Wednesday, August 13, 2008

Surgery Posting: Day 2

I am currently in the comp lab as I am unable to update this blog at the comfort of my newly rented house in Precint 9, Putrajaya.It's cold, I'm tired and exhausted, and I just done on my slides regarding the "Metabolic Response to Trauma & Surgery", which I have to present in the Seminar session tomorrow.By the way, today is my 3rd day of surgery posting and not the 2nd day.I am not able to update yesterday due to unforseen circumstances.You will know at the end of this post.

The second day started at 7.30 am.We waited for our Hepatobiliary surgeon Mr Al-Amin in the lobby of Hosp Putrajaya.Today was our first bed-side teaching and seriously it was interesting.We covered two cases of bed side teaching today.The first case was Dr M, who had a Paraumbilical hernia and the second one was Makcik S who had a Parathyroid Hyperplasia secondary to pr0longed and chronic haemodialisis as a result of renal failure.Azrul and Salwa, two fellow group members clerked the case respectively in front of Mr Al amin.They even did physical examination.Then after a few comments by Mr Al-Amin, we proceed with our activities.As for me, I clerked a few cases.I was a bit nervous as this was my first time to clerk case from a real patient.I am currently attached to the Surgical Ward 3A ( a Male ward).The cases that I manage to see were acute appendicitis, Intrauterine death and Mesenteric tumour.I like this one post-op mesenteric tumour pak cik.He is 73 year old and seriously was healthy.Despite of being a driver of jentera berat who has irregular working hours and had to work 24/7, he appeared to be healthy.He doesnt smoke,.He doesnt have DM or Hypertension.His other 14 children have those diseases instead.Both of him and his wife was really friendly.They even gave their phone number and home adress, asking me to visit them once he has been discharged.So sweet.There is this some feeling of satisfaction in me.

At 2 pm, we had an appointment with Sister Sabariah at the OT department.We had a lecture regarding " Scrubbing, Gowning and Gloving method".Seriously, I felt that going into the OT is not as easy as ABC.There are procedures and steps that we have to follow in order to ensure sterility in the OT.It shows how st*pid that show named Grey's Anatomy is.Haha.Nak jalan kat OT pun ada cara.Nak berus tangan and lengan pun kena ada teknik dan repetition tertentu.No wonder my surgeon told me that as a medical student, do not feel hampa when after finish scrubbing the operation has already ended.As a beginner, it will take quite a lengthy time to scrub in.

The highlight of the day is actually during my On-call hours.Yes, I already have on-call.It began at 7.30pm and ended at 12am.I rushed to the Ward once I have arrived at the hospital that evening.I met a few patients just to update their history.I had ward round at 8.30pm, along with H.O Dr Sufiani( sangat baik ), M.O Dr Zamaq ( Triple A's student masa dekat HUKM dulu, I think) and Endocrine surgeon, Mr Cheong and a few nurses.I was asked to do full abdominal examination to a Pakistani patient, suspected of having Pancreatic tail carcinoma.Doing a full physical examination in front of a specialist, MO and HO for the first time was not easy.I was pretty nervous at the beginning but later managed to maintain my composure.The only thing that I have done wrong was that I forgot to make sure that the patient is lying down 180 in supine position.The head of the patient was actually tilting 45 degress..huhu.Mr Cheong also asked me to feel the difference between the Left iliac fossa and right iliac fossa of this one patient who had just being admitted to the ward, suspected of having acute appendicitis.He said, the problem with medical students nowadays is that they do not know how to differentiate between guarding and tenderness.

Later, I proceed to the Emergency department(ED).Sumpah wallah ramai gile patient malam tu.The department was quite hectic and the staff were running around here and there.Me and my colleagues introduced ourselves to the doctors and nurses there.I was given the task to clerk a patient who had just went into the ED.I later presented the case to a Dr named Dr Hasanah ( sangat baik rupanya) and after a few questions, she gave me two thumbs up.Tak sangka.I occasionally went to the Radiology department and managed to see a few ECGs,X-rays and CT scan.I saw a patient with a multiple infarction of the brain in CT scan.Maybe that's the reason why he is being so restless and is having dementia.There was also a patient who have DM, Hypertension, Gout, history of MI, Left Bundle branch block(LBBB), and Parkinson's disease.Serious, a super combo for me that night.He already have akinesia, cog-wheel rigidity, pill-rolling tremor, slurred speech as a result of Parkinson's disease.He also have bilateral non-pitting oedema of the legs due to his congestive heart disease.However, the chief complaint was SOB (Shortness of breath) .Creps (Crepitations) was heard at the left lung on auscultation.Dind't have time to wait for the X-Ray becoz it was already late.Juru X-ray pun tengah keluar pegi makan masa tu.

One thing I learn today is that do not be shy.Be confident.Ask when you want something.The staff of Hospital Putrajaya is more than happy to assist you,seriously...

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