Records

Salam!

I got my name recorded again today, but this time I took the effort to store some proof for my future. In this very competitive speciality, you can only do well if you start well. That will be my inspiration. But the main thing is, its always good to know you've been upgraded based on your abilities. I feel proud given this title.

My name in the theatre log book, yes, it is me, not someone with the same name. =)

More to come on this post this weekend. I'm going to make the most of this final week of my surgical placement. Later!

ps: happy birthday to Atiyyah Hishamuddin! A wonderful date to remember: 29/11/2010

My first time

Salam

I wanted to document this yesterday but since it clashed with my lovely sister's birthday, so I thought I'ld do it today instead. Yesterday saw me for the very first time officially assist in surgery. Having the surgical team understaffed for the whole week, it was down to us student doctors to step up to the plate and prove ourselves worthy of the title in a few years time.

As for me, I wasn't quite lucky enough to be part of a highly sophisticated operation as one of my colleague was involved the day before yesterday. Imagine having no experience at all, suddenly you're called up into theatre to assist on a roux-en-Y gatric bygass. It might sound simple, but 4hours minimum on that one operation proved it has a lot more to it than it sounds. Anyway, that wasn't me, that was my groupmate.

My part of the game wasn't even planned. I turned up to Day Case theatre to 'observe' and learn from Mr White and his SpR. Mr White, being an angry surgeon like all surgeons are, started barking around asking where the cameraman was if there was going to be any. Unfortunately, being understaffed, there wasn't going to be one. His piercing gaze landed on my partner and I and as I anticipated: "So, which one of you is going to scrub up?"

To be honest I almost jumped at that question, rearing to go before my partner volunteered. But out of the spirit of teamwork and respect, I played it down a bit and looked at her. "You can go if you want", I uttered quitely despite knowing my partner has no interest whatsoever in a surgical carreer and the fact she hates standing in theatres. "Don't act, I know you're jumping to go", she said back with a wry smile. Mission accomplished.

Anyway, I got scrubbed up, gave my details to be recorded in the operation notes and also into the system. She briefed me what she was going to do (the SpR is a she). I nodded my head as if everything was new to me, her not knowing the fact that I've been talked through and observed laparoscopic cholecystectomies more times than the fingers on my hands (not many at all compared to the number the surgeons have done). But as I reminded myself, observing and doing are to different things. To know the theory of riding a bicycle and actually riding one are to worlds apart. So, that was my take on the briefing.

She handed me the scalpel and told me to incise to make openings for the ports. I literally stood and gaped. F*ck, I didn't know I was expected to do that much! After a moment of freezing and being speechless which felt like eternity, she laughed at me and retracted the hand which she had the scalpel in. "I was kidding!". F*ck again, you better be! I was shitting myself! Hahaha.

Anyway, she went in and opened up the skin for ports to go in. She handed me a port with a blunt trocar to put into place in the incision. I went in and secured it. CO2 went in and inflated the abdomen which was followed by my camera. I was now officially the cameraman. She made 3 more ports for the instruments and I had to manoeuvre an instrument in 1 of the ports while she took care of matters through another two ports. So it was 2 ports each. My camera arm was literally crying in pain as I stood there for 30mins static. As I switched side with the Reg, I had to handle the liver to get into the gallbladder fossa as she was dissecting it out after clipping and cutting the cystic duct and artery. This was all after sorting out Calot's triangle.

My arm dangling away from my body made it tire much more quickly compared to being able to rest it on my hip. Anyway, after we managed to get to get the gallbladder off the liver, a bit of diathermy then took place, sorting out the small arterioles that were bleeding. Zapping them with electric just fried them and stopped the bleeding. The next part was to yank out the inflamed gallbladder through the tiny incision. It took quite some effort but it went well. The Reg flushed the inside of the patient from blood and we deflated her. Took the ports out and closed her up.

Manoeuvering the laparoscope was definitely a lot harder than it looked. Imagine moving your hands for milimeters and suddenly everything on the screen moved like meters. A tiny gallbladder looked like the size of a small mineral water bottle. It was also ensuring the camera was always upright as you tend to get carried away when moving them around and not noticing the image is not upright (anterior abdominal wall should always be the superior border in the screen).

The Reg was super as she let me close up all 4 port wounds apart from constantly communicating and talking to me throughout the operation to ensure I wasn't bored and everything was done correctly. Finished off with some local anaesthetics (which she let me do again! I'm loving it!) and hey ho, there was my 1st ever experience properly assisting in an operation from start to finish. Just me, the reg and the scrub nurse. What an experience, one for me to remember if I make it to become a surgeon one day. =)

"Can I have a maryland with fire please. Mosquito please."

Thanks Hannah!

NB: maryland with fire: diathermed laparoscopic curved dissectors; mosquito: a type of clip/forceps

Ini tidak adil

salam

The title says all: INI TIDAK ADIL!!

haha, just to get things going really. its all about this person that is so special to me. I wonder why I don't do the same for everyone else. Its always her, year in year out. The effort I put in just to ensure I don't miss her red letter day. She's so special, I love her very much, as much as I love the others.

I've had my ups and downs, the time I had suicidal thoughts, the times I just wanted to ram my fist into the brick wall or bleed myself to death, or at least put myself in so much pain that my emotions are numbed. It comes down sometimes to me just needing to hear her voice and tell me things are going to be alright, despite the utter mess I was in. Apart from the folks, its again her voice that keeps me reminded that my existence has a purpose and not to end it prematurely. I've had a wonderdul life, better in her presence. I know I don't do much when I'm with her physically but its always having her presence that makes me happy. I was lost when I got here but she showed me how to get around things. She was there with the mature advice at times I was too shy or ashamed to seek advice from the folks. I know she goes through a lot herself, because having the same blood, I can feel her perks and lows. Its a telepathic thing. I'm sure she has elsewhere as a source of serenity at times in need. But for me, she's the one. She's closest to me, and also the fact that our lives are literally a rollercoaster ride. The plateu, the sudden drops, the adrenaline spikes and the end of the ride that you anticipate in a love-hate way. Love because you just can't take anymore unexpected turns on the ride, but hate because you enjoy the adrenaline rush so much you want it to go on.

Anyway, long story short, HAPPY 24TH BIRTHDAY KAK MUNA! I'm so glad I have someone so cheerful as you as my sister to look up to.You've given me colours throughout my life and I know you'll inherit the ability to teach as well as mama has been doing all along, if not better. When I look at you, I see burning passion and I hope you'll continue to inspire me throughout my walk of life. May we all, you, me, the family be granted happiness and success in this world and the world to come. Ameen.

ps: miss you loads!!!! *hugs*

You & I

Mends

Salam

It seems that everything in this world works under a particular law be it objective or subjective things. More often than not, when things break, we tend to mend it. As an example, I jumped onto my bed when I was 16 I think and I heard a crack. It was the wooden frame of the bed supporting the mattress giving way to my weight and downforce from jumping onto the bed. Despite my mattress falling throught the bed frame and having it slanted since the mattress was supported by 2 different sort of 'railtrack' frames, I was able to fix it by just adding on another piece of wood to support cum replace the broken piece of wood. Looking at its gross anatomy, yes, the wood seemed thickened where the break was since I've added another piece of wood.

The same thing happened to my radius. I fractured my left distal radius when I was 13 after performing an overhead kick and landing awkwardly. Had an unknown person not swiped at my supporting arm while I was airborne and upside down, I would like to think that my left radius would be normal up to this day. Anyway, I landed awkwardly and heard a loud crack. I didn't know my radius had gone because I didn't feel any pain. Anyway, I tried to get up by pushing my body off the ground with the fractured arm but realised I couldn't. After heaving myself up with my right arm, I found my left arm in an odd shape; looked like it was sort of a not-so-skewed S shape. In other words, I had a displaced fracture of my left radius. After a while, the pain kicked in and being 13, I started to cry in absolute agony. But it was only a few sniffs, trying to maintain my cool under the pain. I got sent to Kuala Kangsar District Hopsital but was later ambulanced to Taiping General Hospital.

 anterior angulated displaced fracture of left radius

Reaching there at around 11pm after hours of waiting in Kuala Kangsar, Mr Shahriman who escorted me didn't seem to remember to consent for treatment so I had to sleep through the excruciating pain. Unlucky for me, the consultant orthopod was present and wanted to mend my arm there and then but without consent, all was in vain. If only I had been 18, I would've just consented it myself. Anyway, I had to wait till next morning to get attended to. They asked me if anybody could consent and I said "Boleh, mak saudara saya ada dekat Ipoh". So they rang her up and asked her to come in but got consent throught the phone because by that time, my forearm was as big as my thigh. The swelling was massive. They bandaged my arm up for a few hours (my aunt was a teacher and was at school when they rang her up. she decided to come after school hours since she had already consented and there was no emergency) to reduce the swelling and sedated me. Being me with my weird and wonderful congenital abnormalities and metabolic difference, I took longer for the sedation to work and they fixed me while I could still feel the pain and was well awake. The man who fixed me was an MA and I dont really think he knew what he was doing. All I know, there were 4 people in the room. 1 pulled at my wrist, 1 pulled at my forearm just proximal to the fracture and another pulled at my arm near the biceps. The 4th was the MA and he just started chatting to me and without warning, crushed my radius 'back into place' while I screamed my throat off. That pain was worse than the aftermath of breaking my forearm. There were all sorts of complications but to cut the story short, the bone mended but in an anatomically incorrect alignment. 3months onwards, I went back to Taiping to get my radius X-rayed before they took the cast off. and all I could see was a thickening in the bone where the fracture used to be. The Consultant orthopod was there this time and he talked me through understanding the X-ray film of my radius.

Anyway, my main point here is that no matter how severe the trauma is, if it can mend itself, it will definitely be stronger than before. Thats how the body works. If you fracture a bone, where the fracture is will be a thickening of the bone. If you cut yourself, where the wound is will be a scar (fibrous tissue which is strong and elastic compared to normal skin). If you irritate a viscous and it gets inflamed, there'll be fibrosis so that it doesn't get inflamed again. One thing about the body is that it doesn't understand that external things can cause it to break. It believes that it is not good enough and compensates for it through the fibrous tissue, the scars, the adhesions, the strictures, the hyperplasias and all sorts. But there might be a point where the body cannot cope with the stress it was exposed to and just dies. example, try cutting off your finger and see if the proximal part can grow tentacles to rejoin with the distal cut part. (i'm sure you won't have to try that just to prove me wrong). Thats how humans are. I also believe social norms also work in the same way. You fight, you make up and have a stronger relationship. But if its too much to handle, you end up walking away.

Moral of the story is don't try an overhead kick if you've got people swiping at your supporting arm.

Selamat Hari Raya Haji

Salam!
Selamat Hari Raya Haji smua! Che nk mintak maaf zahir batin, mintak halal makan minum smua naaa! Sayu jgk hati ni. Its 1.23am, I'm writing a blog. Biasanya di Maslaysia, dok iron baju time2 ni, nak pakai p semayang raya esok. Asah siap2 pisau byk2 bilah sbb nk p lapah lembu kt UUM. Biasanya, ayah akan pakat dgn kami sekeluarga. Sapa yg berkemampuan amek sorang setompok bg cukup sekoq lembu. Tahun ni dgq cerita, sekoq lembu plus 3 kambing. cukup sorg sebahagian utk setiap ahli keluarga. Alhamdulillah Allah murahkan rezeki kami utk berkorban lagi tahun ni. Alhamdulillah again.

Biasanya esok pagi2 kami akan makan sama2 breakfast, pakai smart2. mama mcm biasala, bising suruh semua org cepat. Ayah tunggu siap2 dlm gheta, start enjin. Kami mmg terkedek2 kalut, ada yg bangun lmbt, yang baru nk mandi, yang dok terpacak dpn cermin berjam2 dok adjust tudung. hehe. mmg typical senario year in year out. Pastu dh smpi kt masjid, pakat join takbir raya. solat raya, khutbah. haish, rindu btoi.

Esok pagi i'll be doing ward rounds wif the surgical team, sayang x dpt smyg raya. tp xpa, blajaq pnya pasai. utk umat Islam jgk bak kata ayah. Buat apa pon, buat utk Allah n nk benefit umat Islam. InsyaAllah.

To everyone out there, Selamat Hari Raya Aidil Adha, maaf zahir batin.

The family

Round 2

Salam!!

I'm definitely gonna start boring people who read my weblog (if anyone ever reads em)! My second week flew by and dare I tell you, I can now imagine how people work up to SpR and still remember what they had for their OSCEs. Time just slip right fast when you're working your ass off, dreading every minute that someone can just crash and die under your watch.

It has been a dramatic week, with Housemans cursing 'shit' under their breath when a failing patient's blood test came back with a Hb count of 4. The frantic call to the transfusion unit, at the same time chucking away everything in their hands, running up to the failing patient to find she was quite well perfused. Then finally understanding that a student doctor had taken blood from the ante cubital vein of the arm which had an IV drip infusing it. Lesson learnt as told by the reg: NEVER TAKE BLOOD FROM THE SAME ARM WITH A DRIP. (the student doctor wasn't me btw. lol)

 our stash

The second most amazing thing that happened was being able to be 'handy' to the doctors and do doctorly tasks. Its always doing bloods that excite ward newbies like us 3rd years and yes, thats what I've been doing as well. Hade a few pokes on ourselves first though, just to be sure we had the confidence to do it on patients. Gave my groupmate a subcutaneous lump of 10ml saline because the cannula I put in him went right through the vein. *try to look innocent* Anyway, luckily everything on the wards were fine. Went on rounds with my favourite Malaysian SpR, acting as his right arm and help out with the simplest tasks: obs chart. Might sound simple, but I missed out on a few MEWS score at the beginning but later on got the grasps of things and was more alert, reporting as required.

 My 1st cannula on Jonny (sorry for the lump!)

Kate had a go on Jonny 1st (yes, its the kitchen. =P)

The other good thing that happened was being able to diagnose 2 patients. Its a baby step in terms of achievement but I have to start somewhere right? The first was tagging along with the SHO on call. Just as he started talking to the patient in A&E (who was writhing around in agony, crying), he got bleeped because another patient's GCS (Glasgow Coma Score) just went down to 4 (the minimum is 3, it means you're dead, normal alert people score 15). So he left me to clerk the patient and come up with differentials. The A&E scenario got me panicking a bit but it was alright. He came back about 1.5hrs later (after I went to look for him on the wards) and presented it to him. Gave my primary diagnosis with a main differential. He agreed straight away and admitted the patient and also left me again to attend the failing patient.

The other experience was in OPD clinics. My consultant was stuck in theatre so the reg who was there just handed to me patients' files and told me to clerk them and examine them. *sweat* anyway, I clerked one and examined her, had 2 differentials in my mind and hung around. An hour delayed, the consultant came (he was pissed off because of the complications in theatre and also the fact he had a pile of files to attend to), and told me to present. I did as asked, gave my differentials and primary diagnosis and he agreed. *pheeeeww* Called in the patient and had a 3minutes chat and sent her on her way. (she was quite mad because her appointment was at 2pm, I attended to her at 2.40pm after waiting for the consultant who was delayed and he attended to her at 4pm) Hoooorraaahh! Its so good to feel useful and to find you've done a good job and made someone else's lighter. Anyway, my consultant wanted me to do more but I just had to rush home because it was thursday afternoon, 4.30pm and I needed to get back to Leeds. So I sneaked out and rushed home. What a week! =)

I'm bound to make mistakes and if unfortunate enough, it can cost someone their life. But I am aware of tthe fact that that stage is a good few years away and I need to continue sponging things up and soaking in knowledge and experience. There will be a day when I fu*k up and screw things, therefore I will take all the opportunity I have to make the most of things and to minimise screwing up. I always thought that I would grow up, working in an office with a suit on because thats what I know from how my father is.  Ive also imagined myself becoming a professional footballer but with a reconstructed knee, that seems very unlikely. Anyway, fate has led me in a different direction and this whole different scenario will be for my children to see.

 Theatre for day case

I hope next week will bring a whole lot more of exciting events insyaAllah!

DDH

Thursday, 4th Dec 2010.

6.20pm.

Its been a long week, but time flew by. I'm loving every bit of my surgical rotation. Constantly in and out of theatre, feeling the rush of excitement each time I see people going under the blade. Will it turn out all right? Complications? Immediate, urgent, intermediate, delayed?

Theatre for electives (Jonny was laughing next to me)

My SpR is a Malaysian who knows everything in the world. He's super. I don't know if he'll ever go back to Malaysia but just to remember his name, Tak Khong. Thats why he's always buzzing, his battery 'tak penah kong'. I've also got a very enthuthiastic SHO whos always shoving us into the theatre to show the weird and wonderful things he can do with people on the table.

I'm last in the pecking order, I know. But I'll grow up one day and I'll be better, insyaAllah! I thought Mr Khong knew everything, but when the top guy, The Surgeon, came in to theatre to teach his registrar, I knew how far I was from getting to his stage. He tied up sutures while chatting and looking at me, not even glancing at the knots he made. But I dare tell you, they were perfect! The SHO and The Reg looked like student doctors compare to The Surgeon and I looked like I was just out of kindergarten. Its amazing, the more you learn, the less you know. MashaAllah!

The accomodation I was in didn't have internet and I realise just how much time I waste on it. Since there was no internet and I didn't have my phone cable to connect it to the laptop to use as a modem, I just sat in bed reading up books and let me tell you this, I've never been studying more intensively than that. Well, maybe I have as in sitting for exams but other than exams, I wouldn't have had done such stuff because I always thought that would be plain boring. But like Terry said, "heads down, work hard and enjoy".

I've got 4 more weeks before I go onto another rotation and I'm going to make the most of this one because I can't see myself enjoying another placement more than this. But yeah, foot on the gas, I'm going straight in! May Allah guide me, ameen! Good luck to everyone else! =)