34...

Today was a busy day...whole day in OT...last case only finished at 630pm and boss asked to do the postponed LA case under emergency...so after finishing the case and settling the post op patients, i finally got to go home by 10pm plus...it was raining the whole day...and i only managed to have my dinner at 1030pm...while having my dinner, i suddenly received a message from Billy...it read: Our beloved friend TKP passed away this morning. MI....The grim reaper sure pulled a 'stunner'...i still can't believe it...KP just celebrated his 34th birthday 2 days ago...the last time i saw him was before he graduated from uni...but i always remembered him as one of the nicest senior i've ever known...

KP was a super nice guy...and he was as skinny as a pole...and he played tennis...how could he have died of an MI? It just sounds so ridiculous...why do good people die young? he has a very young son...KP, i hope you had a good birthday...may God bless your soul and may you rest in peace...may God bring comfort and healing to your family as they grieve for you...

KP's death reminded me of Jesus...He died on the cross at the age of 33...just a year younger...i mourn for KP's passing and cried out at how unfair that his life should be taken from him at such a young age...but i've taken for granted Jesus' death on the cross...i've always accepted that Jesus had to die on the cross to atone for my sins yet i've taken the precious life He has given me for granted...as if i deserved it...Lord, help me to never take Your sacrifice for granted...may i live this life as You will it...so that when it's my turn to pass from this earth, i will see You face to face, Lord...

Goodbye Pa...we miss you...

I was post call yesterday...i was in a pretty foul mood coz i was having a bad call...and i was supposed to be doing 4 eod calls in a row...little did i know while i was having a terrible call, something even more terrible and unimaginable was happening at home...so it was about 756am yesterday and our unit has just finished round in 5th floor...suddenly my phone rang....it was my Ma...she was crying when she spoke...she said,"Kat, can you come back as soon as possible? your daddy is no more...i found him in his bed...cold..."....oh gosh!!! i thought i could be calm for about 5 minutes just so that i could explain to my boss that i needed to take emergency leave but i could feel a breakdown coming so i had to get away from the crowd...i just broke down...

Why did Pa have to leave us so soon? He hasn't even marry me off!!! Who's going to walk me down the aisle when the time comes? Pei still hasn't graduate from med school..he won't get to attend Pei's graduation...Who's going to accompany Ma when we're all busy working? So many questions....and yet i know all attempts for answers is in vain...Pa's gone...and i don't know where he is...and i wished i had share Jesus with him while he was still around...i don't even know if my prayers for him will be heard....

By the time i could compose myself a little, my bosses have left...a colleague saw me red-eyed and teary and she came and asked what happened....i couldn't tell her without breaking down again...so she helped me to call my bosses to tell them what happened and sent me home to pack....then she sent me to the airport to get a flight ticket back to KL...i bought the 1215pm flight so we had time to hang around...really thank God for company at moments like this...if not, i'll be just crying and crying...but it's so painful to cry....i so wished it was just a series that i was watching that i'm crying over...coz at least when the drama's over, i'll stop crying...and Pa will still be around...

I thought i could sleep in the plane...but i only ended up crying even more...i took a MAS flight...so i took the KLIA transit back to Bandar Tasik Selatan...usually Pa and Ma will come pick me up...but yesterday, i was waiting for my cousin and uncle to pick me up...while waiting, i thought: Pa will never keep me waiting...Pa and Ma would always be waiting for me by the time i step off the train....when i got home, i met Ma, Pei and Simon...Ma hugged me and started crying and crying....Pa's body had been enbalmed...he looked so peaceful....like he was just sleeping...and if i called he would wake up....but he wouldn't...he won't ever wake up again...

We're giving him a Buddhist funeral...and the wake would last 5 days...Jie can only come back by Friday...when i called Jie, she was so distraught...i don't think she had stopped crying....i think it's even harder on Jie...i'm not sure if she and Pa parted on a good note when she left for UK last month...

Time and again we've seen and heard of the regrets that people have when they lose their loved ones...and yet i've always thought it would not happen to me that soon...that i'll still have time...i wasn't even there to save Pa...i couldn't save him...everytime i look at him in the casket i keep expecting him to open his eyes and sit up...i keep imagining when i woke up this morning i'll go down and greet Pa 'good morning' and he would greet me back...but there'll be no more breakfast waiting for me at the table...

Pa, where are you now? you must be feeling as lost as we are...i just want you to know Pa...that you've been the best father you could have been to me...and i really thank you for all the love that you've given me...although we were never really close, but i know you loved me and i wish i could have told you that i love you too...i know i've done a lot of things to break your heart....but you've always been patient with your children....you never burden us with your worries...i guess after 63 years, you're tired with all the burden you carried by yourself...i pray that your soul will find peace and rest in the afterworld...and i want you to know that i'm proud to be your daughter, Pa...and i hope i've made you proud to be my father too...Goodbye Pa...may God bless your soul...we miss you very much and you'll always be in our hearts even though you've moved on...

The return of the Angel of Death...

I was on call yesterday...was a relatively good weekend call i must say...although the 2 cases we did in the morning ended up pretty complicated and we only finished at about 3pm...after that, went for lunch with my senior MO and his wife and baby...his wife was shopping for a friend's farewell present... and he wanted to shop for his wife's birthday gift...so after lunch we were at Charles & Keith (coz they were having sale)....

After his wife left, we went back into the store to buy some shoes that she liked...i ended up buying a pair of black strappy heels with studs which was going for 70% discount...so i only paid about rm53 for the pair of heels...i actually preferred the brown or the cream-coloured one but they only have my size in black...oh well, black still looks good...

We went back to do on call rounds and everything was pretty quiet though i had to go back to the hospital once to see some new admissions...thought maybe i could rest at home that night coz i wasn't feeling too well...but i guess the Angel of Death wanted to make a comeback...got a call from my specialist on call about 10pm telling me that there was an UGIB patient coming from Queen casualty...massive bleeding...but as with Malaysian efficiency, the patient only reached the OT at 12am...

Patient was intubated when he arrived...and blood was practically pouring out from his mouth and nostrils...and his nasogastric tube free flow was about 1 litre of fresh blood...so we proceeded to perform an on table OGDS to try to look for the source of bleeding...but all we could see was gush of blood...so we proceeded to exploratory laparotomy immediately...when we opened up the stomach, we found massive amount of blood clots...but no bleeding source...so we moved on to the duodenum...nothing in D1 and D2 but blood...

We were racing against time coz the blood and blood products were taking rather long to reach the OT...i could see the patient's heart rate steadily dropping from 100 plus bpm to 90...then to 80...to 70...to 60...and we still hadn't find the source of bleeding...but my surgeon suspected the worst so he opened up D3 and D4 and we finally found the source of bleeding...it was an aorto-duodenal fistula...we couldn't proceed to repair as patient was too unstable...by then his heart rate was 30 plus...and his pulses were no longer palpable...and we couldn't proceed with CPR due to medical futility...

The poor uncle...may his soul rest in peace...it's a horrible feeling...watching a patient die...and you can't do anything to save him because it was too late...and the indignance you feel when you know the patient could have reached the OT way earlier if not for the gross mismanagement at the referral level...sometimes you wonder if this was all really written in the Book of Life and Death...did God really plan for the 12 hours delay to OT? did God really plan for this uncle to die because of the gross mismanagement of his condition? oh, sorry, activated the God-complex mode...

Sometimes you would think that medical personnels are cold and heartless...coz even in the face of death, we still joke and laugh...forgive us, we don't mean to be cold and heartless...for some of us, it's a defense mechanism to deal with deaths...and many of us have seen too many deaths that we'd all sink into the dark abyss of depression if we allowed them to affect us...and it doesn't help that some of us are the Angel of Death incarnates...

Goodbye Grandma...

I was on call on Tuesday...got a message from Mom telling me that grandma passed away at 9.15am that morning...i didn't cry...i guess i was kinda expecting the news...she hasn't been well since her choking incident during CNY...she had a left BKA done about 2 months ago...been on tube feeding since her choking incident...i supposed that's enough suffering for a poor old lady...

I was never really close to this grandma (she was my dad's mom)...she used to live in Taiping...and i only saw her once a year during CNY...but i remembered that i loved going back to Taiping...my grandpa and grandma lived upstairs this shophouse...there was a Siamese temple on a plot of land next to where they lived...and i've always been intrigued by it...i've never entered the place until the recent Wednesday...they brought my grandma's body back from KL to Taiping...so the wake and funeral service was in the Siamese temple...

I flew back from KK on Wednesday...coz it would have been quite impossible to ask someone to take my call on Tuesday...had to ask boss to help me buy my flight tickets coz i couldn't get out of the hospital...the tickets cost me RM915...and that's the cheapest already, i guess...and i was flying airasia...oh well, no choice...my bro drove my elder sis, my 1st aunt and i back to Taiping...we reached just in time for the prayer service...by the time we finished it was about 930pm...so we went for supper at this place my Dad calls "Kam Pin" (coz it was located among rows of goldsmith and pawn shops)...

Then we went to check-in at this new hotel at the lake garden called The Flemington...bathed and slept...felt quite tired after a whole day of travelling...wanted to skip breakfast and sleep more but my parents wouldn't allow it...we were at the temple again about 9am...the funeral service started about 1015am...then we went to the burial ground...my grandma was buried next to my grandpa...after we checked-out from the hotel, we went to have our customary chendol before we drove back to kl...

I don't usually cry at funerals...especially those of old people...i supposed it's coz i feel that at least my grandma isn't suffering anymore...and that she's in a better place...towards the end, she didn't even recognize me anymore...perhaps when we meet again on the other side, she would remember me...Goodbye Grandma...rest in peace...

Another bleeding splenectomy...

I actually planned to start this post while i was on call on Wednesday...but a laparotomy came up...so i had to abandon my attempt...now it's already early morning Friday...i'm still up..multitasking...packing for my Taipei trip while typing this blog...everything's been happening in a row, which has left me overwhelmed...to the point of being sleepless at night again....

My call on Wednesday was actually quite good during the day...was left with only a plastic case that was posted the previous 2 days...so i did the case...30% dermal flame burn...patient is 34 years-old...and they only debrided the limbs...nothing too complicated...then ortho posted 2 cases...one I & D and one saucerization...nothing too exciting...even had time to help the ortho elective OT to do one of their cases....about 4pm, the neurosurgery MO called...one of the ICU patient needed a re-craniotomy and evacuation of clots....oh well, that would fill up the otherwise wasted OT time, so i thought...it did actually...lasted 5 hours...

Of course i didn't expect that there would be another bleeding splenectomy....i did pre-med the day before for a 14 year-old thalassaemic boy whose spleen and liver were so big that he looked pregnant...last week when i was on call in ICU, i had a bleeding splenectomy as well...this was like history repeating itself...but this time, i was stuck in OT with the neuro case...the surgical MO called me at about 8.15pm and said, "I know you're doing a neuro case now, but i have a bleeding splenec that i need to go in now!"...Like, i wish i was God...but that's just not going to happen...i only have one emergency OT and they were still stitching up the head (that would be like another hour)...where the hell was i supposed to put the bleeding splenectomy? and a bleeding case definitely can't wait...

Thank God my boss came to the rescue and opened the OT upstairs for that splenec boy...but unlike the splenec girl last week, this boy didn't survive the re-exploration....by the time i finished up the neuro case and ran upstairs, the boy was dead...i was just talking to him and his dad the day before...and now he was gone....so this is the God-complex in me thinking...if only i had postponed the case...then he wouldn't have to die...but i didn't have any reason to postpone his case....i couldn't bear to look at the father in his eyes...

Sigh, i think i'm developing a splenectomy-phobia...i wonder if i'd still dare to do a splenectomy when i become a surgical MO...

The Grim Reaper struck again...

I'm on call again today...i was greeted with a news that left me unsettled...the grim reaper struck again last night...burn uncle passed away...Grace said that burn uncle was already on 4 inotropes by yesterday and yet he just continued to deteriorate...

I was praying that burn uncle will not die during my call...i guess i should feel relieved that he wouldn't have to...his sufferings has ended...he's in a better place where there's no pain or fire...but i can't help feeling that he died too soon...that's the God-complex in me acting up i supposed...

Anyway, ICU is full to the brim...hopefully it'll be a peaceful and quiet call...may God bless burn uncle's soul and may he rest in peace...

She asked for it...

I was on call in Queen again yesterday...there were 3 admissions into ICU throughout the day...one was a 42 year-old man who had very bad pneumonia (was intubated) and was in septic shock...requiring maximum double inotropic support...his kidney shut down and he had very severe metabolic acidosis...we gave him bicarbonate correction and even managed to dialysed him...and he seemed to be improving after the dialysis...but eventually by 2am, i guess his whole body was so overwhelmed by the sepsis that he just deteriorated...adding another inotrope didn't seem to help...he finally died at 4.25am today...but at least i think this man had wanted to live..so did his mother and family...

But not so with my other admission...this idiot of a 29 year-old lady (let's call her S for stupid), was a mother of 9 children...had only recently delivered her 9th child less than 2 months ago..S came with symptoms of fever, dehydration and her blood investigations were suggestive of dengue...her ABG showed very severe metabolic acidosis and she was very tachypnoiec (she couldn't even complete a full sentence) by the time i saw her in the ICU...S would have eventually required intubation when she finally got tired from breathing too fast...and she would have needed urgent dialysis to correct her metabolic acidosis as she wasn't really responding to bicarbonate correction...and she was passing very little urine despite us giving her fluid...

Since S was still awake and able to comprehend what was happening to her, we told her that she'd need to be intubated her to prevent her from going into respiratory failure...and she'd need several invasive procedures i.e. central venous line and catheter insertion...but she refused...and so did her husband....and S actually insisted on at own risk (AOR) discharge...she said she cannot bear to be put out of consciousness and be intubated and had all the invasive procedures done to her..although we tried very hard to convince her that was the only way to safe her from dying...S replied that she'd rather go home and die in the presence of her 9 children....i called my boss and asked him what i could do...he said we can't force treatment onto a person who's still in his/her sound mind...somehow we managed to make her stay in the hospital in the hopes that eventually she would allow her to treat her...

So we transferred her to the general female ward...knowing that she'd collapsed in another few hours...though i was hoping that perhaps i'd be proven wrong...that perhaps she didn't need all the 'torture' we planned to subject her to after all...this is one time i'd hate to be proven right...she was transferred out of ICU at 6pm....by 10.30pm, the houseman on call from female acute ward (i supposed the specialist on call transfered her there) called me to say that S' husband finally agreed for intubation...i went down to see her...she was so tachypnoiec, dyspnoiec, restless and drowsy that i guess my question was pointless...but i just had to rub it in...so i asked her and the husband, so you want intubation now?...so we prepared for intubation...but before we managed to give her the medications for induction, she developed hypoxic fit (her saturation by then was only 88% on high flow mask 10L/min)...so we quickly gave the medications and i intubated her....saturation picked up...but her pupils were fixed and dilated...not a good sign...

The husband had the cheek to ask me to do whatever i can to save her...when earlier on he so arrogantly told me that if his wife didn't want any of our treatment, then he won't force her..there you have it..a couple of idiot...so i told him, i am and will do whatever i can....but it's probably too late already...and he broke into tears...anyway, i continued rescuscitating S...gave her more bicarbonate...asked the houseman to refer to the nephro MO on call for urgent dialysis...after about 15 minutes, S actually regained consciousness...i was actually shocked...i thought that maybe there was hope for her after all...she actually looked at me and responded to what i told her...so i asked her husband to see her...so i turned to help the houseman to refer that patient for dialysis...coz the nephro MO on call yesterday was a bitch...she gave the houseman such a hard time...grilling him for like 20 minutes and yet won't agree to the urgent dialysis...so by the time i went to check on S again, she was not responsive again...hmmm...something wasn't right....so i checked her pulse and shit...there was no pulse..no heart sound...

We started CPR....but i wasn't too sure how long it has lapsed since her heart actually stop....there was no proper ECG monitoring in the female acute ward...so an unconscious person might have been dead for like a long time before someone actually bothered to check the pulse and noticed that there wasn't any...so anyway, she wasn't revived after 30 minutes of CPR....and that was the end of the story for S...there was no pity...because she asked for it...and so she only got the fruits of her labour....as for her husband...he was a murderer...because he allowed his wife to die...i only pity the 9 children...few of whom might end up with a short life just like their mother....the husband cried when i told him we were doing CPR on his wife...all the tears in the world would not bring his wife back to life...and he didn't deserve the miracle of resurrection...not him..not a murderer....

Oh well, at least my last admission didn't die..and he was the oldest of them all...69 year-old uncle with chronic kidney disease...was probably uraemic...had Steven-Johnson syndrome...developed a few bouts of supraventricular tachycardia...but managed to stabilized his heart rate and rhythm...hopefully he won't deteriorate after my call...and i don't know if W (of Scenario A) is still alive...by the time i left the hospital, her blood pressure was already very low...well, at least then her husband didn't need to choose...