Friday

Yeay! Today is a public holiday! We still have to go to work but half day, even that is a blessing when you are a houseman. Look forward to having a long day with my family. Insyallah we'll be getting a new family member, on my husband's side. 

Happy New Year! Speaking of new year, I should get my resolutions laminated and put it in my coat pocket so that I remember them! 

Ok... have to get ready for work. 

PAC

This is the sofa which I use to sleep on during on call in PAC (patient assessment centre). Makes it easy to wake up right away!

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Tag call

I just had my first tag call. Here in O&G, not only you have to tag until 10 pm, but you have to tag call too. Just incase some of you don't follow what I mean, it means I have to stay tag with someone on call. So in other words, on call just like any other day. I delivered 2 babies that night and one of them was a premature baby.

The first case that I delivered was really funny. I entered the labour room to do VE (vaginal examination), to assess how her labour is progressing. Then I put my two fingers in and felt the baby's head... and guess what, the lady kept on pushing! She wasn't fully dilated yet, so I told her not to push, and she kept on pushing down while I pushed her baby's head up. So I called my friend, whom I tagged with to confirm my findings. And yes, the baby's head has descent, station 0. The patient kept pushing while we keep telling her not to push yet as her cervix is not fully dilated. Seeing how fast she is progressing, I ran outside to take the apron and mask while alarming the nurses that I am getting ready to conduct a case. Then I ran back inside while putting on my apron and mask... then put on my gloves. As I was putting on my gloves, the nurse said that the baby's head is out already! To my surprise, the baby's was already out facing the perineum. I pushed the baby's head downwards, and waited for him to turn because I didn't know which direction to direct as I didn't see how he came out. Then the shoulder came out followed by the whole body. The delivery set which contains all the instruments needed was not opened yet, so there was no cord clamp. I had to 'clamp' temporarily but pressing on the cord with my fingers. Delaying can cause the baby to be polycythemic. Sorry to say but I found the patient very irritating, hehe. I know it's not nice. Because she didn't listen, we didn't have time to guard her perineum, and because of that, she had some tear which had to be sutured. Suturing for tears is a little more challenging as they are irregular, unlike episiotomy. While I was suturing, she was so uncooperative. She on moving and lifting her butt! I know it's out of reflex from pain, but she was overdoing it!!! Some people are just so difficult to handle.

After that case, I got to sleep from 12 am to 1 am. I woke up because my MO came in and laughed when she saw us (me and my friend) sleeping. So of course, we had to wake up. I was lucky that night, she was one of the cool MOs in O&G. And I didn't sleep until morning. Then I had to deliver a premature labour. Nurses cannot deliver premature cases so the doctors have to attend. Nothing eventful happened during the delivery, it was quite easy as the baby was small. I am so glad that the baby was ok, he was born vigorous and pink. The parents were really nice, they kept on thanking me, eventhough I was causing pain to the mother by suturing her episiotomy wound. Alhamdulillah the baby was not sent to the NICU.

At about 5 am, I had to enter the MOT (maternal OT) for an emergency caesar. There were 2 cases. Whatever it was, I was out of the OT at 7.20 am and attended the morning briefing at 7.50 am, without showering! :P I was hoping that the PAC (patient assessment centre) will be calm. Sadly, it was the busiest day I had ever had. I was aiming by 11 am, if things were under control, I'd go and sleep for a while. I didn't get to sleep at all. The patient's kept coming until we are fully booked. It was up to the extent that we had to transfer patients out to other nearby hospitals. There so many patients wandering around waiting for the ward to call them, the scene looked like the Grey's Anatomy episode where they have one big disaster... where the ED would be full of people walking around in distress. I had to handle a difficult family. The wife was in latent phase of labour, so we told her that she'll be sent to Kajang Hospital. Her husband refused because he said that he doesn't know where the hospital is, so I explained to him that his wife will be sent via ambulance and he can follow from behind. And guess what he replied back, "Nanti saya akan sesat bila nak balik rumah sebab tak ada ambulance!". At this point, I just cannot smile anymore, he kept asking why his wife cannot be sent to Putrajaya. We explained why, about the cost and the limited places there. He told me to call the hospital and confirm... and I did... as expected, fully booked. I just don't understand why they were so stubborn. But in the end, they had to agree. I told them that if they refuse to be sent to Kajang and they want to go to other hospitals of their choice, they'd have to sign an AOR (at own risk) letter. They understood and just agreed to our suggestion. I was so pissed, especially after a sleepless night.

That evening, after I had my dinner... I slept from 6.30 pm until 5.20 am the following day! Full stop!!!

* I still enjoyed my day though because it felt like I was doing something. But I hope it wont happen everyday!

A new rotation

Today is my day 6 of tagging. During my early days of tagging, I was really energetic, but the graph is declining slowly. Sad to admit, but it's true. Usually, when I tag, I would sleep right away when I reach home, now that there is a new addition to the family, I play with Sofiya first then sleep at 12 am. I know that I am the one to blame, but I can't help it, I miss her at work. When I come home and hear her cry, I get excited because I know that her parents are up and I get to see her. Some nights, I SMS Tiyah telling that I am on my way back from the hospital, and she'll leave her door unlocked and I get to see Sofiya. Once, I slept Sofiya, to give some time for the two of them (Aiman and Tiyah) to rest and sleep... I awoken by Sofiya's loud cry. Then I quickly picked her up and knocked on Tiyah's door, poor Tiyah, she had to get out of bed and start nursing. Now, she has on calls every night!!! We try to help her out as much as possible. But I must admit, Aiman did a great job.

The MMS that makes my heart melt

Ok, back to my first day in the labour room. Since I had never conducted any labour during my days in the medical school, I was pretty nervous about catching up with the whole system. I am so blessed that I am the only tagger, so I don't have to compete for labours. The JM's (jururawat masyarakat) had been very helpful, whenever a patient is fully dilated, they'd call me and help with conducting. The first labour was horrible! I observed one labour then I felt like I was ready to start conducting. The process of conducting was not the horrible part, it was the smell of liqour... while I was conducting, I felt like throwing up. The nurses were so supportive and continued my halfway job and told me to sit down before I faint, hehe. The second one was better, the liqour didn't smell so bad, I just had to tie my mask a little tighter. Alhamdulillah, I got to conduct 3 deliveries on first day and a few repair of episiotomy.

Episiotomy repair was another issue... suturing was always my favourite part, I just love seeing the skin approximated nicely by the sutures, but... it wasn't that easy for episiotomy repair. The reason for that was, suturing in a tight canal was a big challenge! During my surgical posting, I was used to suturing on the external structures (eg. the abdominal skin), so it was easy... plus the patient was not awake! The current challenges are:

1. Uncooperative patients - I don't blame them, they just went through severe pain during labour, and next, having needle bites in their most sensitive part. The local anaesth given doesn't work 100%. I just encourage my patients to breath in the Entonox gas!

2. The tight space with so many structures surrounding, especially the vulvar vestibule with the bladder. So I'd have to be very careful so that I wont suture the bladder.

Insyallah I will get better with repairing episiotomy and tear. Anyway, I will blog more. A little tired.

Welcoming the birth of Sofiya

It's been a week already since the birth of my first niece, Baby Sofiya. I received an SMS from my sister last Saturday, telling me that her cervix had dilated 4 cm. I was at my inlaw's place in Gombak, so the next morning, I went to Prince Court Medical Centre (PCMC) after breakfast with Mama (mom-in-law). I got to the labour room at about 9.30 am, to my surprise, Tiyah was in her happy bubbly mood. Even more surprising she was GLOWING with her colourful headband and some lip gloss! I thought that the augmentation might have taken it's action by the time I reached the hospital, I was wrong. Her obstetrian, Dr. Seri started her on a low dose, so the action takes some time. I stayed in labour room with her, I had fun talking and laughing before the active phase of labour. Tiyah's MIL and FIL was also there, we had nasi lemak and the trifle that Tiyah and Aiman had made the day before... while she was in labour! Hihi. Time was passing by really slow, I cannot wait for the labour and at the same time, I felt sorry thinking how Tiyah will be in pain. At about 1 pm, Dr. Seri came and performed amniotomy (ARM - artifical rupture of membrane)... she said that the next time she sees Tiyah, she wont be smiling and laughing. She was right! After about 10 minutes from the amniotomy, her contraction became stronger. Aiman calmed her down with his sweet words and reading the Quran. It was so touching to see the two of them and how much they loved each other... Thank you Aiman for loving my sister. Whenever Tiyah was about to have her contraction, she would alarm us and she will grab our hands. My dad couldn't bare seeing her daughter in pain, he kept looking out the window, refusing to see Tiyah with tears running down her cheek. I just admire Tiyah's strength, she didn't scream out loud at all. When the contraction got even stronger, she just hugged my mom and said, "Mak, sakit..." I just cried hearing her say that.

Tiyah and Aiman in the labour room

After about 1 hour, she felt like bearing down. Then Dr. Seri came and we waited outside for the active part of labour. I just stood outside the labour room and I heard all the motivation coming from the staffnurses and Dr. Seri herself. I was in tears, hugging my mom. Then, after about 2-3 minutes, I heard Sofiya's first cry. It was one of the best moments in my life! Hearing a baby cry after delivery is a big blessing... I realized this since I joined the obstetrics rotation. It was 4.42 pm. My mom didn't wait for the permission by the team to invite us in, she went straight in. I just too a peek behind the curtain, then later Dr. Seri saw me peeking and called me in. Tiyah and the baby was fine, alhamdulillah. Her eyes were blinking... looking up, I guess she was wondering what the hell just happened! Then we called Ayah... and he was overwhelmed with the fact that he's a grandpa! The same with Mak. Aiman azan in Sofiya's ears, and her eyes blinked non-stop! Then, they took Sofiya for her first top-to-tail wash... I stayed with Tiyah and left the room as soon as Tiyah fell into sleep. Aiman and Mak chose which clothes to put on Sofiya... then they pushed Sofiya to her room. I think, I can sit and look at Sofiya all day! The nurses came a few times to aid Tiyah with breastfeeding... Sofiya gets better and better at sucking. A few visitors came to see Sofiya, Aiman's siblings, aunties and uncles, including Alia Ali.

Sofiya and Papa

Sofiya after top-to-tail wash

Both parents after labour, both are tired

I went back home at 11 pm, I wish I could stay. The next morning when I woke up, the only thing that I could think of was Sofiya! I wished that I don't have to go to work and stayed with them in PCMC. Sadly, it was my first day in obstetrics, so I had to report myself and start tagging until 10 pm. The MMS helped!

Feel like blogging

Hello everyone! Yes... it's been a while since I felt like blogging. I don't know why I had not been bothered to update about my life as a houseman. The weird thing is that it was because I had nothing to write about, not that I lost interest or anything, but it's because I didn't find them interesting enough to be put on my blog.


Currently, I am in charge of the acute cubicle in the male surgical ward. Oh boy! It is very challenging! A lot of intracranial bleed and other traumas. I can no longer take long lunch break, to be honest, no more lunch outside! And yes... I had so much time previously that I could afford to lunch outside the hospital. I hope no one from the hospital is reading this... hihi. Erm... I wonder whether there is such rule saying that house officers are not allowed to leave the hospital for lunch... what I know is that we can take our lunch break as long as our work is done. And I never leave my work undone.


Anyway, this morning, I came to work to find that my intracranial bleed patient had passed away yesterday. It was expected, we signed the DIL form already. DIL means death in line, it's a form that the MO and a family member signs after we have explained to the family regarding the poor prognosis. This form prevents any misunderstanding and allows that family to slowly digest the bad news. I wasn't around when my patient went, but I heard that his wife took it well, she had been taking care of her comatose husband for 12 days! He sustained subdural and subarachnoid bleed from a hit and run accident. I don't want to get emotional and wonder how his 2 little kids are surviving, it can make me upset and even cry...


Tomorrow is another half day! Yippee! Another public holiday. I can leave slightly later for tomorrow, unlike today, I was at the ward by 6.35 am. It's quite nice to arrive early actually because I get the best parking space!


Ok... I guess this is all. Insyallah this Friday will be my last day in the surgical department. I cannot deny that I feel a little bit sad and not bothered to change to a new posting. I already felt comfortable here. Nothing in life is permanent except change!