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Go HOME and SLEEP on it...

My first appendicectomy, skin-to-skin, an awesome experience...

 This picture was from the internet. i did not take any picture intraoperatively.

It was exceptionally quiet today.

Sounds around me seemed clear. Amplified.

I clean, draped, , palpated and made the mark with the forceps. Made a silent prayer.
With the scalpel in the right hand, the Lanz incision was made.

‘Deeper’, he said, ‘Do not be afraid’ he offered words of encouragement.

Inhaling, exhaling, I made a deeper incision into the subcutaneous layer. The incision was deepened with the diathermy. Minor bleeders were 'buzz-ed' with it as well. The subcutaneous layer deepened and retracted apart.

‘Proceed’ he said, ‘Don't worry, I am here, I will assist you’ he continued, holding on to the retractor. The rectus sheath gently cut. External oblique muscles, internal oblique muscles and transverse abdominalis muscle split respectively. The peritoneal layer gently lifted.

I could see the bowels floating below. Very carefully, I felt the thin layer of peritoneum between my fingers, and gently made a nip. The peritoneum breached. Peritoneal fluid clear.

‘Now, look for the culprit’ I whisper to myself.
The small bowel stared at me. ‘No, not you’ my heart seemed to talk. The small intestines pushed aside gently with the swabstick.
Now there you are. The ceacum was smiling at me. I traced my way along the Teania Coli with the Babcock, and finally, the little mischievous appendix was there. No more running away. It was green in color, gangrenous, swollen.

‘See, this is a gangrenous appendix, impending perforation’ he commented.
Wow, I thought. ‘Don’t panic’ he said, reassuring.
‘Remember, the window of opportunity’ he said, guiding me.
‘Yes’ I nodded obediently. The artery was gently pushed through and mesoappendix clamped.
‘You know your hand-knots?’ he asked.
‘Yes’ I replied.
So, I tied them, tight and carefully.
Then the mesoappendix were snipped away from the appendix.

The base of appendix was healthy. It was crushed and clamped. Then, carefully tied. Twice.

‘Finally, the most-awaited moment’ he said, as he hand me the kidney dish with the scalpel inside.
And this is when they called it APPENDICECTOMY. He said, smiling, as I gently cut the appendix. Clean.

Phew.

The incision area was rechecked for bleeders. Dry swabbing done. Hemostasis secured.

Now, the abdomen was closed in layers. I happily sutured them, neatly, layers by layers while he started to unscrub. He remained in the room, still watching from the corner of his eyes. Offered me confidence yet ready to catch me if ever I fall.

Today, I did my first appendicectomy with Dr Mitesh, skin-to-skin.

'Appendicectomy of a gangrenous appendix in 50 minutes, with lessons in between. Not bad for a start,' he said.

And guess what??

It was the most awesome experience in my whole surgical posting and perhaps one of the notable best experience in housemanship.
I think I idolized him. Dr Mitesh.

He was the first person whom i met had the patience to teach housemen to do surgery, step by step.

First teaching, guiding them, then allowing them hands on. He guides you along the way, helps you when you are stuck and teaches you.

For that, I respect you and hope that one day, I will be just like you.

It is my dream that more and more Medical Officers and Specialist would spare some time to teach their housemen.

You know, a teacher’s contribution never ends. It continues to shine in the works of their students.

To him, I may be just another houseman, eager to learn.

For me, this is one of the most awesome moment in my life. A motivation in life. A lesson learnt. and perhaps one day, a life saved. A difference made.

13/05/2010, 1500Hour – 1550Hour, OT6.

P/s: Post operatively, The patient was later reviewed in the ward.

He was discharged well, happy, ambulating and tolerating well orally. Wound clean.

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A little history about appendicectomy:

The first successful appendectomy was done in Davenport, Iowa in 1885 by Dr. William West Grant. The patient was Mary Gartside, age 22.

Footnote:

Acute Appendicitis - acute inflammation of the appendix, a life threatening condition. If ruptures, may result in perforation, sepsis and death.

Appendicectomy or Appendectomy - a surgical procedure in which the appendix is removed

p/ss: i've heard of my stories of bomoh removing stones via magical way. Just a thought, somehow they have not figure out a magical way to remove the appendix, have they? haha... obviously, you can't just pick up appendix from the roadside, can you?

Together, making a difference

‘Wu, go to the Emergency Department STAT!’
-that was Dr Thurstan shouting over the phone.

27 year old, female lady, referred for lower abdominal pain.

BP 80/50

Pulse 130bpm, tachycardic.

She was pale, as white as a ghost, cold clammy hands.

Abdomen distended, tender, guarding.

Was referred from clinic TRO Acute appendicitis.

Further history revealed POA 10 weeks. Recent sexual activity.

UPT POSITIVE.

Scan stat: Uterus empty, fluid in POD.

DIAGNOSIS :

RUPTURED ECTOPIC TUBAL PREGNANCY

She was in hypovolumic SHOCK!!!

Or basically bleeding away.

She was dying.

We were losing her.

1 pint Packed Cells- emergency ‘O’ in transfusion.

Bloods sent for FBC, GXM 6 pints, coagulation profile.

S/B Dr Raj.

Within 5 minutes, the specialist and OT (Operating Theather) were informed, consent taken, and the patient was pushed to OT for a Laparotomy Salphingectomy.

(simply means cutting her open and removing her fallopion tube)

Dr Nadiya was running for bloods.

Surprisingly, that’s how efficient our Government Hospital can be in times of dire emergency at 8.00pm.

I was assisting Dr Raj at the Operation Theather.

INTRAOPERATIVELY:

Hemoperitoneum noted.
Blood was oozing from her peritoneal cavity.

Left ruptured tubal pregnancy was seen.
Left salphingectomy done.

Right ovary and tube normal
Estimated blood loss : 3.0 Liters
Hemostasis secured.

Food for thought:

This is one of those amazing days which reminds me the beauty of being a doctor despite the tiredness and stresses.

A normal lady have approximately 5 liters of blood.

And this lady, she was losing 3 liters, which was 60% of her body blood.

And was indeed still bleeding.

And something need to be done FAST.

The adrenaline rush.

In the end, Dr Raj and the team saved this young lady’s life.

I was doing post-operative rounds and reviewed the patient later.

Her vital signs stable, Blood transfusion on-going.

She was with her mother.

I explained the operative findings and future plans.

She managed a smile and said 'thanks'

And that, well, that is something that money or anything in the world can’t buy.

To all house officers, medical officers, specialist, staff nurses, PPK, hospital staffs,

Sometimes, life can be tiring, exhausting, with the heavy workload,

sleepless nights, empty stomachs, terrible stress, ache-ing feets.

Perhaps, we need to remind ourselves from time to time,

to be strong,

to hold on........

the people need us.....

friends, relatives, friends of friends...

we are one big family....

well, i did not had time for dinner until 12 midnight,

i had a hectic on-call,

but i guess, sometimes, it's still all worthwhile...

Together,

making a difference.......

Malaysia vs Singapore - a tough decision made...

I guess I had too much on my mind lately… You know, after graduating, you are to step into the working world, a new phase of life. And there are options, many options. It is about time to plan our future, to decide where we stand 10 years from now. What decisions we make today, decides tomorrow. And being a Libran, decisions are what I feared most. And therefore, I had put a lot of thoughts into this.

Let’s see, there are two sides of the coin, at this moment. One side offers better working conditions, more advanced technology, better working hours (having only 1-2 oncalls per week), and halved the housemanship period (one year only). More importantly, it promised better opportunities for postgraduate programs (postgraduate training after housemanship itself!), educational funds and sponsorships. As a bonus, you get better salary and higher increments. It is almost like a dream come true.

On the other side of the coin, you have the hectic working conditions, work politics, every-other-day-calls (EOD) pushing a straight 36hours call and then given the night off and expected to report back the next day for another 36 hours call. On top of that, the doubled housemanship period (2 years), sleepless nights, heavy workloads, and your superior pushing you beyond your limits. Opportunities for post-graduate programs, from what I gathered, was somewhat slim, especially if you plan to opt a surgical field. The competitions are great, too many demands, yet too little supply. And the salary? Oh boy, you would certainly be surprised if I were to show you our starting salary… and with only an increment on RM100 yearly… so, I don’t think anyone would want to opt to be a chronic MO, now to think of it…

Funny, despite all that and more, I turned down the offer to work in Singapore.

A friend of mine once said, there is no ending to this argument, this debate. Either way, they had their pros and cons. In the end, you just have to close your eyes, shut your mind, search deep within you and follow your heart.

So, there I am, back at the beginning. I came back to the big question, why am I here? Why did I take this path? Why did I study Medicine in the first place? Knowing that this is probably one of the most challenging professions on Earth! One that requires sacrifices, choices… yet here I am…

-To make a difference-

Why else take up medicine if not to one day treat you family, friends and loved ones?

After a year of consideration, and cracking my mind for the past whole month, I have decided… Yet, yesterday, Su Yin and my cousin asked me again, why did I rejected the offer to Singapore… and today, MK asked. In fact, everyday, people had been asking… and news on the papers has been disappointing… news like this(1) and this(2).... it sometimes clouds my mind… perhaps I needed reassurance that I had made the right choice.

So, I needed to blog about this.

I want to constantly remind myself why I chose this path. I needed to remind myself, constantly.

-HOPE-

Something I strongly held on to. I have hopes that the Malaysian Health System can be improved. Hopes that there are still many doors opened for us, opportunities for us to specialize in our desired post-graduate field. Hopes that after 10 years, when I looked back, I would be glad I made this decision.

Sometimes, it strike my mind, that if I were to take the greener road, the comfortable path, I would probably be away for a solid 10 years. It’s like uprooting yourself, starting a fresh. And there is a fat chance that one may not come back to the country. My friends thought that I think too far ahead. And so, I was thinking, if all our good doctors were to leave our country, despite the lack-of-doctor-crisis, who else is there to treat our loved ones? The vicious cycle continues…

Perhaps, it was because I was trained locally, I felt that I owed it to the country, that I should serve our people… Did I sound almost too patriotic? Haha! Very unlike-shinyin, ei?

Besides, my Professor, Prof Shahrir, once said, 'Don't go, the Singaporeans are just using you...'. Perhaps, he was right. Singaporeans are smart people, they would not do a losing business.

In fact, during the interview with Dr Liam, the Singaporean Recruitment team, I popped out the question, 'Why employ us?', despite knowing very well the answer, perhaps i needed reassurance.
He answered, 'because we are building 2 new hospitals, and we do not have enough doctors to sustain the hospitals'.
'2 new hospitals?'
'Yup, we plan to make Singapore the one-stop Medical Centre'
'What about your local students?'
'We had opened new medical schools, but it would take another 5 years before they graduate and practice'.

So, the fact hits hard.

1. The Singaporeans wants to build new hospitals to earn money
2. They did not have enough resources
3. They needed us
Repeat: THEY NEEDED US

So really, to think about it, the decision is all up to us. Do you want to help them? and if you noticed close enough, we were needed merely to fill in the gap.

My dad had this interesting illustration for this... He said that our country nurtured us from young, right from the seeds, with patience, with love, and when we start bearing fruits, the Singapore government added some fertilizer, promised a better future, and start plucking us...

It would be nice though, if our country itself can provide us, that better future. I think most of the people who left the country, was doing it against their heart. They were disappointed, and perhaps lacked the sense of security... the reassurance...

So maybe today, I felt that I loved my country, I loved my people, I loved my family, I loved my friends, I loved them too much to leave… I loved the life here. The people. (and the food, of course!)

And I hope

Yes, I do

I hope that, I will be loved in returned.

Hope, faith and love can take a person very far indeed...

Like Robert Frost once said, I took the road less travelled by, and that had made all the difference!

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p/s: i'll be leaving for my BTN and induction course tomorrow at Pontian, Johor & Port Dickson respectively... will keep you all updated whenever possible ^^

shinyin's busy eating pancakes...

Lingesh sent me an interesting link today. It was a story written by Topher, who is a Caribbean medical student at St. George’s University. I liked his medical school metaphor : pancakes every morning. Here's the article, enjoy reading: (don't forget to watch the video at the end- it's classic!!)

Medical school is like trying to eat five pancakes every morning for breakfast.

At the beginning of each course, we’re given a syllabus telling us how we’re going to be graded, the question break-down for each test, and the schedule of lectures each day for the next 4-5 months. Nothing is going to sneak up on you unless you can’t read the print on the page (in which case you’re blind and things sneak up on you all the time).

But it’s sunny outside or snowing outside or Tuesday. Whatever. You’re in medical school to become a doctor, not to be in a classroom (scheduling conflicts here) and you find yourself out on the weekends, maybe catching a movie on the weekday, and so on. You blow off the first week of any course because the material is supposed to be introductory and you certainly blow off the first week after any exam to recuperate. Maybe you take off two weeks if it was especially difficult and draining.

Eventually though, the next exam is closer than the last exam and you have to return to the desk and pretend to be a serious student. The first week back studying, you won’t be as efficient and as familiar with the material as you were leading up to the last test, so there’s some built-in catching up to do. You can’t understand the material taught TODAY because you blew off the introduction, so until you catch up, you keep falling behind. By the time you’re back in your stride the exam is so close you can feel it’s breath on your neck and you still have material to cover on a first pass. Let’s not forget: you haven’t reviewed or committed anything to memory at this point. It’s now that you understand the truth:

Medical school is like trying to eat five pancakes every morning for breakfast.

You know you can do it. A Premed advisory committee endorsed you saying, “He has the stomach for it. He’s committed.” And you prove them all right. Every day you show up with your first-year optimism and your annoying hunger for learning and you clean that plate (just kidding, it’s adorable). But you begin to notice that those pancakes are slowing you down a little each day and the sugar highs and lows are screwing with your sleep. Smart person that you are, you decide to pass on the flapjacks one day. You think to yourself, “Self, I’m going to eat ten pancakes tomorrow so that I don’t have to eat any today.”

But it never stops. Turns out that “self” isn’t the most responsible lender, and before you know it there are 40 pancakes in front of you and your plate needs to be clean by tomorrow. So yeah, at this point it looks impossible. But really, it’s your fault.

In the future, as I like to imagine it, I’ll be in charge of all medical school admissions. The process will be six weeks long and will consist of nothing more than showing up each morning to eat five pancakes, at which point you can then go about whatever you were going to do that day. At the end of the five weeks a few jaded, newly diabetic hopefuls will come to my office and, mixed with both pride and resignation say, “I did it. I finished those goddamn pancakes.”

“Wow,” I’ll say. “That’s very impressive. You must be very proud, and your parents must be very proud. Just one more thing.” They’ll reflexively clutch their stomachs, shifting their girth from one hip onto the next and groan, “What’s that?”

“Regurgitate it.”

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As much as i liked to laugh at this metaphor, i could not. I find my very self in those shoes. My stacks of pancakes is nearly as high as the ceiling, standing tall and proud, like the Petronas Twin Tower, overlooking me, challenging me to gobble them down.
arGHHhhh!!
You see the pancakes. You dream of pancakes. You hallucinate of pancakes!
I am developing an evil plan to drug the examiners, and maybe smuggle the stack of pancakes into the exam hall and throw them all in the bin!! Who's with me?? - in my dreams!

The truth is, noone can help you eat those pancakes.
You have to settle your stack of pancakes.
Sometimes, i felt the walls closing in, almost suffocating, as the days count down, time cruelly past us, the pancakes stack higher.
We cannot afford to give up, can we? Just merely inches away... How we managed to get this far is a mystery. How can we go on, another mystery. Yes, we are just inches away, inches away to graduating, to finally achieve our dreams, make your parents proud, save lives, blah, blah, blah..
little do we realized, this is just the beginning...

Okay, I have to get back to my pancakes~

When *JC in da house* met *Confessions of a medical student*

(Sook Jiuan, I malas to think of a title, so just curi yours, hehe..)

(picture from JC in da House)

Last Christmas holidays, I met Sook Jiuan and Boon Lee, my good old friends from high school. And the day before, I had lunch with Boon Lee, Xiang Ying, Suk Teng and Jack. Meeting them brings back all those good old memories… Many had changed but some things are still the same after all.

And yesterday, I was surprised to see that Sook Jiuan had blogged about it! Such a pro blogger!!

As you all probably had already known BoonLee from the previous post : Happy Birthday, Boon Lee!, allow me to introduce Sook Jiuan aka Joanne (JC in da house). I like to call her Sook Jiuan because I think it’s a beautiful name, and that’s how we used to call her back then, in KGV.

We were classmates in form six. How I missed our beloved school, SMK King George V (KGV)… i'll like to comment about what Sook Jiuan said, about KGV being the top school... well, academically, not always,.. i came to realize that there were many other schools across Malaysia with even more outstanding academical performance!! but i still liked KGV.. well, at least, i didn't have to grow up in a stressful environment that a student's worth is measured by the numbers of A's in your report card.. mind you, there were times i almost failed my school exams... but, our teachers were very encouraging...

i grew up in an environment where i had never witness a fight in my school before... or watch any student smoke in the toilets.... the biggest offense i suppose is students not wearing their nametags!! well, occasionally, some students skip school, but usually it's to stay home and study for exams.. okay, now you think i come form a school of nerds... it is just that people around here happened to be nice, that's all~

i missed the good old teachers, classmates, friends… I can go on forever, just talking about my high school life… Lower six Iskandar- that was our class, with Mr Foo being our supervisor.

Sook Jiuan is one of those pretty girls in class, you know, the kind that guys would go like: ‘Gosh, I wished she were my girl~’ *wink* She’s so sweet, soft-spoken and friendly. And she's very cool to be with! I remembered those days we were all crazy over Jay Chow... yeah, those times i had ShinLoo to translate song lyrics for me to han yi pin yin, hehe... and you, me and Shin Loo would all like go crazy during class breaks.. good to hear that you are still such a loyal fan.. while, sadly, i started losing him, as his songs became more complex and harder for me to understand..

Remember the times we had so much fun at English Fest, Telematch, etc.? Our class, for some unknown reasons, keep on winning lots of prizes and hampers... how nice... sharing it around...

and i remembered you had really neat and pretty handwriting, as we used to write to each other when we first enter university...

it has been like, how many years? 6 years.. wow! time flies~ and now you are working already, in Singapore... meeting up old friends brings back good old memories... take care my friends~

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on the other hand, i have one more good news: my baby had finally been discharged!! yeay! took it around for a spin, oh, it feels so great... i took a slow drive back to HUKM today... mummy would be so happy to hear i wasn't even above 100! oh well..
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i'll like to end this post with a very touching email i received from ShinLoo today... Thanks for the awesome translation... you can read the original script in Chinese in her blog

Love, at the very beginning it's always sweet
There's always a person to be there for you, to share everything with you
You're not alone anymore, at least there's a person who loves you, who thinks of you
Whatever you do,
Long as you're together, everything is well
But then, as you know each other better,
You'd begin to notice his flaws
Thus problems arise one after another
You begin to feel troubled, tired, and you want to escape
People say it's like picking up little pebbles
You want to pick up The One that's suitable for youself
But how would you know when you'd find one?
If she's The One for you, are you The One for her?
Well, love is like polishing pebbles
When you first picked up the pebble, you may not feel satisfied
But humans are flexible
A lot of things can be changed
Long as you have the heart, and courage
If you want to go around picking up unknown pebbles,
Wouldn't you rather polish up the pebble that's already in your hands?
People think because the feeling subsided
Thus they become lazy
Wrong!
It's actually people tend to be lazy
And causes the feeling to subside

In a dinner gathering, at one point someone mentioned that eating shrimps is good for health
A middle-aged man then said, "Ten years ago, when my wife was still my girlfriend, if she said she wants to eat ten shrimps, I'd peel twenty for her. Now, she wants me to do that? No way! I don't even have interest to take off her clothes."

Understand?
It's no wonder why people nowadays don't fancy an early marriage
This is because, marriage makes people lazy
If everyone is
Lazy to talk
Lazy to listen
Lazy to create surprises
Lazy to be gentle and considerate
Then I'd be surprise if they don't go their separate ways
So please remember
An active romantic relationship
Needs sufficient nourishment
To be in a relationship
You can't be lazy

A couple had decided to go for a dinner after work. But the girl was late because of an office meeting. She was wet from the rain and was late for 30 minutes. Her boyfriend was very unhappy and said, "You are always like this. I will not wait for you anymore." At that moment the girl totally broke down, she thought, "Maybe, we don't have a future together."

The same situation, same place, same time. The girl was also late for 30 minutes. Her boyfriend said to her, "You must be very tired." He then wiped the rain water from her face and put on a coat for her. At that moment, the girl cried too. But the tears that rolled down her cheeks are warm, so as her heart.

Can you understand?
Between love and hate, there's just one fine line.

Love needs forgiveness and timing. It all depends on how you think.
When a person falls in love with you, and you think he's a fine guy
That doesn't mean you'd pick him
You say, "I want to find a guy whom I love very much, before I can commit."
But when asked, how would you consider that you love very much?
You may not be able to answer, because you can't

That's right. We always think we'd find the person whom we love very very much.
But when we look back, we'd find ourselves were indeed very naive
If it was never started, how would you know you wouldn't love him very very much?
The feeling of love is being discovered, only after you've been with him through ups and downs
You're hoping to find The One
But maybe, just maybe, someone has already been there all along, just that you never noticed.
So, take a look around
Maybe he's been waiting for a very long time

When you love someone, love him 80%
The hopes and expectations, make them 80%, the remaining 20% is for you to love yourself
If you love him too much, you may form a kind of pressure, causing both to suffocate

A friend once asked me, "How do you love someone?"
I told him,"Everyone has a different perception for love. I wouldn't want to mislead you."

Best wishes for all the lovebirds in the world

Nick Vujicic : No Arms, No Legs, No Worries!

today, let's share something inspirational:

this is Nick Vujicic, and as the title implies, he does not have arms or legs, yet he has been able to achieve to much, inspire so many people.. a few quotes that i liked from his was:

'we should not compare sufferings'


'do not put off the things you can do today. do not procrastinate!'


'when we fall, all we have to do is to get up! and the stupiest thing we were made to believe is that we have to do it alone. the truth is, we are not alone...'


' there is a perfect time for everything'

i think i shall leave it to you all to venture his life:





A bit of history from wikipedia:
Nick Vujicic (born December 4, 1982) is a motivational speaker and the director for Life Without Limbs, an organization that is for the physically disabled.
First-born child into his devout Serbian Christian family, Nick Vujicic was born in Melbourne, limbless, missing both arms at shoulder level, and having one small foot with two toes protruding from his left thigh. Initially, his parents were devastated. However, Nick turned out to be otherwise perfectly healthy.
His life was filled with difficulties and hardships. One hardship was not being able to attend a mainstream school because of his physical disability, as the law of Australia required, even though he was not mentally impaired. During his schooling, the laws were changed, and Nick was one of the first disabled students to be migrated to a mainstream school. He learned to write using the two toes on his left "foot," and a special device that slid onto his big toe to grip. He also learned to use a computer and type using the "heel and toe" method (as demonstrated in his speeches). He can also throw tennis balls and answer the phone (also demonstrated in speeches).
Being bullied at his school, Nick grew extremely depressed, and by the age of eight, started contemplating suicide. After begging God to grow arms and legs, Nick eventually began to realize that his accomplishments were inspirational to many, and began to thank God he was alive. When he was seventeen, he started to give talks at his prayer group, and eventually started his non-profit organization, Life Without Limbs...
Nick graduated from college at the age of 21 with a double major in Accounting and Financial Planning. He began his travels as a motivational speaker, focusing on the topics that today's teenagers face. He also speaks in the corporate sector, although his aim is to become an international inspirational speaker, in both Christian and non-Christian venues. He regularly travels internationally to speak to Christian congregations, schools, and corporate meetings. He has spoken on four continents (Africa, Asia, Australia, and North America), in over twelve countries, and to over two million people face-to-face.
By the age of 25, Nick hopes to become financially independent. He wishes to promote his words through shows like The Oprah Winfrey Show, as well as by writing books. His first book, planned for completion by the end of 2009, is to be called No Arms, No Legs, No Worries!
A DVD, Life's Greater Purpose, is available on the Life Without Limbs website. Most of the DVD was filmed in 2005, featuring a brief documentary about his home life, and how he does regular things without limbs. The second part of the DVD was filmed at his local church in Brisbane, and was one of his first professional motivational speeches.
His secular DVD "No Arms, No Legs, No Worries" is available online through his corporate motivational speaking company "Attitude Is Altitude."
Nick's first worldwide television interview, featured on 20/20 (ABC) with Bob Cummings was aired on March 28, 2008.

Inspired? visit his official website at : http://lifewithoutlimbs.org/

Want to hear more?

This is one of his motivational speech...
Part 1

Part2

Part3


p/ss: If you haven't done the poll on the right side of the page, do participate,
will be closing the poll soon... any ideas for the next poll?

-scheduled-