only had 3 pint of bloods...pale as sheet...got DIVC cycle so we were just pumping in that...saving the blood for op...was contemplating on intubating him early since he was getting a bit restless and confused...and it'd be easier for me to get in the central line...opportunity came when GI bleed uncle suddenly said he was dizzy..and he was gasping and all..so intubate!!...good thing wasn't difficult...then Chen Chen came from OT to help me out...she managed to put in the central line and we had to add IV noradrenaline coz uncle's BP was dropping further...we put in a Ryle's tube and blood about 500ml poured out into the bag....

The surgical team was debating on whether to go in or not..since by then uncle was no longer stable...his BP on maximum double inotropes was only about 50/30mmHg....i wanted to transfuse 1 pint of the blood in the hopes of bringing the BP up a bit...when they finally decided to go in at about almost 11pm, uncle became bradycardic and BP was barely recordable..no pulses...had to start CPR...pushed in the blood and all but i think it was too late de...irreversible shock...CPR for about 40 minutes...the grim reaper won....uncle's son was crying so hard, i couldn't bear to look him in the eyes...

So that was that...thank God the meningioma lady who came in post op didn't give me much problem...so i could concentrate on trying to save burn uncle...i had to call his family members to inform DIL coz i was so worried he wouldn't make it through the night...but i was pumping in FFPs and cryos for him...and giving him colloids hourly...he was also pale as sheet...blood bank didn't have O+ blood...but i managed to get him 2 more pints (after already transfused 3 pints of blood throughout the evening and night)....took the GI bleed uncle's leftover 2 pints blood (since he didn't need them anymore, plus they were O+ too) and gave it to burn uncle...of course i sent it back to the blood bank for them to re-cross match....

From after midnight to about 4am, i was sitting in front of the computer while looking at burn uncle's monitor...we couldn't get an arterial line thanks to his burn....so took BP reading every 5 minutes...thankfully, i was chatting with John on the computer...so i could stay awake to keep vigil on burn uncle...by 4am something, we've managed to taper off IV dopamine...and his heart rate came down from 140 bpm to 110 bpm....so i could finally get some rest...thank God i didn't get nightmare about burn uncle dying while i was sleeping...awakened by a call from boss about 745am...asked regarding the GI bleed and burn uncle...she asked if i was ok...which was rare...and proceeded to console me by saying that it was ok, GI bleed uncle was a no-hoper anyway...and she actually said 'good job'...to me...wow!!! i must have done something right huh? though that didn't change the fact that i lost GI bleed uncle to the grim reaper...

Came home after i passed over to Kevin...had dim sum for breakfast with Elaine..then sent her to the airport...came home and crashed...good thing i didn't crash on the way home...