Saturday, September 27, 2008

Nothing is enuff

Yes, no matter what you do, no matter how much you sacrifice yourself in the sacrificial pit, it will never be enough.So enough, I've had it, I am not going to become the saviour anymore.It's all about me now.Me first!You second!

We'll be amazed of how many superficial people around you, just waiting the right time to bite you...

Wednesday, September 24, 2008

Key-hole dressing

It's a type of wound dressing that is usually used for various types of drainage.It was an honour for me as a clinical year MAD medical student, to be given such trust by the nurses and doctors to perform such procedure.Ohhhh well... it's not that complicated anyway.The patient himself was giving me the instructions throughout the process.Haha.

First, make sure the sterility of the equipments and your hands must be clean.Perform the surgical hand washing (yes, there are many methods of hand washing)

What you need is basically a dressing set which contains other stuffs, povidone iodine,normal saline, Hapifax-wide body ( a type of plaster), cotton balls gauze and of course the working brain.Introduce yourself to the patient and make sure he/she is comfortable.Get a good exposure of the abdomen.

Remove the previous dressing and throw it in the waste bin.
Use the plastic forcep, soak the cotton balls with normal saline.Apply that at the wound in circular motion,starting from inside to outside.Do not dab it for so many times.Remember, sterility! Since I am in a government hospital, so boleh laa membazir sikit.The goal is not to develop any nosocomial(hospital-acquired) infections!

This patient has a drain, which is connected to a plastic bottle.It contains blood, originated from the abdominal cavity.Later, wear mask, open the bottle and drain it into the sink.Rinse it with running tap water.Connect it to the vacuum port and depressurized it.Reconnect it to the tube.
Soak the gauze with iodine.Close the wound and secure the tube.Dont let it dangling like a yoyo.Apply Hapifax in order to close the wound with iodinated gauze.And voila my job is done.
Today, did a few venepunctures.I failed once and it was humiliating.Cant blame coz the patient was well built!Veins lari lari okay.Clerked a number of new patients in the ward and did physical examination on them.
Currently its 11.50pm, I'm only half way on my long case write up.I intend to present it tomorrow.I've decided to go to the Dewan Bedah tomorrow so that I can update my patient.Bye

Tuesday, September 23, 2008

23rd Septembr 2008

What did I do today

1) Bed-side teaching by Mr Al-Amin, the Hepatobiliary surgeon.I presented a case of an anterior neck swelling.This patient is having a rare thyroid pathology known as Hashimoto's thyroiditis, which is an autoimmune disease where there is an infiltration of T-lympocytes, leading to follicular cells destruction.This patient is a textbook patient.During the acute phase of attack, this patient had transient hyperthyroidism symptoms, also known as 'Hashitoxicosis'.During this period of time, she experienced palpitations, sweating,agitation, loss of weight despite good appetite and anxiety.After a significant number of thyroid's follicular cells( cells that produces the thyroxine and Triiodothyronine) destruction, the patient slowly progresses to hypothyroid state.On neck examination, there is a visible, diffuse neck swelling only on swallowing and not on tongue potrusion.The mass is diffuse, soft in consistency with ill-defined margin.

2) Went to the Emergency department for orientation by an MO

3) Went to the Surgery clinic.Assist Mr Hisham in inserting Foley's catheter for Continuous Bladder Drainage (CBD) to a patient known to have BPH (Benign Prostatic Hypertrophy).Did some venepuncture, not by looking but by palpating the veins at the cubital fossa.Patient to berkulit gelap okay and tak nampak veins!Luckily, my first attempt of withdrawing blood from this patient was successful.

4)Had another bed-side teaching by Miss Sarinah, the Breast and Endocrine surgeon.I presented a new case of 4th degree Haemorrhoid.Did physical examination on him but unfortunately the patient refused to be PR-ed! However, on inspection, there appears to be a single mass at the anal opening which is ulcerated and and thrombosed.Will try to request for PR from him again tomorrow =)

Currently listening to Raya songs while writing my case write up

Monday, September 22, 2008

22nd November 2008

It really scares me sometimes that we can die, literally anytime when the time comes.Thats what I felt when I was in the surgical clinic today.
Encik A, who is only a 29 years oldmalay gentleman has come to the clinic with a left testicular mass of 2 weeks duration.Yes, its only 2 weeks duration and the mass is already as big as a tennisball.Anyway, I am not going into the details regarding the mass ( like we usually have to describein our case presentation).In order to differentiate whether it is a hydroecele or a solitary mass, me and the MO Dr Syikin did the transluminent test.And guess what the test was negative and the mass is nota hydrocoele.Our impression:Left Testicular carcinoma.The patient is scheduled for urgent ultrasound and we need to perform Orchidectomy(testicular removal) on him.Poor guy.I talked to him later while Venepuncturi-ing( withdrawing blood from veins), tried my best to console him.

I also managed to assist Dr Kerwin in doing Proctoscopy.There was this patient, Encik R who came to the clinic with a TertiaryInternal haemorrhoid ( Piles whichis prolapse upon defecation and can onlybereduce manually).I performed a rectal examination on him and seriously he was in pain whenever I touched the hemorrhoid.I had to slowly push back the pile with my fingers.Later, we used the proctoscopy and did Haemorrhoid rubber banding.He is scheduled to come again later in a month time, and if necessary a surgical procedure known as 'Staple Haemorrhoidectomy' will be done.Oh forgot to mention that this patient works as a Penjaga Kuda, and he used to take care Tun Dr Mahathir's horses.

I joined Hanan'sgroup for their bedside teaching.Hanan had to do clerking to a patient with a right breast lump in front of us and Mr Hisham ( the soon to be Minimally invasive and Bariatric Surgeon).The session ended with case presentation and case discussion

Saturday, September 20, 2008

Post call

It's 12.50am now, juz got back from the Hospital due to on-call.

The day started well.Observed an operation; Total parathyroidectomy.Mr A was mypatient for my 5th long case.He has a conctellation of past surgical and medical illnesses.He was diagnosed with Diabetes mellitus when he was only 16 yrs old and now he is 43.Had generalied oedema in 1995 due to nephrotic syndrome and was treated in Hosp Seremban.His kidney function starts to deteriorate from that day onwards and was diagnosed as End-Staged Renal Failure (ESRF) and is on haemodialysis since 1998, 3 times per week.Later, tertiary parathyroidism developed ( Autonomous secretion of PTH hormone despite normal serum calcium level).Anyway, the operation took 3 hours.It could have been shorter but the surgeons could not locate the right lower parathyroid gland.A parathyroid gland is located posteriorly to the thyroid gland and is only 4-6mm in length.Sgt kecik okay!

I decided to do on-call today.Managed to do a few things such as
1) Set a few new IV lines ( Brannula)
2) a few Venepunctures
3)Went to the radiology department with Mr Hisham and Dr Izyan to see a CT scan of a patient with head trauma.This patient had Extradural haematoma.Biconcave appearance were seen in the CT scan.

Tomorrow, I am supposed to go to a place called Sungai Pelek in Sepang to help out my friends who are currently doing their Public Health(or Hell) posting.They are having their 'HIP'-Health Intervention Programme.Malas tapi rasa mcm kena pergi jugak.Probably going to singgah the Hospital again tomorrow.Hopefully can do Arterial Blood Gas(ABG) again!

Thursday, September 18, 2008

6th week already

What did I do today?Lemme see...I've just presented my 5th Long case.It was a difficult case to begin with.Even the surgeons said it was difficult.But I think I did just fine.I got 7/10, which is a good mark! Susah nk dapat...
We had a bedside teaching by our own lecturer Mr Al-Amin, the Hepatobiliary surgeon.A few of us presented a few cases to him.They did well.I think we have got a good grasp in terms of writing and presenting a good case write up, though it was hard at the beginning because of the nitty gritty stuff and thouroughness.
I did my first arterial blood withdrawal today from the femoral artery.I did not feel afraid anymore.In order to become good at any clinical procedures, I notice that we need to have a good grasp of the anatomy and also...GUTS.Yes, we have to be brave and trust ourselves.InshaAllah everything will be okay.I'm thinking of going to the hospital at 6am tomorrow, so that I will get the chance to do more venepunctures and other procedures.Life is good~ =) On-call at the wards and emergency department tomorrow night! arghh

Friday, September 12, 2008

The absurdity of life

I've just completed my 5th weekof Surgery posting.Frankly speaking, I like surgery.I can see myself as a surgeon one day.God willing,if I am destined to become one...I am really not that surprise.A friend of mine said that there is a theory that we medical students will fall in love to our first posting in our clinical years( Surgery in my case) and will tend to like it more than the other postings and eventually will become specialist in that area.I leave that to you dear readers for your own thoughts.

Fast and efficient is the word for surgery.As a medical student, aggressiveness is an important asset!We cant afford to be left behind coz nobody will wait for you.Never ever wait for invitation.Make your own initiative.

I've presented my fourth Long case write up today and yet I have just received an sms from the coordinator saying that we need to prepare and present our long case by next wednesday.Usually, the presentation day will be on every Friday.Seriously, give me a break.Not only that, TBL and seminars must be completed by next Wednesday.This is what I called absurdityof life.

Thursday, September 4, 2008

TOILET mastectomy O_o

I am currently doing my Long case.It is regarding a 56 year old lady patient who has an advanced left breast cancer ( TNM Staging: T4c, N1, Mx ) .She cried today right in front of me.I was speechless at first, but later managed to calm her down.I cant imagine if I were at her position at that time.She is scheduled for a CT scan tomorrow morning.She will be undergoing a surgical procedure called "Toilet Mastectomy" in order to remove a fungating breast mass ( which in my opinion doesn't look like a breast at all.There was a complete destruction of the nipple and the general breast architecture.It has active bleeding with puss collection already).Why the name 'Toilet"? hmm dont asked me.Miss Anita the surgeon had explained to me earlier but I still dont get it as to why it was named as TOILET mastectomy.I thought it was a typo error initially and had a great laughed, but seriously...the name is toilet.god knows why...
Earlier that day, I was in the OT observing a Total thyroidectomy ( total removal of the thyroid gland).Makcik H had this one HUGEEEEEE anterior neck swelling.The operation began at 9 am with initial problem because the anaesthetist couldn't set the arterial line due to frequent thrombosis.I was standing like 5 hours straight until when the clock showed 2 o'clock, I had to leave the OT and rush to a TBL session.By that time the enlarged thyroid has been successfully being removed.Try to guess the weight? I bet its around 1 to 1.5 kg.Seriously, it was that hugee man...
K ciao~

Monday, September 1, 2008

Conserving energy mode

Can somebody teach me on how to conserve energy?I so really need this skill. Can I just put my body on Standby mode while in the OT (operation theatre)? Can I put my body to Hibernate mode during lunch break?

Here's what gonna happened tomorrow

- Bed-side teaching at 7.30am.Lambat seminit Prof takmau sign attendance! Must present a few short cases.Huu..

- Have to srub in the OT.Later kalau sempat pergi Surgical clinics pulak.

-Afternoon: Now its Ramadahan so I plan to use the break to actually take a nap in the surau tingkat lima of Hosp Putrajaya hehe

- Later that afternoon, pergi ke wards and clerk a few patients.I need to select one of them for my Long case.Not forgeting the physical examination and the rectal examination!I need a chaperon because I really hope that I will get a thyroid case this week.Woman are the ones who usually have abnormal thyroid condition!

-Malam: On-call! I really want to Terawikh coz now its Ramadhan.I really love Ramadhan. I think I'll just do my terawikh alone at home.Sigh...