Wednesday, September 30, 2009

attachment

2minggu attachment kt hosp banting. Seminggu sebelum n seminggu masa ramadhan. Sgt penat. Dan mengujakn! Masuk wad medicine. Seminggu kat wad perempuan n lg seminggu kt wad lelaki. Rutin setiap hari, dtg hosp pkl 8. Ikut dr round wad. Then dlm kul 9-10 specialist dtg. Ikut dr present case sampai tgh hari. Then buatla ape2, blaja dr nurse o tanya2 soalan kt dr. dlm kul 3-4 blk.

Hari pertama, dtg kenalkn diri kt drs n nurses in both ward. Kt wad perempuan dgn dr tan n dr sharimila. N wad lelaki dgn dr yap, dr girija n dr musniza. Specialist int med, dr siva. 6 org dr, sorg je dr melayu, dr musniza. Dr girija kate, ni 1st malay student yg buat elective course kt hosp ni. Before ni, Chinese n Indian students je ramai. Hoh. X byk belajar sgt. Sbb baru dan kekok. N blur dgn byk bende yg x pernah tau. Eg. Pasoxymeter, glucometer, spO2meter, GTN, few common drugs n all machines. Keep asking nurse sbb takut ganggu dr. n nurse jawab ‘ni pun awk x tau ke?’ hoh. Maafla cik misi. Ni 1st time sy masuk hosp. kalau tanya kt dr, ape agknye reaksi dr. 1st task, dr suruh comfort relatives of death patient. Haha. Okla..

Hari ke 3, mase tgh round wad dr siva bg task. Cr psl pick wickian syndrome dlm Kumar’s & Clark. Dua2 name x penah dgr. Dr ckp ulang sekali je, n spelling pun x sure. Hoh ape bende la ni kn. Mintk buku kt nurse n try start cr kt index, xde. Sbb tgh tgk bronchiactesis pt mase dr bg task, jd mane la tau mayb related. So cr kt resp system. Pun x jumpe jgk. So go through all 1k+ pages buku kumar yg tebal tu. Tanye dr sharimila which part of medicine of the disease? Still x jumpe. End up, lps almost 3jam selak buku sehelai2, da x larat, n x jumpe pun. Tebalkn muka tanye blk kt dr siva. Dr kate, cuba cr dlm buku Harrison’s pulak. Buku tu ade kt wad lain. Hohh. Rase cm kene buli je. G la wad lain cr buku Harrison’s. n at last! Alhamdulillah nasib baik terus jumpe ade kt index.

Metabolism disease 2ry to obesity that may cause heart failure with central apnea, pulmonary hypertension, cor pulmonale and hypoxemia.

The next day, dr siva tunjukkn pt that admitted dt heart disease and DM with pick wickian syndrome. she got cor pulmonale n central apnea. n ade cushing’s jgk! rase buffalo hump with thin limb, moon face, abdominal obesity n purplish striae. hohh. da susah payah mencari dlm buku n then tgk pt yg mcm2 sakitnya, so iA x kn lupa kot pick wickian syndrome.

Dr siva suka tanya soalan histo n anat. What are the muscles of the thigh, muscles that support the vertebrae, stain for the cells, structure related to tonsil, etc. jumpe 2 pts parkinson disease. Should be x patut lupa kot main characteristic of Parkinson disease. bid rolling tremors, muscle rigidity - cog wheel or lead pipe and bradykinesia with shuffling gait n mask face; no wrinkle, expressionless. It caused by? decrease of dopamine production due to degeneration of substantia niagra of the basal ganglia in the brain. Huh. Br blaja sem lps. Tp dr tanya pun x dpt jawab. *sigh

Kt dua2 wad, byk pt admitted dt dengue fever, DM, hypertension, anemia, heart n resp disease; COPD, bronchial asthma, etc. n got 2 cases of paraquat poisoining. Both Indian. 1 male n 1 female. Attempt suicide kot, minum weedkiller. Dr kate selalunya paraquat poisoning pt got bad prognosis, x boleh survive lame sbb die buat erosion of GIT n caused fibrosis of internal organ. Treat by fuller’s earth (air tanah liat) for gastric lavage n n-acetyl cysteine to prevent hepatotoxicity. cm lg seksa je. Kene minum air tanah liat setiap setgh jam. nurse letak kn 1 jag terus suruh pt habiskn minum. huh. N ade tgk case lain, addison disease, pyelonephritis, methadone poisoning, cellulitis, bed sore, diabetic retinopathy..

Kt wad lelaki byk ikut round dgn dr yap. Dr cina, mcm x la ramah sgt. garang n tanya byk soalan. tp best sbb dpt blaja lg byk. Tp kalau dpt jawab semua soalan dgn btol lg seronokla. Hehe. Dr bg pegang pt. kalau ikut rule, medical student cuma boleh observe je. Jd dpt buat byk practical n blajar lg byk dlm wad lelaki. count resp rate, take bp, read ecg, help drs to take drug n xray sheet, read xray, listen to the lung's sound if there any transmitted sound, crepitation or clear. Da la x bwk blk stethoscope. Each time dr suruh dgr lung sound or amik bp, gelabah cr kt nurse. ade yg da penah belajar. Tp x igt da. Sgt penting! Rase teruk ble x dpt jwb. Pengalaman blaja CBD (continuous bladder drainage). Put catheter in the urinary tract for urine outflow. 1st time tgk dr buat, serious rase nk muntah. 1st time tgk an. plus the pt was not in very good hygiene sgt, ade pus kt genital. Then dr yup suruh student plak buat kt another pt. Omg! Palpitation. Haha. I did by my own. Hoh. da siap masukkn catheter, ade urine leak n hujung catheter tu x boleh masuk dgn btol ke urine bag. At the end, semua ok. Walaupun amik masa sgt lame. Maafla pakcik, sy student lg. hehe

Ade pt, complain of severe pain on neck and shoulder. Precipitating by tilting of the head. Dr yap tanya, what is ur diagnosis? err.. neuropathy? Waktu tu tbayang brachial plexus je. Cm pelik jgk, ade kaitan ke? Dr order xray. N then dr suruh bace, plain xray of vertebrae. Err.. x tau kot. the diagnose, osteophytes. Kalau tgk kt x-ray nampak cm ade extra protrusion cm taring kt vertebrae. That caused the pain. Menarik2.

N hari jumaat, last day hari yg plng penat n penuh kot sepanjang 2 minggu. Nursing student, dak KUIS da habis derg nye pract smlm. Jd makin byk keje kot derg da xde dlm wad. Sbb ade ape2 semua mintk budak nurse yg buat. Dr suruh handle 1 senile old pt that act out of control. Off his cbd, give iv anti-anxiety? n bring him back to bed as the pakcik off his cloth n wants to back home. Kene marah dgn pt, n his aggressiveness. Huhh. Dlm kul 10, 1 indian guy, dr girija’s pt got suddenly drop of bp. Semua dr dtg dgn dr siva skali try do a lot of things to increase his bp again. Sgt byk machines n bottles of drugs inserted to his body. Kt tangan je ade 6 branula, 3 in each side attached together by 1 branula inserted to his vein. N 1 procedure done, I’m not sure what it is. the drs insert a small catheter below the clavicle to insert the drug directly to his heart. I’m not sure the exact spot, tp nmpk cm susah. Dr girija n dr yup try byk kali, then the blood came out they pull out the catheter again. Dr siva did it n dr yup make stitches of the catheter to his chest. The bp slightly increases. Then it drop again. The drs insert another 2 branula in femoral vein. The bp still low, average 76/30 and spO2 got no reading. Pegang pt, sejuk. Dr siva mintak dr musniza amik fresh blood kt blood bank. At 1 pm, the heart stop beating n pt passed away. By the time dr musniza bring back the blood, pt already gone. Bad prognosis. Cm kecewa sbb ikut dr round jumpe pt tu setiap hari dlm minggu ni n nmpk die ok je. n I saw the drs try very hard to save his life in last few hours, cm sia2.

Then ikut dr siva sambung round wad. Got 1 pt with osteomylitis n other complications. Semua dr ade kt situ tgk that pt. dr tan, dr sharimila, dr yap, dr girija n dr musniza. Dr siva ask the drs to listen to his lung. Semua drs got diff answer. Pelik an. Dr yap got it right, dr siva leave his comment n finished the review of that pt.

n that’s all. I finished my elective course. Dr tan kate, ok I’ll see u next year. Hoho. iA ade peluang buat lg tahun dpn. Best! :)

Thursday, September 3, 2009

summer camp

awesome!



what drives you? -dr latiff