Friday, September 30, 2011

elective course

Day 2: Stay till 7pm. Tu pun cm ambivalence nk blk. Rase nk stay lebih lama. Tp sbb pk da pkl 7. Mesti la kena blk pkl 8-9. Cuak jgk nk blk drive mlm2 sorg2 kalau lewat sgt. Then nk tunggu beberapa jam je lagi cm tk larat je. Da ngantuk. tp rase nk stay sbb malam lg best, lg2 hr ni dgn dr mikraz. Wktu abg hafeez cerita psl dr mikraz pg td, I wonder dr ni lelaki ke perempuan, Chinese Indian or malay? Guess what?.. ble jumpe die tgh hari td, die sgt cool~

Smlm 1st day, blk awl. Pkl 3 da lari da. Sbb tk kenal sgt staff ptg. mula2 masuk pagi smlm seronok la. Ade dr nanthaa, abg faizal, abg hafeez, abg shukri, & fadzrul. Semua kenal. Semua excited kn jumpe lg, semangat borak mcm2. kul 2 start tukar shift ptg da tk knal sesiapa. Semua MA br, dr oncall pun br. Segan lg, terus lari.

So 2nd day, da gain lebih byk confident. staffs tkde tanya2 da reti buat ke tk. bg arahan je terus. Rase lg best la sbnrnya, sbb rase cm da gain trust. Tp cm gelabah jgk sbb on my own. Amik sendri drug kt mana, sediakn set terus apply kt pt, etc.  Though they already know my name, but they still called me adik. Kenkadang la derg panggil hani. Haha. Seronok. Mngade~

Pg2 td  abg hafeez ajk breakfast, die belanje!. tgh hari makan kt unit farmasi buat mkn2 raya. Dr mikraz ngan kak azizah ajak. Segan jgk sbnrnya sbb student je. Pastu kt farmasi derg tanye org siapa, err.. cm awkward tk tahu nk jawab ape. then dr mikraz jwb; adik sy. oh :’). Attached belajar dgn dr mikraz best.!

byk ambulance call and ke klang, HTAR. Ade 3 kes polis td, salah satunya polis klia bwk suspect bukan warganegara utk buat blood test & DNA sbb kena tangkap bwk dadah kt airport. tak sangka sampai ke hosp banting. Leceh procedure die, ramai polis yg jaga. And specimen dihantar ke lab kt PJ, bkn process kt banting. Paling menarik, proses nk seal specimen. Sbb bahan bukti kn. Tahu tk cop mohor kalau tgk cerita lama2. Derg buat cmtu la. Cairkn logam? Tk sure sumthing keras kaler merah, tuang atas bekas specimen. Then copkn cap lambang kerajaan.

Oh exhausted.! Looking forward for tomorrow.

Day 3: Pagi dr ajak tgk post mortem. Body jumpe kt ladang kelapa sawit, suspected murder, decomposed for 4days. To go or not to go? Nk tgk. Nk cuba rasa pengalaman. Tp takut tk larat je la kn. Last year tgk fresh body pun tak tahan. Pk lama kot! End up.. tentula tk pergi. Nanti la, tk ready lg. pastu pkl 10 ikut kak yati g scan ke klang. Mintk permission dgn dr nanthaa, dr kata on ur own risk. Tkde jaminan keselamatan if sumthing happened. Dr buat cuak je. Ikut naik ambulance ke HTAR. Laju! 15 min je da sampai. Cool! lps CT, hantar pt ke yellow zone utk dr oncall assess. Result revealed pt ade brain hg. So tinggalkn pt terus kt HTAR. Pt terus masuk red zone. Huhh nasib baik sepanjang perjalanan pt tk collapse ke ape. Pkl 130 br sampai banting blk.

Hr ni tk chaos sgt tp continuous pt masuk. Ok la. Mlm, I did my very own suture!. Straight 2 cases utk T&S (toilet & suture). 1st MA tlng guide and assist. 2nd, all by my own. On the knee and another one on the toe. Start prep the pt. amik set T&S, needle, sediakn lignocaine, bersihkn wound, bg anaesthesia, gunakn surgical glove and stitch the wound. then dressing the wound after put topical antibiotic, gel chlomphenical. Suruh pt dtg blk after a week utk bukak suture. Total: 12 stitches. Yeay da gain confident!  Da boleh la nk handle kalau mild case wound laceration masuk. 

Day 5: da reti set IV line and amik darah sorg2. Tp confident je lebih. Lps set line, amik darah je lepas, nk masuk saline, sumbat. Aigoo. Needle tk masuk betul sgt. Pastu gelabah panggil nurse kena insert line baru. Tp kanak2 n org tua tk lps lagi. Kalau baby vein die memang susah tk nmpk. Org tua plak vein die lari, susah nk masuk needle straight. Seronok sgt memang gain a lot of skills, and confident.

ER msia sgt berbeza dgn Egypt. Kt Egypt memang lagi byk red case. Tp mx die cm.. hurmm org pun tk paham. Rase mcm da tk nk masuk ER kt Egypt lg da. Another 1 thing kn, org tk tahu nape ble pt obgyn masuk, rase mcm blur sgt tk paham case lansung. Mcm tk pernah belajar, sedangkn I’m soo into obgyn. Wktu ni rase mcm nk bace semua buku blk.

Da tahu juga nk set cbd and ecg. So far da 2kali masukkn cbd. Ecg belum lg buat sorg2. Tp da byk assist. Ecg for limb: red, yellow, green, black. Kt chest: red yellow green brown black purple. Tekan button on. Tekan button stabilkn? graft. Graft da cantik tekan button start. Habis analyze, tunggu 10sec then tekan lg sekali button start utk lead limb pula. Senang je, kena make sure pt tk gerak and lead betul2 attach kt pt.

Br tanya dr psl procedure utk SPC, supra pubic catheter. Pastu bernasib baik tiba2 masuk pt BPH nk change SPC. Change je la. Tp dpt tgk procedure die mcm mane..

Smlm I did T&S on scalp. Kt parietal region. All by my own. Hoho. Seronok.! 3 stitches je. Tahu tk sbnrnya memang gelabah ble jahit pt sorg2. Pastu ade family members kt sblh tgk je. Dpt pula pt india yg memang exaggerated. huhh memang kena buat2 cool lebih sikit.

seronok sorg je med student kt a&e. rase dpt belajar sgt byk. most of the staffs da tahu da nama. Just ask, and they will let me do everything. Staff sgt best. They’re willing to teach and org pun dgn sgt gembira belajar dgn derg. Tk kisah la kena tlng buat ape pun, kte kn yg nk belajar. Mayb sbb sorg, senang nk attachd dgn semua org, mcm dpt special rx pun iye jgk. Hbs da seminggu. Laju masa berlalu. Ade student UM masuk hari ni, cm tk best sgt sbb mcm kena berebut nk buat procedure dgn derg. Haha. pastu ramai2 nk kerumun pt. jd cm, ntah kurg best kot.

Day 7: da masuk 2nd day of 2nd week. Jona. And I learned from the best, seronok ble abg shidi masuk. Td kena tengking dgn family members. Tgh chaos, 2 pt mva sekali masuk. Tlanggar IV drip pt A, tiba2 abg pt B marah, “ hey rawat la betul2. Tu adik sy!.” Pfftt. Tkde effect langgar IV drip tu. Tk tcabut pun. Tk nmpk ke 3-4 org staff tgh work on that pt. pt teruk jgk, multitrauma. staffs lg hangin marah la, die lawan blk, ade gaduh mulut, terus suruh keluar. Nasib baik all the staffs back me up. Td memang tkesima skjp.

amik darah HIV pt. clumsy hani. Comot jgk. Alahai~ cuak! da pkai glove, lps tu memang sterile tgn byk2 kali. Kate staff, ni nasib baik pt bg tahu. Ade pt yg tk ckp ape2, lg la.. medical profession memang exposed to many fatal things; radiation, infection. perasan tk perasan je. cth, seminggu berapa ramai pt TB. And red cases yg  kena buat portable x-ray; xray pt on bed, setiap hari mesti ade. Berapa byk exposure da.

bloody yellow case masuk, org tk tahu kena pkai apron. Staff tegur. Derg tk pe, sbb derg da pkai baju overdress biru yg ER punya. Org br nk amik, staff da amikkn and pakaikn sekali kt org. like seriously?. segannya. -__- and I did T&S on that pt. kt medial side of arm and scalp. Yeay.

Ade case masuk. Adik clerk case. Nk tgk sket bdak mesir clerk case. Ok, boleh!. Confident je terus clerk pt. pt MVA je pun. then present case, derg kate tulis la terus dlm report pt. huh?. seriously tk confident lg nk handle pt. ie clerk, full examination, mx and tulis semua dlm report siap2. selalu buat mx yg Dr order je la. cth mcm ni MVA yg mild case bg IM ATT 0.5ml, pain killer IM tramal 1ml. suspect frx, order xray, then buat T&S kalau perlu. kalau nk handle clerk case dr awal tu memang tkdela.. derg byk kali da kot courage suruh clerk pt kt triage green case yg common, sampai bertolak2 kadang. knp tk berani lg hani?..

ptg smlm ikut ambulance call dgn abg faezal. seronok, suka naik ambulance sbb laju. lampu merah pun boleh jalan and kenderaan semua ke tepi bg laluan. dekt je kt teluk datuk. n call dr rumah. means bukn MVA la. elder pt, unconcious GCS dlm 7. bed ridden. medical hx advanced stage of tumor, on chemo and hv done surgical removal. tp tk sure cancer ape, mayb jaw or tongue. tgk buku hx die pun cuma tulis dr onco unit, advanced stage cancer, tk ckp in detail. just terus bwk blk pt ke hosp. dr tan tk hbs lg clerk pt, ecg da flat. haihh. so claimed as BID (bring in death).

Day 9: result final 5th year keluar. Kt hospital lg. Pkl 6ptg dpt text psl result, tp tk perasan. G keluar beli makanan dgn kak see. Sibuk2 lps buka puasa br perasan msg. cuak sgt2! Palpitation. Try bukak internet kt hosp, application block. Tunggu la reply derg text kn result sambil2 triage dgn abg faezal. Rase jantung nk meletup.  Alhmdulillah lulus. Lega. Syukur sgt2. Alhamdulillah. Sungguh smlm rase sgt bahagia. Dpt buat T&S kt hand, buat ABG. and officially final year in med school. :’)

masa nk buat ABG td. Latep tanya nk buat tk? Nk. Tp org tk pernah lagi amik ABG. latep sediakn syringe n terus bg kt org. Kena buat muka confident je dpn pt tau. Rase kelakar wktu ni sbb latep ckp berbisik kt org mbelakangkn pt. terus pergi dgn confidentnya kt pt. and he let me do all alone. Oh my. Cool hani, cool.
The technique, rase radial pulse yg plng kuat and insert needle 90 degree. Its deeper than vein, agak2 je. 1st attempt masukkn tk terus dpt, jgn pull out the syringe, kena godek2 dlm tu, gerakkn needle to all direction. then latep dtg tlng guide. Kalau hit the right spot, akan ada rapid back flow of red cherry blood. Beza dgn vein dark red blood and back flow vein tk laju sgt mcm artery. I got it.! And pull off the syringe to get few mil of arterial blood. Oh my! I did it on 1st attempt! Bangga sgt seronok.

minggu ni serious byk post mortem. bak kate hj yunus, murah daging minggu ni. lol. da ade 3 case, n smlm je pg ptg case masuk. PTB n lg satu lung infection jgk. still.. tk ready lg nk tgk. rase rugi bile dgr staff cerita, tk pernah tgk keadaan lung yg putih sampai mcm tu. kalau tgk dlm jar tk la real mcm yg fresh punya, combo dgn bau sekali kn. and ade case MVA motor kena langgar dgn kereta. da jatuh, lori pulak langgar. dgr pun scary. body memang da hancur, dr lum kate tk jumpe tulang yg tk patah. huhh.


Day 10: last day. Hari plng busy. Sungguh. Pg dgn dr lee. Ptg dr samirah. Non stop jona. Dr pagi- tgh hari non stop. Then lps asar jona blk sampai mlm. Tk menang tangan. Chaos. Katil penuh. Dgn prisoners, pt kena intubate, pt PSY. Byk plak tu pt kena intubate sehari ni; ade baby and org tua. Ble ade pt kena intubate tu yg plng busy. 4-5 staffs kena work on that pt. staffs pun bukn ramai sgt, satu shif ade 6-7 org je campur MA, nurse and PPK. Memang busy. Kena intubate, masukkn byk line, cbd, ecg, riegel’s tube, did all blood test, close monitor of the pt. Dua2 specialist int med pun turun ER. 4 doctor sekali work on that pt. tk follow case sgt, sbb CVS.

Tp puas hati.! Sehari  ni dpt buat semua. Sterile cbd insertion on male pt, ecg, suture on dorsal of hand, amik blood,  IM ATT tramal, voltaren, IV hydrocort, supp, check DXT.. Semua on my own. Tp masuk branula td byk kali failed. ble case masuk confident je terus pergi kt pt nk set line, tp tk dpt. Ceit. Pastu kena mintk tlng MA/nurse. abg shidi kate yg penting kena btenang. Nmpk sgt clumsy. Plng best kalau nk belajar dgn abg shidi. Tanya A, abg shidi akan jawab A,B,C,D. MA ade senior n muda br2 lg. senior cm mls nk layan student sgt and tk berani nk tegur jgk. tp da knal actually derg ok je. Abg israr, abg faezal, abg din.. td abg hafeez suruh buat continuous suture kt palm. Tp tk nk sbb tk reti nk matikn last notch. tk pernah try lagi buat simple continuous kt real pt, biasa buat simple interrupted je. Ble da siap menyesalkn tk nk buat. Rugi2.


A&E was awesome.! Sungguh lg byk belajar dgn MA and nurse. Just be humble and confidentThank you all the staffs.Abg shidi, abg faezal, abg din, abg israr, abg hafeez, abg shukri, pakelah, syafiq, abg azli, abg zul, abg khairol, latep, cik hisam, cik zuki, hj yunus, kak zira, kak see, kak suhayati, kak suhaida, kak shanty, abg sardi, asrin, kak nirmala, kak azizah, kak linda, abg amir, abg roslee, amir aysraf. Dr nanthaa, dr tan, dr mikraz, dr lee, dr Chandra, dr Alvin, dr samirah, dr thirucelvi, dr lum, dr siva.  You guys are awesome!

Berakhir la most hectic 2 weeks of my summer hols. Drive 50km and spend 12hours at hosp almost every day. Exhausted and fun. Gain a lot of clinical skills and confident. And totally worth it.! Priceless.  I start missing them already.

last night. pakelah-kak su-kak see- latep- abg shukri kt blkg - kak azira.

kaksu- kak see- abg hafeez.
*credit all pics to pakelah

Saturday, September 17, 2011

MALAYSIA

summer hols~ 5 weeks holiday in malaysia. home sweet home.

1st 2 weeks da habis raya. hbskn masa dgn family. ziarah sanak saudara, seronok ble dpt jumpe family semua. 1st week blk hr tu tk rase sgt, serious bosan. nk pulak br 2nd day sampai malaysia accident. haaa! sape suruh drive jauh2 mula2 sampai. kereta teruk. trauma skjp. skjp je. 2nd day raya baru full house semua org ade kt rumah. ble semua family berkumpul, perasaan tu, priceless~ n last week jumpe shbt handai, g wedding joe & dhana. seronok. congrts guys. korg sgt cantik. :)

n skrg spend 2 minggu elective kt emergency department hosp banting. 12-23 sept. it is awesome! laju je masa berlalu hbs da seminggu. staffs sgt cool. almost everyday 8am-8pm kt hosp. penat but totally worth it.

enjoy the hols guys!