Friday, October 29, 2010

My first Spinal Anesthesia Experience

‘First give-PUSH, Second give- STOP’

‘First give-PUSH, Second give- STOP’

‘First give-PUSH, Second give- STOP’

The thoughts rolled through my mine, repeatedly, again and again, as I scrubbed my hands. It had been quite a while since I last scrubbed into the OR. My head goes through the process again, picturing myself doing it. Briefly, swiftly. I have seen this many times, I can do it – I tried to deceive myself, or rather, encourage.

The emotion tensed. My MO pat my shoulder, as if giving reassurance.

I am ready.

I have to be.

I put on my surgical gown. Glove size 6 and a half. Latex.

I spread the sterile set, arranging the instruments the way I liked it to be.

With my right hand, I shaked the 0.5% heavy bupivacaine, to-and-fro. Then, break the vial.

I carefully attached the 21G green needle to the 5cc syringe. 2cc was syringed out from the vial.

I added 0.5cc fentanyl, making it a total of 2.5 cc.

In another syringe, I syringed out 2cc of Lignocaine 2% (Local Analgesia).

I folded the the sterile green gauze into triangular shapes , neatly and placed them into a galipod as my assistant poured some disinfectant inside.

I prepared the spinal 25G Pencan needle, putting it through a 21G needle.

Then, I took a deep breath.

It is time.

My patient was seated up on the operating table, with straight back, head looking down, arms hugging a pillow.

‘Encik, doctor nak cuci belakang ya. Sejuk sikit. Cuba relax’ I said, with my awfully broken bahasa, with attempts to comfort the patient.

With a sponge forceps holding the green gauze, I cleaned the procedure site in circular motion. I repeated this procedure again, and then draped the site with a grean cyst towel.

I run my fingers by the sides of the man, trying to feel for the protruding bone (PSIS) and palpating for the intravertebrae space, locating for L4-L5. I marked the area.

‘Doktor nak bagi ubat tahan sakit ya. Sakit sikit macam semut gigit ya. Encik sabar ya.’ I said and injected the local analgesia.

Then I took a deep breathe.

‘Encik relax ya, badan tegak, kepala tunduk bawah. Doktor nak injek ubat ya. Cuba jangan gerak’

I rechecked the marking and space.

With the 21G needle guiding my 25G spinal pencan needle, I inserted the needle into the marked area, towards L4-L5.

I felt a resistance at first, then a give. –THE FIRST GIVE, I reminded myself.

Then, I inserted the spinal needle further, then I felt some resistant, gritty sensation, then another give –THE SECOND GIVE.

YES, this should be it!

I removed the trochar (inner needle).

I felt almost euphoric when I saw what I saw.

Clear CSF flowing out, driping out at the end of it, drop by drop.

Thank you GOD! My heart shouted.

I reconfirmed the flow with a syringe, slowly. Good flow. Then, slowly, I injected the prepared anesthetic solution in.

With a breath, I removed the needle.

The Staff Nurse sprayed the operation site and plastered it with a gauze. ‘Bolehlah jadi MO GA nanti’, she teased me.

The patient was layed flat again.

I monitored the blood pressure, making sure it do not drop drastically.

‘Encik okay tak? Boleh cuba angkat kaki’ I said.

‘Tak bolehlah,' he said. 'Kaki berat’ he replied.

‘Jangan risau, Ini kesan daripada ubat bius. Kalau rasa sakit, beritahu ya’ I said.

The surgeon rechecked with a forcep. –No pain

‘You may proceed’

He made an incision –No Pain.

YES, the spinal worked.

The surgery went well, completed in 49minutes. Patient had good anesthesia. Thank God for that.

I documented – No difficulty during procedure, single attempt, atraumatic tip, clear CSF, good flow.

My MO teased me, ‘There, wasn’t that hard, isn’t it?’

YA RITE! (sarcastically)

THERE – my first spinal.

The satisfaction & feeling – PRICELESS!

Gee, I think I am starting to like GA!! (well, maybe)


-For the benefit of Non-medical related fields reader,below are some terms and  abbrevations used in the above article:
OR = Operating Room
MO=Medical Officer
CSF = CerebroSpinalFluid
PSIS =Posterior Superior Illiac Spine (at the level of L4-L5)
L4-L5 = Lumbar spine bone level 4 - 5
heavy bupivaccaine = anesthesia solution
Lignocaine = local analgesia
euphoric = high peak of joy, happiness
DISCLAIMER: The author will not be responsible if this article or part of this article is used as a guide to one's medical practice. note that this is the author's personal experience and should never be used as a guideline.

Acknowledgement to Datin, The HOD, for permiting and encouraging House Officers to perform procedures under supervision and provide a good learning environment.
Acknowledgement to Medical Officers & Specialists for teaching us with patience and giving us the opportunity to learn and grow into better doctors.
Acknowledgement to my collegues and other House Officers for helping one another, and encouraging each other as we go through housemanship.
Acknowledgement to the hospital staff, staff nurses, PPKs, for being supportive.
Most importantly, Acknowledgement to patients, for having trust in us.


Sunday, October 17, 2010

shinyin's love at first sight...

2 years ago, during Christmas, when honneyy and i were shopping in Mid Valley,
i found LOVE at first sight...

i want this bear...

~Forever Friends bear & i~

we were meant to be together...

honey liked it very much too!

the fur soooo soft...
and 2 years LATER,...
i found this lonely....
lonely bear.....
. kesian this bear.... just waiting for me....

and so, i packed it home!!!!

and here's where the fun begins...

smile bear bear~~~


bear bear saying and waving  'hi'

bear bear- the big boss...

relaxing on the bed,,,,.....

a little shy...

bear bear studying...


The Original VERY Cute Bear.....

I have been lovingly hand-crafted to meet all safety requirements.
I do not like washing machines and tumble dryers,
but i liked being wiped with a warm damp flannel
and being left to dry naturally.
If my fur goes flat,
I do not mind being brushed genttly,
as long as I get a hug afterwards...

bear bear likes sunflowers too!

bear bear scaring the fishes...


bear bear like to drink...

bear bear loves christmas!

Saturday, October 16, 2010

pleasant surprises from kevin this year...

This year birthday is somewhat special...
not only that it falls on a special date = 101010...
well, i was on leave
and got to spend it with special people whom i care...
so, YES, i'm happy... ^^

Kevin took me to...
- The Ship-
it was a place i always wanted to go, but somewhat never did...

So, that's Kevin....
awating the cruise...

and me,..
can't wait to get onto the ship...

the ambience is nice...
each table lit with a lamp...
i heard that years ago, they used to use candles,
which was perhaps more romantic...

that's our seat...
*note the picture of the sailor at the back: shouting heiyo...
thought it was kinda funny.. hehe..
So, we had our very own pirate too...

Hmmm... what should we order....

the layout for the day....

JUMBO honey dew drink...
super HUGE...

i wonder whether can finish or not...

super huge mug...

soft soft bread... ~complimentary~

fresh salad ~complimentary~
it was very fresh...
reminded us of Cameron,..

Kev taking a bite...

ooohhh.... this is Kev's FAVOURITE!!!
it's made of...

shrimp + crab meat+oyster+squid+fish eggs

super KENG!

just LOOK at that!!
oh babe...

Kevin's savouring it...
the smell...
the taste...
the feel, when it melts in your mouth...

yummy, yummy...
don't care, must eat...

a tinge of lemon...

kevin ordered Minute steak...

looked a little dry outside...
and red inside...

and i ordered Chef's Recommendation ~ Rib Eye Steak...

this is super SUPER SUPER nice & juicy...

see the differences???
Minute Steak VS Rib Eye Steak...
(minute lose FLAT)

oh yes, the waitress very PRO and very busy..
all dressed in cute cute outfit... ^^

the handsome Captain...

and this is us...

time for the bill~

Verdict: Food is Good
will come again... ^^

After dinner Kevin had another surprise...

guess what???


Kg Kelip-Kelip kuala Selangor...

had to take a sampan across
RM40 only per sampan..
can fit 4 person in a sampan...
but there was just Kevin & i,
so we took 1 sampan...

fireflies migrating...

like christmas trees...

fireflies @ kuala Selangor...
on the 101010, there was no moon seen in the sky,
therefore being one of the best time to watch fireflies....

awesome... ^^

there's more....

and the last surprise for the day.....




what an awesome birthday!

Thank you very much dear....

love you dear...

Author's Note

Dear friends and readers, Thank you for dropping by and leaving comments/ shoutouts. More importantly, thank you for being there... please accept my apology that, lately, i may be busy with work and not have time to reply youir messages/comments, but rest assured, each and everyone is read, and highly appreciated :) have a nice day! ^^

of love

Today, i heard a story which was not a story of falling...
of living in the dark end of winter turmoil..
instead, it was a love story..
of a couple who did not live happily ever after...
but they live, loving each other..