Waktu Melawat

Seorang bapa datang ke wad pada pukul 8 pagi untuk bersama anaknya yang dimasukkan ke wad hari sebelumnya kerana allergic reaction from insect bite. Si ibu ada menemani anaknya sepanjang malam. Pengawal keselamatan yang setia menunggu di hadapan pintu masuk wad tidak membenarkan si bapa masuk. Belum waktu melawat. Lagipun, si bapa bukanlah ada perkara penting pun, sekadar mahu menemani anaknya. Bukanlah mahu menghantar barang, ataupun mahu mengambil alih tugas si ibu. 

Sejak bermula syif pagi, jururawat telah berpesan kepada pengawal keselamatan itu, agar mengetatkan kawalan di pintu masuk. Wad penuh, tiada langsung katil yang kosong. Setiap pesakit telah ada seseorang yang menemani. Jika ada tambahan orang lagi, keadaan akan menjadi sesak dan sukar bagi mereka untuk bekerja. Bed making, vital signs monitoring, serve medication, ambil darah...itu kerja-kerja pada waktu awal pagi. Doktor pun akan mula rounds waktu itu.

Si bapa tidak berpuas hati, lalu dimaki hamun pada pengawal keselamatan wanita itu. Disebutnya anjing dan kucing. Segala perkataan buruk keluar. Dada didabik, tidak takut pada pengawal, tidak takut pada doktor pun! Bantuan dipanggil melalui walkie talkie. Seorang pengawal keselamatan lelaki datang, cuba meredakan keadaan. Dimaki hamun juga. Pengawal diam, jika dijawab nanti lebih dahsyat jadinya. Telefon dikeluarkan dari kocek, seakan-akan mahu merakam detik hangat itu. Barulah si bapa diam.

Si ibu kembali ke wad dengan linangan air mata. Dikemukakan hasrat kepada doktor, bahawa suaminya nak minta discajkan anak, mahu ke hospital lain pula. Doktor menjawab selembut mungkin, jangan macam ni, mana boleh nak masuk keluar sesuka hati...memikirkan si anak yang dah semakin baik, doktor memberi jaminan bahawa si anak kemungkinan sudah boleh discaj nanti, tak perlu terburu-buru, biar doktor rounds dulu. Si doktor telah terlebih dahulu mengetahui kejadian itu,jadi usah mengeruhkan keadaan lagi.

Cerita penuh diperoleh daripada kedua-dua pengawal keselamatan. Si bapa biadap, hanya kerana tak dibenarkan masuk ke wad. Peraturan ini untuk semua, bukan si bapa saja. Jika orang lain boleh ikut peraturan, kenapa si bapa tak boleh? Mana perginya akal yang waras, budi bahasa yang santun dan agama yang memelihara diri? Semua hospital awam begitu, ada ditetapkan waktu lawatannya. Patuhlah, kecuali jika benar-benar ada hal penting.

Pengawal keselamatan yang buat kerja dengan betul, dimaki hamun dan diherdik. Pengawal keselamatan yang leka dan tidak sungguh-sungguh bekerja, dikatakan makan gaji buta dan tidak boleh dipercayai. Bukankah lebih senang jika kita menghormati pekerjaan masing-masing?

Dalam peristiwa ini, si bapa memang bersalah. 

Dahulu, aku juga rasa bahawa waktu melawat ni sengaja menyusahkan orang. Namun bila diri sendiri mula bekerja,baru aku faham. Betapa susahnya nak bekerja jika wad sesak dengan pelawat. Pergerakan menjadi perlahan, susah nak access kepada patients, setiap perilaku diperhatikan. Memang perlu ada waktu tanpa pelawat untuk petugas membuat kerja. 

Unexpected Friday

Alhamdulillah, started the morning with good breakfast. Gastritis resolved.

23 patients in the ward. The day before, I left the ward with only 13 patients. It seems that my on called colleague just had a good business. Non stop admissions since midnight. He, as usual, will clerk patients one by one slowly, takes his own sweet time, gives the basic management and leaves the rests to other people. Such a lucky guy. Despite his never-serious character, he always survived. His patients were always okay, or a bit unstable but saved by us.

I reviewed a neonate of day3 of life with the intention of helping him. Such a young baby with fever secondary to dehydration. Increased urea, creatinine and sodium. Mother admitted that she stopped feeding the baby the day before due to too tired. Despite explaination and simple management plans, the mother already started asking on discharge. That is not a good sign. I emphasized on supplementary feeding as a form of rehydration, plus mother's breast milk.

Another patient that worried me is another new case in isolation room, treated as pharyngitis. When I told my colleague about the low platelet count, he seemed not worry at all. He is post call, what he thought was only about going back and sleep. Patient is suspected dengue fever. Only 9 months old, clinically quite well. Another FBC was ordered in the afternoon, together with FBP and dengue serology.

Another review of the baby. Mother seemed not keen for the supplementary feeding. I was told that she threw away the feeding. She wanted only her milk. Understandable. Yet, do you think the 46mls formula milk that I ordered was freely available? Do not waste, my dear, just tell us that you do not want it, so we do not have to prepare for your baby. Husband came. Also very keen on discharge. He suggested for discharged today and return the next day for check up. Okay, now parents have become the paediatrician. I told them to continue feeding first and we will discuss this matter with the paediatrician when she comes later in the afternoon. They agreeed and thanked me.

I checked a patient with simple febrile fit, but with very low grade fever. Not warmed. No temperature spike. No abnormal behaviour. It seems that I did not have a good day with febrile fit patient lately. So I better be more careful. The patient next bed is also a febrile fit patient. He looks better, not fretful.

We had an early lunch as we expected to do rounds with specialist during lunch time. Big treats by our staff nurse who is going to other hospital for transfer. She must be very happy. Alhamdulillah, happy for her too. She stays too far away from our hospital and already involved in MVA twice. Such a lucky hospital to have her, a dedicated and hardworking nurse.

I managed to rest and closed my eyes for a while before Zuhur prayer. I came out to the ward right after prayer. Specialist came at 2.45pm and straight away came to me. She scolded me for not completing the MRI parental consent. Boss, did you know that I wasn't the one who took the consent? I just accepted the scolding. No point answering to someone who won't listen.

Rounds started. Dehydrated baby first. She explained about the current condition and blood results, exactly like what I did. The father came quickly. Then they started their own theory and plan. This time, specialist spoke in a very strict tone. Discharge at your own risk, it is a high risk discharge, baby's kidney might stop working, baby might stop breathing. Mother said if any problem arise, she will bring the baby immediately to the hospital. Specialist replied in strict voice, "you need to be informed that if baby is brought in a bad condition, there is nothing much we could do about it anymore." And she repeated it at least twice. Maybe thrice. Wow! I was surprised too that those words came out from a paediatrician. Of course that she was right but its just sounded a bit "loud". Yes, the parents need to know this, they can't just simply make decision for their baby like they are the doctors, at least listen and respect to the knowledge and experince that we have. Oh ya, they did ask the nurse whether I was a houseman or a medical officer. I wished to answer, oh I am just a medical student <sarcastic>. AOR discharge was allowed. I am sure they won't come back anymore. Hopefully we won't get referral from KK for jaundice. Take care of your baby well please.

The second child with febrile fit was very fretful. Non stop crying.Suspected meningitis. Septic work out stat, IV Rocephine and prepare for transfer!
One patient diagnosed as measles. Another wow. From penicillin allergy, to dengue fever, to measles. Patient needs to be isolated stat!

Day 40 of life, admitted early morning, diagnosed as bronchiolitis. He was reviewed in the morning by my colleague ,patient well, tolerated BFOD, no fever, lungs clear. Neb was off, IVD off, diagnosis changed to acute pharyngitis. I didn't see him in the morning until that afternoon rounds. Child was pale, tachypnoiec, laboured breathing, no feeding since morning, SPO2 not picking up. Child in shocked! Child was brought to NICU room for resus. Bolus given.Intubated for airway protection. Someone was so impatient, everything wants as fast as the blink of eyes. It should be a team work, boss, and please be more cool.Very warm room, the air conditioner seemed not working at the wrong hour. Loaded with midazolam, antibiotic and IVD maintenance. One team left to HSJ for the suspected meningitis child.

Results came back. Mild respiratory acidosis. Hb was only 7.4. Bleeding somewhere. Child was pale.Treated as septic shock secondary to pneumonia, TRO meningitis. I was nauseated even before sending the patient. Luckily my colleague came back from HSJ. We "forced" him to accompany this child to HPP. Both patients were reviewed by him in the morning, he should at least be responsible. I'll be on call the next day, so at least I should rest today.

Continued with rounds. My thrombocytopenic patient now treat as dengue. Why I never send her out? She appears okay clinically, vital signs stable. Already sent out so many patients. Like specialist never exists. Patient on close monitoring with repeat FBC coming morning.

Did discharges and notification. Left the ward at 6.45pm. A bit worried about tomorrow. Yet I believe that He will never test me with something that I couldn't handle. Everything happens for a reason. Just do my job with sincerity. InsyaAllah He will guide me along the way. Bismillah, may tomorrow's on call be peaceful.

p/s I wonder everyday, why since we have this permanent boss, many of our cases are very bad, many intubation cases and unstable patients? Is there an outbreak of meningitis? Are the patients over treated or under treated? And I realised that I  have become more dependent, I use my brain less since I have someone to refer to. We'll see how is it gonna happen when she is not around soon.

Headache

Slept 9 hours last night...like a baby. Alhamdulillah for the nikmat. The night before that I only slept for two hours due to headache and some other issues. Almost took sick leave or emergency leave yesterday due to unwell but decided to force myself to work as we were short of staff. Alhamdulillah everything went well yesterday.

Been having headache for the past three days since I sent the infant with meningoencephalitis to PICU. Been thinking perhaps the bacteria or virus had spread to me? My housemate helped me to get tab Ciprobay 500mg stat dose as a prophylaxis. 

Perhaps its only a tension headache... Lack of rest and too much of pressure at work, family problems, adjustment disorder etc...

Pertolongan Allah

La haula wala quwatailla billah...
Ku ulang-ulang banyak kali. Tiada daya dan kekuatan kecuali dengan pertolongan Allah. Allah yang melancarkan perjalanan kami dalam ambulans tadi, sungguhpun aku bertarung dengan rasa pening dan mual yang hebat.

Kelmarin dulu aku sudah rasa tak sedap hati. Bertukar oncall dengan seorang colleague yang MC dua hari kerana laryngitis. Makan tak lalu. Jamuan Tahun Baru Cina anjuran BAKTI aku abaikan. Hanya makan on call breakfast pukul 10.30am. Lunch hour...dapat referral dari labour room. Ada BBA case. Baby not doing well. Grunting, hypothermia dan hypoglycaemia. Terpaksa refer case ke SCN untuk CPAP. Pukul 1 dah di labour room, 4.15pm baru balik ke wad. Uneventful night. Hanya dua admissions, first case at 9pm, second one at 3 am. Even masa solat Subuh aku masih mendoakan yang sama - agar Allah permudahan urusan on call, semoga semua patients stabil dan tiada referral yang pelik-pelik.

7.15am, sedang aku angkut beg keluar dari oncall room, ED MO called, referred a case of 6  year old with cerebral palsy, presented with vomiting and breathlessness. Our regular customer.Aku suruh admit saja. Boss kan ada, dia boleh tengok dulu and decide later either needs to transfer out or not. Mujur aku tak pergi attend that case in ED. Sedang aku duduk review results, patient yang came in at 3 am tu fitted. Attended stat.

Generalised tonic clonic..aborted with IV Valium...for a while. Boss was called. Mujurlah ada team yang sangat bagus pagi ni. From staff nurses, to JM, to sister, to PPK...masyaAllah, alhamdulillah. Patient developed septic shock, and covered for meningitis as well. Surprisingly boss asked to refer Anaesthetic team for intubation. Can't she intubate?

Masa tengah busy resus tu, patient with cerebral palsy tu masuk. Aku terpaksa ignore dia. My colleague yang attended him. Difficult intravenous line, as usual. Tak cukup dengan itu, ada 3-4 admissions that early hours, before we send off patient yang fit tu. Another regular customer, patient with IBD tu pun appeared at the same time. Ibu dia tengok kami semua busy, dia minta diri dulu and promised to come back in the afternoon.

I was at the centre of attention when I took over bagging from my colleague, ready to move the patient to the ambulance. Every eyes in the ward was on us. (I hope) everyone prays that the child will be safe and healthy. Even sister ikut hingga ke ambulance and helped us with all the wires and tubes. The journey was quite fast despite the traffic congestion on Friday late morning.

Aku terpaksa turunkan my facial mask. Perlukan udara untuk bernafas. I knew that I was hunger for oxygen as I kept on yawning. My head was spinning. I was nauseated to the max. My empty stomach was really hurt. My last meal was my lunch at 5.30pm the day before. No dinner. No breakfast. We arrived safely. Patient did not desaturate, only struggled several times, despite midazolam and fentanyl.

PICU was full. Alhamdulillah they managed to arrange a bed for us. Syukur. Warm welcome from the staff nurses. 4-5 of them, happily received our patient. They continuously praised our patient for his cuteness (even though he is sick). Case was presented to Consultant Paediatric Intensivist. Such a cool and calm consultant. She did not even question or scold us for our humble management. She continued most of our plans. She did some history taking from mother. Alhamdulillah, things that she asked were exactly the same with my initial clerking. So I did not miss anything. Patient was well upon admission.

She explained about child's current condition and future near plans to the mother. Also, about the same with what I had explained to the mother prior to transfer. Mother seems to accept it calmly. I did not give wrong information..and I was glad that I did the explanation, and not my boss. Allah made it easy for me, alhamdulillah, subhanallah. Before we left, I whispered to the mother to keep on praying to Allah, she shooked my hands and thanked me. I really hope that she is satisfied with our management and stay strong.

Ya Allah, please heal our little patient, make him back to his healthy life and protect him from any unwanted circumstances. We all love him.

This is the thing that I really don't want to happen during on call. Yet, it still happened. A test from Allah. Allah never tests me with what I couldn't bear. He guided me through and made it smooth for me. Alhamdulillah.

La haula wala quwatailla billah...

Jerebu

I Owe Them

Sabar