After the night rounds and clerking new cases, I finally got some time to rest, that was about 1 am. Somehow, my eyes were wide awake, to be honest, I was feeling scared... I had all kinds of ghost on my mind - thanks to the horror series advert that keep playing again and again! So I thought, I better to do some studying while I feel fresh, after about 10 minutes, my friend who was on call in the labour room called me and said that there is an emergency LSCS about to be pushed in. Luckily I was awake, so I went straight away. When I reached the MOT, I heard a lady screaming... she was 'cursing' in a weird language... she was Nepalese! No one understood her and she doesn't understand either one of us... PERFECT! The anaesthetist decided to put her under GA rather than spinal because we didn't think she'd cooperate. The operation went well, the baby was out after 2 minutes, Apgar score 7, 8, 9.
So I keyed in the notes of the operation, then my MO called and told me to go to the red zone in ED because there is a new case. Erm... red zone for a gynae case, I wondered what case it was! She was a Burmese lady who came in with peritonitis. It was the first time I felt board-like rigidity per abdomen, because all my past palpations were soft abdomen... VERY NICE, a new experience. Basically, it was a very tense abdomen, that's all! This lady had D&C done two days ago at a private clinic (which she claims she cannot remember where, obviously it was a cover up)... since the procedure, she was feeling sick. She developed fever and vomited a few times, it was challenging to dig up the history due to the language barrier. On X-ray, there was air under diaphragm, so we knew the intestines were involved... hence, the surgeon was informed. She was pushed in for a laparotomy, that was about 4 am... and my eyes could barely open, I don't know how my MO could stay awake! The operation was the interesting part, when the peritoneal layer was cut, feculent fluid started gushing out. We found a small uterine perforation with 2 small bowel perforation... and a lot of fecal matter in the peritoneal cavity. The specialist (gynae) said that this is rare complication of D&C, it occurs in about 1 in 1000 cases... but that is for the well-experienced surgeon. For the unexperienced, the incidence rate is much higher! I felt sorry for the patient but it was an unforgettable experience for me. So point of perforation in the uterus were sutured, but the small bowel had to be cut-off and sutured back with end-to-end anastomosis.
Currently, the patient is kept under close observation in the ICU, I hope she recovers well. She was very acidotic when she came in. My next on-call is next Monday and I look forward to that! :)
Here are a few photos captured weeks ago... just want to share.. :P
Iza, me and Laili
Murni and me
Conclusion: I am loving houseman ship although there are its ups and downs but overall, I love what I do because I surrounded by great supportive friends. Our days are filled with laughters!
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