:(
Tuesday, October 04, 2011
Sunday, October 02, 2011
RESPIRATORY
Alhamdulillah, I completed 5 weeks of Respi last Wednesday, plus I got 2 days leave after that. What a beneficial experience, and great knowledge I had obtained. My specialist is my own supervisor, at least she knows me, knows my capability. I feel comfortable working with her, she is a young specialist, perhaps her pathway in her career was smooth. We were oncall together a few times, and we felt comfortable and easy working with each other. My consultant is a Kelantanese modern Malay woman. She is unique, can be nice and can be stunning as well. During oncall, all the MOs and HOs are afraid of her especially during rounds. That day she ignored the new MO (as she was unable to present the case and didn't know how to prescribe the right antibiotics) and asked me to present the case. I heard she is usually okay with house officers.I did learn something important from her : "remember your case well".
My MO...uh,hard to say about her.She had always been on leave, leaving me alone doing her job and my job. People said she is @#$%^ but with me she seems okay, she trusted me and told me her personal feelings. She warned me earlier if specialist was in bad mood. She needed my help in translating to Malay several times, I needed her help in inserting difficult branula several times.Yet, everyone was horrified by the way she poked the patients.The nurses said, even HOs are better aka more humanly...
I learnt about the metered dose inhaler...from salbutamol, to budesonide, seretide, flixotide etc. From simple MDI to easyhaler e.g. giona, buventhol etc...nebulisation - from 0.5:3.5 salbutamol to AVN to budesonide 1 mg BD. I listened to all kind of lungs - crepitations, ronchi, biphasic stridor (prolonged inspiratory sound), wheeze, prolonged expiratory phase etc. Learnt about anti reflux for GERD - omeprazole, ranitidine, domperidone...learnt about sleep study and pH study...learnt about BIPAP - the IPAP/EPAP, rate and oxygen..went to radiology department many times to get barium swallow appointment and HRCT appointment...counting respiratory rate every reviews..
All patient under respi follow up who presented to casualty will be admitted, they are chronic patients, so better be safe than sorry, admit them for at least one day, then discharge the next day if well.My specialist called me lucky as I discharged many chronic patients once I joined the team the week before Raya.But I was the one who suffered to finish the long and complicated discharge summaries...Also the stacked of census in clinic...unsure who will do it next month as there will be no more HO in respi...
My favourite respi patient, Adam currently just re-admitted for aspiration pneumonia...poor that cute little baby.So adorable, I feel like hugging him, of course I can't do that...My second favourite is of course Cingi, who was acutely unwell and pushed into PICU when I was oncall there for the first time. Now she is very well in the ward, so friendly, she likes to touch people's hands and always smiles..
My good friend took over respi for 2 days when I was on leave, and she had been complaining about the workload and environment to my other good friend. I thank her for her presence, but imagine, how I suffered for the past one month, being alone and stress?? Despite all the hardships, I considered lucky for not being sent to oncology or nephrology...because that is even more difficult.
Thank you Allah, tomorrow I'll start general medicine with most of my good friends in the same ward with me :) And tomorrow I am going to be oncall and off the next day. Now we have new rules, whoever oncall, tomorrow will get day off after pass over to the morning persons.So now we work for 24 hours, no longer 36 hours.They can't practice the shift system, so this is the best they can do...
My MO...uh,hard to say about her.She had always been on leave, leaving me alone doing her job and my job. People said she is @#$%^ but with me she seems okay, she trusted me and told me her personal feelings. She warned me earlier if specialist was in bad mood. She needed my help in translating to Malay several times, I needed her help in inserting difficult branula several times.Yet, everyone was horrified by the way she poked the patients.The nurses said, even HOs are better aka more humanly...
I learnt about the metered dose inhaler...from salbutamol, to budesonide, seretide, flixotide etc. From simple MDI to easyhaler e.g. giona, buventhol etc...nebulisation - from 0.5:3.5 salbutamol to AVN to budesonide 1 mg BD. I listened to all kind of lungs - crepitations, ronchi, biphasic stridor (prolonged inspiratory sound), wheeze, prolonged expiratory phase etc. Learnt about anti reflux for GERD - omeprazole, ranitidine, domperidone...learnt about sleep study and pH study...learnt about BIPAP - the IPAP/EPAP, rate and oxygen..went to radiology department many times to get barium swallow appointment and HRCT appointment...counting respiratory rate every reviews..
All patient under respi follow up who presented to casualty will be admitted, they are chronic patients, so better be safe than sorry, admit them for at least one day, then discharge the next day if well.My specialist called me lucky as I discharged many chronic patients once I joined the team the week before Raya.But I was the one who suffered to finish the long and complicated discharge summaries...Also the stacked of census in clinic...unsure who will do it next month as there will be no more HO in respi...
My favourite respi patient, Adam currently just re-admitted for aspiration pneumonia...poor that cute little baby.So adorable, I feel like hugging him, of course I can't do that...My second favourite is of course Cingi, who was acutely unwell and pushed into PICU when I was oncall there for the first time. Now she is very well in the ward, so friendly, she likes to touch people's hands and always smiles..
My good friend took over respi for 2 days when I was on leave, and she had been complaining about the workload and environment to my other good friend. I thank her for her presence, but imagine, how I suffered for the past one month, being alone and stress?? Despite all the hardships, I considered lucky for not being sent to oncology or nephrology...because that is even more difficult.
Thank you Allah, tomorrow I'll start general medicine with most of my good friends in the same ward with me :) And tomorrow I am going to be oncall and off the next day. Now we have new rules, whoever oncall, tomorrow will get day off after pass over to the morning persons.So now we work for 24 hours, no longer 36 hours.They can't practice the shift system, so this is the best they can do...
Saturday, September 24, 2011
Alhamdulillah
Semalam tubuhku meronta meminta rehat,selepas minggu dan hari yang panjang. Subhanallah, aku masih lagi bernafas dan bergerak despite "penderaan" yang dialami sepanjang minggu ini. Esok adalah my third Sunday call, thanks to my SHO,aku takkan lupakan "jasa"mu itu. Sepanjang minggu ni memang sibuk yang amat, untuk duduk pun aku berkira, kerana berharganya setiap saat itu. Isnin dan Selasa aku menghadiri NRP, alhamdulillah, pengalaman standby dan oncall banyak membantu memberikan keyakinan dan kemudahan semasa megacode itu, dan aku juga berjaya lulus semua ujian bertulis. Hard life began again hari rabu itu walaupun consultant tiada, kerja tetap banyak, lebih-lebih lagi apabila MO selalu lepas tangan. Semalam semasa di klinik, depan-depan aku consultants bercakap mengenai MO itu. Aku diam sajalah, tak perlu aku nak komplen pun mereka dah tahu.
Hari Rabu...syukur Alhamdulillah...hari yang membuatkanku tersenyum. Aku pulun buat kerja cepat-cepat supaya tak perlu stay back late after work. Pukul 5.30 aku dah chow selepas solat Asar. Pandu sendirian ke USM, menghadiri konvokesyen seorang kenalan. Sepupuku dan suaminya juga ada di situ.Rasa tenang dan hilang stress sebentar dapat berbicara dan makan sama-sama.Terima kasih Allah kerana mengurniakan nikmat bahagia itu walau hanya sebentar, kerana ia amatlah memberi makna. Semoga jalan itu yang terbaik...
Khamis...oncall lagi, kali ni di neonatal ward. Considered a good call, able to sleep well (due to exhaustion, jarang tidur lena masa oncall), until the nurse woke me up at 4.50am to attend a tachypnoiec baby.Then, the next day aku buat rounds berdua dengan consultant as my specialist and MO tak ada..
Semalam post call, penat bukan main lagi, tidur awal, rugi betul masa tidur waktu perdana.Esok oncall lagi...I am so gonna dislike the SHO, biar Tuhan saja membalas perbuatannya. Dia senang-senang ambil cuti, orang lain suffer. Aku bermanis muka dengannya selama ni pun mengenangkan kita saudara seagama. Astaghfirullah...
Lepas ni mungkin nak singgah ke Popular sebentar, ada pre-renovation promotion. Tapi yang kelakarnya boleh dapat free RM10 voucher with purchase of RM200 and above. Ceh..tak berbaloi langsung.Juga ingin membeli jam baru untuk ayah yang kehilangan jam tangannya...nak tunggu birthday lambat lagi pulak.
Minggu depan ada klinik one week stretch, Monday to Thursday...patutnya aku habis rotation Respi semalam, tapi specialist minta extend sebab tak mahu orang baru masa busy clinic days..walaupun aku kata nak minta cuti Monday and Tuesday, dia siap cadangkan aku cuti Thursday and Friday. Wahhhh...terseksalah aku lagi...tak tahu sama ada nak gembira sebab mereka suka cara kerjaku sebab tu tak nak lepaskanku atau pun nak sedih sebab masih stuck di lubuk yang kacau itu...oh ya, memandangkan aku berdepan respi patients everyday, aku pun kini dah menggunakan MDI Salbutamol as per PRN basis. Kerjaya begini memang banyak risiko..but still ramai yang pandang sebelah mata dan langsung tak appreciate. Surgical department dah mula shift system dengan jayanya...one day am, one day pm, one day off..nikmat betul. Other departments still struggling nak susun jadual, termasuk departmentku yang dah beberapa kali meeting tapi tak settle pun, nak buat macam mana kalau dapat consultant in charge yang mulut aktif tapi buah fikiran kurang aktif...
Banyak betul komplen,cubalah bersyukur lebih banyak. Bukankah ada banyak lagi nikmat di depan mata yang Allah dah beri?
Tuesday, September 20, 2011
Dracula call
I am postcall, a dracula NICU call, yet I am still awake and studying through the NRP book. There is going to be a Megacode tomorrow, and after that, either I pass or fail, I'm going to return to the busy Respi team. Despite the "labour" work during oncall yesterday, I was happy when the O&G nurse told me that I looked thinner. :) After a few weeks of torturing job, who wouldn't be thinner? No meals and just jobs...exercise and dieting are no longer needed. Last Thursday I only started my call at 6.30pm after finishing my Respi tasks and so my call continued till the next morning without any piece of food entering my stomach since morning. The same exact scenario occurred yesterday, where I was totally "full" after continuously "sucking" bloods from the patients.Plus other days that I was not oncall but still went home late with empty gastric cavity.
Hopefully everything will go well during NRP tomorrow, after a hard time in ACLS before.
Since many of them have already settled, it is time for me to think about it seriously. The hope is still there...Allah, show me the way, and make me steadfast living under Your Love...
Hopefully everything will go well during NRP tomorrow, after a hard time in ACLS before.
Since many of them have already settled, it is time for me to think about it seriously. The hope is still there...Allah, show me the way, and make me steadfast living under Your Love...
Sunday, September 04, 2011
Salam Aidilfitri
Esok kerja....
Alhamdulillah cuti seminggu telah berlalu.
Segala suka-duka menyambut lebaran telah dilalui.
Murah rezeki kami tahun ni dikunjungi ramai tetamu, kerana kini Tok tinggal bersama kami.
Juga satu cabaran besar buat kami menjaga seorang warga tua, menuntut kesabaran dan kecekalan yang amat tinggi.
Beraya sebagai orang bekerjaya, dapat menghadiahkan duit raya kepada sanak-saudara..
Jika merasa diri ini susah, ada orang lain yang lebih perit lagi
Jika merasa diri ini sepi, ada orang lain yang lebih sunyi lagi
Jika merasa diri ini sedih, ada orang lain yang lebih sadis lagi
Maka bersyukurlah dengan nikmat Allah, kerana setiap orang itu mendapat nikmat yang berbeza, walau suka,walau duka, semuanya adalah dugaanNya.
Keinginan yang terpendam tetap bermain dalam rahsia hidup
Semoga Tuhan mendengar doaku untuk menjadikannya satu kenyataan
Harus tabahkan hati untuk menempuh segala cabaran
Jika mereka boleh, diri ini juga pasti boleh
Harus teguh berdiri, yakin akan janjiNya
Salam Aidilfitri
Maaf zahir dan batin
Berhati-hati di jalanraya
Selamat bekerja semula
Jadikan hidup dan mati hanya untuk Allah
InsyaAllah yang lain-lain akan menyusul
Tuesday, August 16, 2011
Ramadhan Yang Berlalu
Sudah separuh Ramadhan berlalu. Ini yang pertama sejak bergelar seorang pekerja. Seribu satu peristiwa berlaku dan bakal berlaku di bulan yang mulia ini.
Hari pertama Ramadhan aku hanya bertolak pulang ke rumah pada pukul 7 malam. Mujur sempat sampai sebelum waktu berbuka. Bagai mahu menangis rasanya waktu itu. Pukul lima baru MO nak buat census rounds, partnerku yang non-Muslim tu pula kena pergi oncall, jadi terpaksalah aku tinggalkan case yang aku admit itu untuk ikut rounds. Lepas rounds, kena handle case tu, berlambak-lambak darah kena ambil, dah la patient tu chubby.Mujurlah rakan oncall malam itu memahami dan bersedia untuk menolong.Tak sempat hendak bermain puas-puas dengan si Aliff yang semakin tinggi dan tegap itu.
Beberapa hari yang awal memang rasa amat penat. Betapa seronoknya Ramadhan tahun lalu, tak perlu fikir pasal hal lain. Tarawih di sini Alhamdulillah, pihak surau menjemput Ustaz muda yang Hafiz, sedap suaranya membaca ayat-ayat al-Quran.Masih 20 rakaat, habis dalam pukul 10.40 malam.
Pada hari keenam puasa, mak pula yang kena pneumonia, masuk ward selama enam hari. Agaknya jika hari tu aku pergi private hospital, mesti kena admit juga. Sampai sekarang aku masih batuk-batuk lagi.CXR ku ada bilateral haziness tapi pneumonic changes tak obvious pun. Kata consultantku, ramai kakitangan seperti kami terkena atypical pneumonia. Dah complete one week augmentin, aku minta consultantku sign untuk second cycle, tapi dia bagi azithromycin sebab aku tak demam dah.
Jadi selama enam hari itu, aku berulang alik ke hospital pergi visit mak tiap-tiap malam lepas berbuka. Abang and family datang visit petang sabtu itu juga lepas aku maklumkan. YB dan wife pula datang dari KL, sampai Penang lepas waktu berbuka.Esoknya aku oncall pula, tapi busy sangat sampai tak sempat nak rasa sedih sebab tak dapat visit mak. Dari pagi aku sampai, sampai esok pagi, admission non stop!!!Aku geram betul dengan certain parents yang tak faham-faham lagi pasal kepentingan kesihatan anak-anak.
Waktu berbuka, adalah satu admission, non-Muslim (manalah dia tahu itu waktu berbuka,kan). Habis saja waktu berbuka, berduyun-duyun admissions melibatkan Muslims. Semua ibu bapa ini pentingkan perut mereka, lepas berbuka baru bawa anak datang hospital, padahal anak dah sakit berhari-hari. Ada tu bawa anak untuk admit pukul 4 pagi, padahal surat admit dah bagi pukul 9 pagi hari sebelumnya, bila ditanya, si ayah jawab, nak tunggu buka puasa dulu, tengok anak okay saja. Bagai mahu putus telinga aku dengar, suka hati saja buat keputusan begitu, padahal anak tu tak puasa pun. Mungkin dia sedar aku nak marah, cepat-cepat dia minta maaf sebab lambat bawa anak admit.Tak jadi aku nak marah. Ketahuilah wahai ibubapa, jangan buat keputusan sendiri, bila doktor suruh admit, admitlah segera, dan tahukah anda bahawa pada waktu malam, bilangan doktor adalah kurang, dan doktor yang penat dan mengantuk akan meninggikan risiko melakukan kesilapan?Akhirnya aku dan oncall partnerku tak tidur langsung selama 40 jam lebih, thanks to the parents...
Esok Nuzul Quran, cuti umum di sini tapi aku perlu oncall, thanks to the monitor yang tak sensitive soal agama, I hope masa your time nanti, you have to work because you did not request for no calls and the person incharge is not aware.Dah la first time oncall di PICU, dengan specialist yang begitu pula. Lepas ni EOD call, minggu depan start subspecialty.
Kecoh di surat khabar semalam dan hari ni pasal ex-majikan aku. Penulis bagai membuka pekung department itu, daripada oncall list yang tidak sekata (tapi kononnya disemak oleh specialist sebelum diluluskan), kepada specialist yang berpakaian seksi sampailah specialist yang suka cakap Cina masa rounds.Semuanya aku tahu siapa.Tak mahu komen banyak, biarlah mereka sedar sendiri.
Bulan depan akan start shift system, tadi aku dan rakan-rakan duduk semeja dengan consultant cuba susun jadual kerja.Tak nampak advantage sangat pun, seriously they need to study from overseas first before implement it.Tunggu dan lihat sajalah.
Semoga Allah permudahkan urusanku...
Hari pertama Ramadhan aku hanya bertolak pulang ke rumah pada pukul 7 malam. Mujur sempat sampai sebelum waktu berbuka. Bagai mahu menangis rasanya waktu itu. Pukul lima baru MO nak buat census rounds, partnerku yang non-Muslim tu pula kena pergi oncall, jadi terpaksalah aku tinggalkan case yang aku admit itu untuk ikut rounds. Lepas rounds, kena handle case tu, berlambak-lambak darah kena ambil, dah la patient tu chubby.Mujurlah rakan oncall malam itu memahami dan bersedia untuk menolong.Tak sempat hendak bermain puas-puas dengan si Aliff yang semakin tinggi dan tegap itu.
Beberapa hari yang awal memang rasa amat penat. Betapa seronoknya Ramadhan tahun lalu, tak perlu fikir pasal hal lain. Tarawih di sini Alhamdulillah, pihak surau menjemput Ustaz muda yang Hafiz, sedap suaranya membaca ayat-ayat al-Quran.Masih 20 rakaat, habis dalam pukul 10.40 malam.
Pada hari keenam puasa, mak pula yang kena pneumonia, masuk ward selama enam hari. Agaknya jika hari tu aku pergi private hospital, mesti kena admit juga. Sampai sekarang aku masih batuk-batuk lagi.CXR ku ada bilateral haziness tapi pneumonic changes tak obvious pun. Kata consultantku, ramai kakitangan seperti kami terkena atypical pneumonia. Dah complete one week augmentin, aku minta consultantku sign untuk second cycle, tapi dia bagi azithromycin sebab aku tak demam dah.
Jadi selama enam hari itu, aku berulang alik ke hospital pergi visit mak tiap-tiap malam lepas berbuka. Abang and family datang visit petang sabtu itu juga lepas aku maklumkan. YB dan wife pula datang dari KL, sampai Penang lepas waktu berbuka.Esoknya aku oncall pula, tapi busy sangat sampai tak sempat nak rasa sedih sebab tak dapat visit mak. Dari pagi aku sampai, sampai esok pagi, admission non stop!!!Aku geram betul dengan certain parents yang tak faham-faham lagi pasal kepentingan kesihatan anak-anak.
Waktu berbuka, adalah satu admission, non-Muslim (manalah dia tahu itu waktu berbuka,kan). Habis saja waktu berbuka, berduyun-duyun admissions melibatkan Muslims. Semua ibu bapa ini pentingkan perut mereka, lepas berbuka baru bawa anak datang hospital, padahal anak dah sakit berhari-hari. Ada tu bawa anak untuk admit pukul 4 pagi, padahal surat admit dah bagi pukul 9 pagi hari sebelumnya, bila ditanya, si ayah jawab, nak tunggu buka puasa dulu, tengok anak okay saja. Bagai mahu putus telinga aku dengar, suka hati saja buat keputusan begitu, padahal anak tu tak puasa pun. Mungkin dia sedar aku nak marah, cepat-cepat dia minta maaf sebab lambat bawa anak admit.Tak jadi aku nak marah. Ketahuilah wahai ibubapa, jangan buat keputusan sendiri, bila doktor suruh admit, admitlah segera, dan tahukah anda bahawa pada waktu malam, bilangan doktor adalah kurang, dan doktor yang penat dan mengantuk akan meninggikan risiko melakukan kesilapan?Akhirnya aku dan oncall partnerku tak tidur langsung selama 40 jam lebih, thanks to the parents...
Esok Nuzul Quran, cuti umum di sini tapi aku perlu oncall, thanks to the monitor yang tak sensitive soal agama, I hope masa your time nanti, you have to work because you did not request for no calls and the person incharge is not aware.Dah la first time oncall di PICU, dengan specialist yang begitu pula. Lepas ni EOD call, minggu depan start subspecialty.
Kecoh di surat khabar semalam dan hari ni pasal ex-majikan aku. Penulis bagai membuka pekung department itu, daripada oncall list yang tidak sekata (tapi kononnya disemak oleh specialist sebelum diluluskan), kepada specialist yang berpakaian seksi sampailah specialist yang suka cakap Cina masa rounds.Semuanya aku tahu siapa.Tak mahu komen banyak, biarlah mereka sedar sendiri.
Bulan depan akan start shift system, tadi aku dan rakan-rakan duduk semeja dengan consultant cuba susun jadual kerja.Tak nampak advantage sangat pun, seriously they need to study from overseas first before implement it.Tunggu dan lihat sajalah.
Semoga Allah permudahkan urusanku...
Tuesday, July 26, 2011
Working Pneumoniac
I have been loading myself with tonnes of medication for the past two weeks, only to find out that I've been suffering with pneumonia. Last weekend, I was feeling so unwell that I almost escape the ACLS course (which I should have done). The venue was too cold, really making my condition worse. I felt like switching off the air conditioner, for the sake of everyone.
Yesterday my temperature came up and I was having headache as I was coughing too much. I started doing census and standby, which means, whenever they call for neonatal resuscitation, I have to run and be there on time. At night, I was oncall for standby again, luckily they changed my call from C1 to passive call. I considered I had a good call, only 3 babies needed standby. But, at night, during my semiconscious state, I coughed and coughed and coughed badly, I even gasped for breath, that's according to my oncall partner.
That is why this morning I decided not to be strong anymore, I asked for leave from my MO, went to OPD to get checked up, tested my blood to rule out dengue, got my medication, got my 2 days MC and went home. My FBC did show dengue picture but my WBC and neutrophil are slightly raised. My temperature was 39.3 and I had some crepitations over left lower zone. So, diagnosed as pneumonia.Given Augmentin to complete 1 week.
To my surprise, two of my good friends are having sick leave too, one for fever, another one for conjunctivitis. All of us are unwell at the same time.I am glad that I got sick leave for today and tomorrow, because for the past two weeks I have been working like zombie, with no off at all, thanks to the ACLS course which took my weekend completely away.
Now after two doses of Augmentin, my cough is still bad with on and off dyspnoea but temperature has gone down. I let myself to sweat a lot to get the fever down as previously I was shivering constantly while others were feeling warm.Now I have to do chest physiotherapy and learn to spit out the phlegm.
May Allah cure me and forgive my sins.
Yesterday my temperature came up and I was having headache as I was coughing too much. I started doing census and standby, which means, whenever they call for neonatal resuscitation, I have to run and be there on time. At night, I was oncall for standby again, luckily they changed my call from C1 to passive call. I considered I had a good call, only 3 babies needed standby. But, at night, during my semiconscious state, I coughed and coughed and coughed badly, I even gasped for breath, that's according to my oncall partner.
That is why this morning I decided not to be strong anymore, I asked for leave from my MO, went to OPD to get checked up, tested my blood to rule out dengue, got my medication, got my 2 days MC and went home. My FBC did show dengue picture but my WBC and neutrophil are slightly raised. My temperature was 39.3 and I had some crepitations over left lower zone. So, diagnosed as pneumonia.Given Augmentin to complete 1 week.
To my surprise, two of my good friends are having sick leave too, one for fever, another one for conjunctivitis. All of us are unwell at the same time.I am glad that I got sick leave for today and tomorrow, because for the past two weeks I have been working like zombie, with no off at all, thanks to the ACLS course which took my weekend completely away.
Now after two doses of Augmentin, my cough is still bad with on and off dyspnoea but temperature has gone down. I let myself to sweat a lot to get the fever down as previously I was shivering constantly while others were feeling warm.Now I have to do chest physiotherapy and learn to spit out the phlegm.
May Allah cure me and forgive my sins.
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