Tuesday, May 21, 2013

of viva


so 1 down. 5 more to go. mcm da hbs medical terus je kn. heee. at least 75% done.  a month left in medical and tinggal utk completekn log book and oncall saja lg.

so far rase dipermudahkan juga because my examiner are Dr N and Dr R. when i saw my name with them, partially relieved because everybody said they're very nice.

and yesterday i have like worse dysmenorrhea ever. 1st dysmenorrhea so far at work. i completed my job at 11am and sleep all afternoon cant bare with the pain and nausea as well. urghhh. go back home sharp at 4 and continue sleep till night. i dont know when i open my book and read. and the pain still does not relieved till i come to work today. really, im so not ready for viva today. with pain and hypo as well this morning.

and Alhamdulillah only 10pts in ward today, other than regular boss did round and she did very fast. double relieved. 3 of my pt kiv discharged pm, none of them hv big issue. so then nothing much for me to do in the morning.
and thanks to my teammate cover and did my job in ward and help me revise for viva today.

I wish they postpone the exam, but then get a phone call confirm viva at 2pm today at SACC building. there are 5 of us in the same group. before starting, the examiner asking us, do u want examine 1 by 1 or all of u want to enter together. so we decided to enter all together. less anxiety and maybe we can help each other. so all 5 of us sit side by side and being examine 1 by 1 in the room.

im the 2nd person. i got ecg and ask to interpret it. it was extensive ant MI with ST elevation in v2-v6. and further question are how to manage; just tell everything about the drugs and dose, precaution in streptokinase, absolute and relative CI, complications, SE. and last questions, complications of MI.
honestly, im not very fluent answering those questions, few err... and.. i just did my best.

my other colleague got COPD, mx , organisms and choice of antibiotics. VT and the mx. drugs and SE of anti TB medication. malaria. another ACS. and BA.

our examiner are very super duper nice. all of us pass.
though honestly i think we answer fairly enough. not really very well. and we just borderline pass.
sokay, at least we pass.
they even said, we're here not to fail you. and we dont want to give you a pressure.

thank you very much Drs.


so now hv to read. read. and read.
pass viva doesnt mean i'm a good doctor. still hv a lot to read and learn.

and reminder..
dont let ourself be a unsafe doctor.

Tuesday, May 7, 2013


got 1 pt. i clerk her yesterday.

38yo/MALAY/LADY. underlying ?schizo/ substance induced psycosis, RVD +ve with co-infection hep C,  EX IVDU on methadone therapy. presented with fever, lethargy, nausea, vomiting x1, dysuria, loss of appetite and abdominal pain for 4 days. otherwise no URTI symptoms.  urine dipstick leukocyte 3+ and blood 2+.
so we treated her for AGE and UTI.

i took all blood ix and start treatment appropriately. pt is a afebrile but noted that blood pressure is persistently borderline low. 90/60. run fast 1 pint NS and give IVD and monitor the vital hourly and to inform if persistently drop KIV to start inotrope.

that pt was not in my cubicle. i only clerk her. so, ok settled the case.

today this morning, that particular pt, developed respiratory distress. SPO2 85-90% under RA. upgrade to VM 60% still low about 90%.  abg stat O2 saturation 87%.

so they decided to transfer her to acute cubicle.

since i know the case, so my colleague pass over the case to me.

they conclude that pt may developed iatrogenic pulmonary oedema dt fluid overload because urine output only 500cc leaves positive balance positive 2500cc.
later then did CXR. it is fairly clear. only borderline cardiomegaly no pulmonary oedema.
SPO2 improved 97% on high flow mask. otherwise pt not complain of SOB at all. but BP still low.
noted Cr 470 WBC 24 and Hb 7.9.
so she's already immunocompromissed with underlying infection with sepsis, anemia, ?AKI. ?PCP (pneumocystic carinii) and hv hx allergic to bactrim.

she frequently defaulted TCA of HAART treatment and developed resistant already. now awaiting  for NGO support to start 2nd line treatment because the drugs are expensive. obviously she's not even care of herself. but now seek for medical advice and i hv to took care of her.

since the pt has hx of allergy to bactrim, referred her to infectitious disease team hosp Sgbuloh for further mx and they suggest to treat her with quinolone.
then.. she developed thrombocytopenia on quinolone, plt drop from 130 to 20!.
so hv to checked again her medical record, digging all her hx and medical record from GP and other hospital to get further information of allergic hx because leave other choice to start with bactrim again for treatment of PCP.

i wouldnt mind at all.(denial) but thinking of she's RVD +ve and ex-IVDU and MALAY LADY, made me feel so mad. try not to be judgmental but cant help myself. i dont think she deserve a treatment.

my bad. :(


i feel so mad at myself of being mad to her.

astaghfirullahalazim. :/

Friday, May 3, 2013


im incharge of acute cubicle this week; a cubicle of critical pts in the ward.

lega minggu ni table4. cuma 1hari oncall and 1hari blk pkl 10, the rest of the days blk pkl 4. risau kalau oncall jg acute. sbb tinggal sorg, u're the person in-charge, only u know the pt's details and anything can happened to the pts.

ade satu hari, full beds in acute, all 8 beds. and ALL of them are DIL (death in line), awaiting time to death. like their conditions already deteriorate and in pretty bad condition. only either AR or NAR from our side. (active resuscitation/ non-active resuscitation). either we have to do everything all the intervention we can to save them OR just give supportive management and let them go peacefully because of poor prognosis and unable resume to previous health if they recover. half of them opt for NAR. brain stem infact, septic shock, brain hemorrhage only for conservative mx, stroke, sepsis 2ry HAP with steven johnson syndrome resistance to acinobacter, CCF with AKI on top of CKD, cardiogenic shock, DKA with CVA.

and on this one afternoon all of sudden 2 pt desat while another 2 pt asystole. my 1st time wrote 'a death entry'. a pt of my colleague and he went home post call already. i just review her 15min ago with specialist and when the nurse want to take vital, BP is unrecordable. pt is AR. did CPR. 20min. still asystole. called MO and pronounced time of death.

so finished already 2weeks in acute.

im proved myself im not jonah. non of my pt died in my hand so far i'm in ward 24. haha.
instead there is 1 chronic pt hv been in ward for A MONTH. already issued DIL and AR. more than 2weeks she's in acute cubicle. lots of issues. AKI on top CKD require HD, CCF, NCNC anemia, HAP, sepsis, breast lump TRO breast Ca. she still unable to wean off O2. initially with BiPAP and when i take pass over still on HFM. under my care so now she's been transfer out from acute cubicle and currently on nasal prong. nothing much to be proud of. but just happy for myself because i take good care of her. ;)

as in acute, hv extra HO than other cubicle and 1st cubicle boss do round in the morning. so max 2pt per HO, boss start round at 7am and by 8am usually im jobless. :p but depends on boss. if u know ur pt thoroughly and u did ur job, boss tk marah, and round hbs cepat la kn.
and i made a plan for my pt. yes. making plan is a big thing. which meds to off or add on. how many fluid we want to give. should or should not increase the dose. need to refer to other specialty or not, etc.
so in morning review, i just put my thought wht i think the best mx for that pt and ask boss during round whether to carry on that plan or not. though usually it is insufficient and boss yg tambah lg plan byk2. but sokay. at least i did sumthing right.

happy. gain much more confident now. :)

Thursday, May 2, 2013


escaped. somehow its therapeutic.


lol im too lazy to write an entry.