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....

-----------------------------------------------------------------------------------------------------------------

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

Dear diary,

Dear diary,

I had been rather depressed (correction: emotional) for the past week. It is a feeling that is rather hard to express. I wanted to get a drink, maybe to chill out and relax, to forget everything, yet, I couldn't.

That was when I realized, I had no one here to turn to.

I DO NOT BELONG HERE.

I am not the sociable kind of person.

I am not friendly.

I am not histrionic.

I do not open up easily to a friend, it takes time, time to build trust and comfort.

(at least in my case)

So, I had to pay for the consequences for being who I am.

I had a problem with adaptation. I always had. When I move to a new place, I would try to run away from it.

I dread being in a new place. It gives me no comfort, that new place.

Maybe it was partly because of my childhood memory, the time when I was 9 year old, and my family decided to move from Subang Jaya to Seremban. I was suddenly told that I had to leave. I resented it. And No, I had no vote in it. And I left, without a word or notice.

So, each time I go somewhere new, I get the same feeling all over again.

When I first shifted to Seremban, I resented it in my new primary school. I was exceptionally quiet – according to my report card. When I entered university, same resentment. And when I came to Melacca- resentment.

I hate it that everytime, when I reach a comfort zone, I had to leave.

And here, I am unsure, whether I have found my comfort zone.

Funny, being nearly two years here in Melaka,.. I had not one person to turn to in times of sadness.

I just could not open up. (it’s not them, it’s me) Friends here are cool, nice, but just, we do not talk feelings. We are lunch partners, dinner partners, shopping-partners, movie-partners, bowling-partners, happy-times-partners. They see me as a happy person, having a good career, a good family, a good boyfriend.  Even when my world turns up-side-down.

Perhaps, it is because, at every opportunity, I ran home. When it is the weekends, even when I am post-call, tired and sleepy, I grab the keys and drive. I had to. I just had to get out of here.  I missed my high school days and university days, those times that we can talk about almost anything.

I DO NOT BELONGED HERE.

IT IS TIME TO DECIDE, TO STAY OR TO MOVE.

I know I will miss my happy-times-partners…. And I feared again, the need to adapt again, the resentment.

My mum said, this is the circle of life, friends come and go. And I noticed, my mum is so occupied with work and family, she never meets up with any of her old friends. ‘we lost touch’ – she said.

It makes me wonder, will I be like that when I grow older, reach forties.

I think mum is a very strong women.

And I, I am not as strong as her. 

I needed friends, close friends, the happy-times-and-sad-times-friends. 

Just in case, if things did not turn out well, I needed something to fall on.

Love isn’t everything, Work isn’t everything, Then, WHAT IS EVERYTHING???

They say,

Love isn’t everything, 

Work isn’t everything,

Then, WHAT IS EVERYTHING???

Say we wake up at 6 in the morning, get to work at 7, plus minus the traffic jam, starts work at 8am, be very lucky enough to leave at 5pm, reach home in more or less 6pm… that is like 7am-6pm, which makes about 11 hours which is 45% of our day (11 out of 24 hours), EXCLUDING on-calls, studies, etc…  furthermore, if we were to minus 8 hours of sleep,  our job makes up 68% of our life… (i know, it is a sad fact, isn't it)

So, whatever JOB we choose, seriously, we MUST LOVE (LOVE, not just like, yes, deep-down-inside-L-O-V-E) it, right??? 

Then, we get home, we spend the remaining 13 hours with our love ones, whether friends, family, or the other half… laughed about what happened at work... share each other's experience, give each other comfort, give each other a pat in the shoulder, encouragement, love, smiles, support, surely, we SHOULD have a home to get back to, shouldn’t we? shouldn't we enjoy the other part of life to the fullest??

So, if we were to have a life partner, we SHOULD LOVE (LOVE, not just like) him (or her), right???

Imagine, if you had to remove that first half… so like I had to go to work, doing something I don’t like, 11 hours a day, for lets say, the next 2 years… how would it feel like?? Living that daily routine, dreading to get up for work, being blue all mondays and throughout the week.... Horrible. ain't it??? Well, at least I get to come home to people I loved… maybe that will make up for the 45% of the day, maybe not enough...

On the other hand, imagine, if you keep the first, and remove the second half… so like, I do something I like very much, live my passion, follow my dreams… but at the end of the day, I come home to an empty rented home… cuddle myself to sleep, treat myself when ill, dapao food home or called for delivery, watch VCD on my laptop until i doze off, …  is that happiness? 

So, 

when forced to make a decision,
i was torn apart between two worlds...

So, 

when forced to make a decision,

 I asked,

 WHY CAN’T WE HAVE THE BEST OF BOTH WORLDS??








WHAT IS EVERYTHING???

so, we live only once, heck it!

BABIES DO NOT GROW ON TREES. PLEASE LOVE YOUR CHILDREN.

I was on call in the operating theater (OT) last night.

It was quite an eventful night. Very taxing, both physically and emotionally.

Then, there was this case which was put up at about 4am in the morning.

There was this 4 year old boy, let’s call him XY, 13 kg, with total amputation of the left middle finger and amputation of the tip of the 4^th finger with open fracture of the middle phalanx. Are they going to resuture the finger? – I asked Khalidah. She was not sure either.

The child arrived at the OT. Small and fretful. I could not imagine how mischievous he might have been, to be involved in such accident. He held on to his mother.

Further history from the mother, XY was playing alone when his hand, in her very own words, ‘tersepit kat pintu’. How did it happened?? I blurred, she replied ‘tak tahu lah’. DENIAL. I quickly ran through some short medical and surgical history and examined the child, then pushed him to OR6. (Operating Room 6).

The child was put under general anesthesia and the orthopedic team planned for a refashioning on his fingers, which means, no they were not going to reattach his fingers. This was obvious right from the start – we did not have a hand surgeon in hospital Melaka.

I went through the case notes later, only to discover the hidden agenda. The child was the youngest out of 4 sibling. He was playing alone at home, at the door, when the accident happened. His parents brought him to the hospital only FOUR hours later. The ortho team initially planned to refer and transfer them to Hospital Serdang for reattachment, however, the parents refused for referral because of ‘domestic issues’.

WTF!

I mean it is difficult to salvage a finger which had been amputated for 4 hours, but if you were the mother, and you know that your kid still have a chance to reattached the amputated limb, wouldn’t you go all out??? And they say mother’s love is the greatest love of all… I cannot be too sure. His father wasn’t around for opinions either. Just because you think you can have as many babies as you like, it does not mean you get to neglect them.

BABIES DO NOT GROW ON TREES. 

PLEASE LOVE YOUR CHILDREN.           

It pains my heart so very much when seeing incidents like that. What if the child grew up and wanted to be a surgeon? What if he wanted to be a pianist? Of course, there is prosthesis and all, but why not give him a chance? It is such a sad story….

To add salt to the wound, rub it in, there was another unfortunate case last night, following that case. 10 year old girl, let’s call her XX, came with amputated right ring finger, case put up by orthopeadic team for refashioning of finger. From the history, it was an accident, the child was riding on a bicycle when her finger caught between the wheel and amputated. I feel sorry for the girl. She would never wear her wedding ring perfectly again. It is so sad.

I think I will not like my next houseman posting – orthopeadics. It is a ‘BRUTAL’ department, I think, with lots of amputations which I could not bear to see. Amputation of finger, or fingers, toes, limbs, BKA, AKA, etc…. I wonder how would I ever survive the OT then.

My GA MO, Soon, newly wed last month, apparently, he shared similar opinions, he said disappointedly, ‘I really cannot understand these parents, how could they leave their kids like this’.

I replied, ‘Soon, when you have kids, please take good care of them’

i think parent-ship can be one of the biggest challenges... 

sometimes, i wonder how my parents did it...

they must have been like SUPER MOM and SUPER DAD...

how i missed you...

will be home soon...

(p/s: names and demographic data had been modified to preserve confidentiality)