A CALL WITH A FANTASTIC MO

*Disclaimer: Cerita ini cuma rekaan semata-mata, tidak berkaitan sama ada dengan yang hidup ataupun yang mati* This is a fiction story, not related to anyone dead, or alive.*

I remembered I used to read Darren’s blog on how miserable calls can get when you get ‘certain’ HO who calls you for many reasons. Sometimes, things can be the otherway round.

DARREN’s :

Most of the time, your call's quality largely depends on whom you're working with, in the particular night. A good and reliable helper would definitely lighten your work, whereas the opposite can cause you a sleepless night. Just some examples of the calls that MO received from a HO during an on-call night... (click to continue reading)

QUOTE:

Most of the time, your call’s quality largely depends on whom you’re working with, in the particular night. A good and reliable boss (who makes good and quick decisions) would definitely lighten your work, whereas the opposite can cause you a sleepless night. Just some examples of calls that HO received during an on-call night…

*phone ring* HO#1 pick up phone @ 2:37am:

HO#1: hello??

HO#2: Hello, I need your help with a branula.

HO#1: Okay

HO#2:  I was trying with MO for a very long time already but still cannot get venous access. Can 

you come to HDW to set a neck line?

HO#1: What? You are with an MO and can’t get a line? What case is it? How is the patient?

HO#2 briefly present the case.

HO#1: Okay, I am coming.

Upon arrival, patient was a C5-C6 compression fracture patient with C5 cord injury, ventilating on trachy. BP falling. Has one IV access. MO miserably trying to set another peripheral line.

MO: Good, you are here. This patient very hard to get line. You need to set a neck line.

HO#1: Isn’t he on inotropes, shouldn’t we insert a triple lumen?? (central line)

MO: You can insert a triple lumen?? I mean, can you insert? If not, we can call GA MO to insert.

HO#1: Okay, I’ll try.

Coagulation profile normal, in view to keep the neck in neutral position and not flex the neck, HO#1 decided for a subclavian approach.

HO#1 attempt failed.

HO#1: I think someone else should try. (Hoping that the MO will take over)

MO: Hmm… let’s call the GA MO to help. I'm not very good with lines.

HO#1: Okay. Please do then.

MO: Ermm… could you talk to the GA MO?

Apparently, the GA MO on-call was well known to be very ‘fierce’ and the MO had some unpleasant previous history with the GA MO.

SN took a peep next door: The GA MO is very busy in ICU, attending to a collapse patient.

Having no choice, HO#1 kept her fingers crossed and said: Very well, I’ll try again

*Thank God, Left Subclavian Central line inserted successfully, anchored at 15cm, no acute complication, good flow. Placement confirmed with VBG and CXR. Bloods sent for investigation. Patient resuscitated with fluids and inotropes, BP picked up and patient stabilized.

After documentation, the SN asked: Siapa HO#1? Specialist ke??MO ke?

.....silence....

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CASE II, later that morning,

* phone ring* HO#1 pick up phone @ 6:45am:

HO#1: Hello? I am reviewing patient, anything?

HO#3: Hello, there is a patient in wardXXX who collapsed. Asystole. I informed MO already, she asked me to ‘buat apa-apa yang patut’ and ask you to come stat. I tengah CPR now.

*Upon arrival stat, HO#3 was performing CPR, SN bagging, MO holding mask.

MO looked at HO#1 with an anxious face and said: HO#1, you boleh intubate patient, kan?

*HO#1 almost fainted when heard that. ^^|||

HO#1: SN, cepat prepare intubation set. ETT size 7 and 6.5. Prepare blade, suction. Prepare Midazolam 5ml.  

SN: Kena buka DDA ni …. (FAINT~!)

HO#1: Student nurse, tau bagging?

Student nurse 1: YA

HO#1: pakai gloves, ambil alih tempat SN. SN prepare for intubation.

SN kelam-kabut, busy preparing the equipment and drug.

HO#1: How’s the patient? What happened? (HO#1 asked while putting on gloves and mask)

MO: I tak sempat access lagi

HO#3: Patient asystole, pupils dilated, BP unrecordable,..

HO#1 quickly accessing the patient and asked: How long CPR?

HO#3: about 15 minutes

HO#1: What was given? How many atrophin , adrenaline?

MO quiet (…)

HO#3: None given.

HO#1: SN2, syringe out adrenaline and atropine, give 1 atrophic, 3 adrenaline.

Apparently, SN2 was so slow… HO#1 started breaking the ampules and syringed out herself and gave the drug while the SN prepare intubation set. HO#1 took over MO position and intubated the patient. Condition was bad. More Adrenaline and atrophin given, still no response.

HO#1: Ada siapa-siapa call medical? call relative?

SN: No.

HO#1: Make sure panggil. Suruh SN3 yang tengah serve ubat kat tu call.

After 45mins CPR still no response.

HO#3: MO, do you still one to proceed?

MO: Huh? Kita dah buat semua kan? Ada ape-ape lagi?

HO#3: MO, do you think we should pronounce death?

MO: Erm…

(pause…)

MO: Okaylah

*documentation done*

HO#1: What’s the cause of death?

MO: Kena bagi cause of death ke?

HO#3: I think it is APO secondary to CCF and CRF. Maybe it’s time to call the medical team and our specialist to discuss.

MO: Okay.


After discussion: Cause of death: Acute Pulmonary Edema secondary to CCF

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MORAL OF THE STORY: Dear HO colleagues, HO life is not all fun and relax. Sure, we will always be covered by MO, but remember, we will become MO (or even specialist) one day. It is very important to learn the most from your housemanship days. Otherwise, it will be regrettable. 


And NEVER EVER GIVE INSTRUCTIONS: buat apa-apa yang patut.
Do ask what has been done, and give further plans of what else can be done while you are on your way to see the patient.
When  a HO calls his MO, means he needs help. (or he needs to be covered)
Imagine documenting : 
S/T DR XXX, case and progress and Investigation noted. Plan: To carry out all necessary procedures. (apa-apa yang patut?) 


Please, be a safe doctor.

HAPPY SONGKRAN FESTIVAL!!!

WORLD HISTORY:
The Songkran festival (Thai: สงกรานต์, from Sanskrit saṃkrānti,^[1] "astrological passage") is celebrated in Thailand as the traditional New Year's Day from 13 to 15 April. It coincides with the New Year of many calendars of South and Southeast Asia. 


The most obvious celebration of Songkran is the throwing of water. Thais roam the streets with containers of water or water guns (sometimes mixed with mentholated talc), or post themselves at the side of roads with a garden hose and drench each other and passersby. This, however, was not always the main activity of this festival. Songkran was traditionally a time to visit and pay respects to elders, including family members, friends, neighbors, and monks.


(source: wikipedia)


OUR HISTORY:

13 APRIL 2009, BANGKOK : We celebrated the Thai New Year with water splashing, water guns and white powder.. there was live bands, and even the fireman involved!! wow!! an awesome experience!!!

All messed up from Songran!!
Btw, Songkran or Thai New Year is celebrated with water splashing.. the streets were filled with people splashing water, shooting with waterguns, and wiping each other faces with white powder...

all messy and dirty...

more amazingly, there were even live bands and the firemens participating in this grand event in silom street and khaosan street!! but we didnt manage to capture them on film... need a waterproof camera for that, haha!

happy songkran = THIS GUY CARRIES A HUGE WATERGUN, BEWARE!!

the cars and taxis were not left out... tuk-tuks passengers were all wet!
i remember leaving finger prints marks on every car we saw, wahaha!! happy songran festival!!

Songran festival: people equiped with water guns and pails of water... even on vehicles.. searching for victims.. noone is spared!




So, everyone, wishing you a good HAPPY SONGKRAN FESTIVAL!!!


If you are planning a water party, count me in! ^^

Katy Perry - Firework (inspiring lyrics)

Do you ever feel like a plastic bag
Drifting throught the wind
Wanting to start again

Do you ever feel, feel so paper thin
Like a house of cards
One blow from caving in

Do you ever feel already buried deep
Six feet under scream
But no one seems to hear a thing

Do you know that there's still a chance for you
Cause there's a spark in you

You just gotta ignite the light
And let it shine
Just own the night
Like the Fourth of July

Cause baby you're a firework
Come on show 'em what you're worth
Make 'em go "Oh, oh, oh!"
As you shoot across the sky-y-y

Baby you're a firework
Come on let your colors burst
Make 'em go "Oh, oh, oh!"
You're gunna leave 'em fallin' down-own-own

You don't have to feel like a waste of space
You're original, cannot be replaced
If you only knew what the future holds
After a hurricane comes a rainbow

Maybe you're reason why all the doors are closed
So you could open one that leads you to the perfect road
Like a lightning bolt, your heart will blow
And when it's time, you'll know

You just gotta ignite the light
And let it shine
Just own the night
Like the Fourth of July

Cause baby you're a firework
Come on show 'em what you're worth
Make 'em go "Oh, oh, oh!"
As you shoot across the sky-y-y

Baby you're a firework
Come on let your colors burst
Make 'em go "Oh, oh, oh!"
You're gonna leave 'em all in awe-awe-awe"


Boom, boom, boom
Even brighter than the moon, moon, moon
It's always been inside of you, you, you
And now it's time to let it through

Cause baby you're a firework
Come on show 'em what your worth
Make 'em go "Oh, oh, oh!"
As you shoot across the sky-y-y

Baby you're a firework
Come on slet your colors burst
Make 'em go "Oh, oh, oh!"
You're gonna leave 'em all in awe-awe-awe

Boom, boom, boom
Even brighter than the moon, moon, moon
Boom, boom, boom
Even brighter than the moon, moon, moon