Deprived

Yes, I am deprived of my social life.

A buddy of mine called me this morning, ajak main Pool and lepas tu Karaoke tonight.But I had to reject those offer.Sorry dude, I have final O&G exam next week.I still got tons of stuff to be revised.However, being me I always offer another alternative date.

Pray for my success.Nak success with flying colours lagi~

By the way, Octuplets were born today via Caesarean section in California, USA.I just cant imagine how could 8 babies being stuffed together in a uterus!I have personally have had the chance to observed twin deliveries, and all I can tell is that it is not an easy task both for the mother and the hospital staff to manage the situation.There is a suspicion that the 8 babies were not there by chance.I suspect that an IVF( In vitro fertilisation) were done.Yes the doctors in the US claimed that it has got something to do with ovulation induction drug( ubat kesuburan) and not IVF.But come on, you think you can fool me?What are the odds of having 8 fertilised embryos in the uterus thru ovulation induction drugs?In my opinion, it was very unethical for the doctors to do that.Multiple pregnancies is never good to both the mother and the babies.It has a significant increase in so many complications such as preterm birth, congenital defects and even death to the mother.Would you risk so many lives just to attained personal glory?

Note 1: I never karaoke-ed before.Ntah kena rasuk ape tetibe nk try haha.Pool pun lama dah tak main.Oh yeah, I forgot.I am deprived.I dont have the luxury of time.

Note 2: Currently addicted to a band called Dishwalla.Genre= Alternative rock .Underground band je tapi lagu best best.One of their song called Angels or Devils were made as a theme song for one of the episode of Smallville. <---- WHY AM I TELLING YOU ALL THESE????

Baby bengkak

(Apela punye title)



Anyway, hari ni ade case Intrauterine death -Hydrops fetalis.The first pregnancy ada hydrops fetalis.This time the second pregnancy pun ade hydrops fetalis.I wonder whether her Obstetrician have identified the cause.My best bet: She must be a Thalassaemia trait while her husband is also a Thalassaemia trait.So that wud make the baby Thalassamia major.However, there are many causes of hydrops fetalis which I will not deal here.I did not clerk her case so I dont know her story.

Dah la nak tido.Penat + mengantuk.Besok pagi pukul 7.50am dah kena ada kat seminar room for morning pass over...sigh...

Note 1: Pic above:Thats me assisting Dr Dahlia.We were doing Caeserean section on a lady.It was a GDM (Gestational Diabetes Mellitus) mother with macrosomic baby, 4.1kg

ZZzzzzzzZZZZzzzzzzzz.........

Gaza

I would like to ask everyone to pray for the safety and success of the mision for two of my beloved professors who has just entered Gaza yesterday.Both of them are:

Prof Dr Ikram Saleh ( An Anesthesiologist)

and

Mr Al-Amin Daud ( Hepatobiliary surgeon )

Let us pray so that Allah will always be with them,ensuring their mission under the banner of MERCY Malaysia will be successful.

Masih igt lagi patient yg ada anak takde tempurung kepala tu? She gave birth to the baby at 8.20am today.Didn't manage to see the delivery sbb tgh bekpesmasa tu.Member call, ape lagi berlari lari la dari cafe ke labour room.However, I still manage to see the baby.Excited pun ade, kesian pun ade.Excited sbb dpt tgk Anencephaly bedebuk depan mata.Kesian sebab simpati dgn mak dia.The baby has already passed away masa kat dalam kandungan lagi.Really want to take the picture buat kenangan, tapi tak sampai hati nak mintak permission dari mak dia.The baby was taken away by the father at 9 am camtu.
Anencephaly, or fetus without the skull is due to lack of folic acid in the body.Folic acid is essential for the development of the central nervous system during the period of embryogenesis (at first trimester ).Inadequacy will result in neural tube defects such anencephaly.In Malaysia,folic acid will be prescribed to expecting mothers during the booking date.However, theoretically folic acid should be taken 3 months prior to pregnancy, I repeat 3 months prior to pregnancy.This is to give some time for the body to store adequate folic acid before a mother became pregnant.Tapi iyela, sapa la yang nk makan folic acid saja saja kan?Tapi kan, kenapa ada still pregnant lady yang malas mengambil ubat-ubat doktor.Beringatlah bahawa semua benda yang doktor berikan adalah untuk kebaikan anda dan juga kandungan anda.Semuanya ada sebabnya.fullstop.

Note 1: Mr Al-Amin is one of my idol to become a surgeon.

Note 2: Just came back from on-call.Presented my case to the MO on-call, Dr Dahlia.She is super duper nice.I learn a lot from her, particularly tips regarding the long case exams.Thank you so much Dr Dahlia.I will definitely give u some small present at the end of this posting =)

Takde kepala

I'm officially in the Obstetric ward.A lot of patients.Both of the wards are full.We had to actually open some pseudobed ( pseudo= tipu, bed= well..it means katil) Haha...

Most of the antenatal cases are Pre-eclampsia and Gestational Diabetes Mellitus.However, I had a patient with an Anencephalic fetus ( Baby without the skull and brain).Yep,poor her.I really really sympathize.She is currently in her36 weeks of pregnancy.However, according to the protocol we need to induce the labour.She is currently on Prostin, a type of progesterone for cervical ripening.The last time I checked, the cervical os is opened at 4cm.My professor is asking me to keep track ofthis patient, especially the management part.

I was on-call-ed last nite.Observed an LSCS( lower segment caeserean section) of a transverse lie baby. I became the first assistant to the surgeon for the second LSCS for macrosomic baby.The birthweight was 4.1kg.Memang nampak montel la baby tu.

Some interesting quotes for the past 2 days

" She does not have early symptoms of pregnancy.However, her husband does"
Med student 1 during case presentation

" Med students are the only human beings who are still alive despite being anencephalic"
Prof Dr H after hearing our case presentation this morning

** Ni lawak medic, susah sket nak paham..

Note 1: Becoming the first assistant for the LSCS has been a wonderful experience for me.I gain so much wealth of knowledge.The MO who performed the operation are so helpful.We actually teach each other.I teach her a little bit about embryology and she taught me like A LOT in return. Surgery surgery surgery...I simply love surgery and being in the OT...

Note2: I think I love seeing blood.fullstop

Note 3: Today,I think I've found a patient for my Obs case writeup.She has pre-eclampsia with impending HELLP syndrome and she is symptomatic.Interesting!She has to deliver her baby by tonight,regardless the method of delivery either vaginally or Caeserean-lly

Midnight ramblings

It's 12.47 am and I am still stuck with this powerpoint.I have a presentation tomorrow.I just hate doing power point.fullstop.I, on the other hand love teaching(<---- habisla gelak guling guling member-member aku yg baca statement ni).I've had a few occasion volunteered myself to tutor my juniors during my pre clinical years.I dont mind spend my time until late at night so that they understand.I love who participate in class( Come on people, you cannot wait until somebody feeds you!).I hate those who only act merely as passengers.I totally anti-ed those who talk when I am doing the talking.Rasa nak baling kasut.

During pre clinical years, we have exams every friday morning.READ: EVERY FRIDAY MORNING.Exam pun bukan yg memain punye.Ni yg stail duduk kat hall mcm nak amik SPM.The ones that the invigilators would say 'Para pelajar yang didapati menipu didalam peperiksaan akan dibuang dari institusi pendidikan-type of exams'.The idea is to make sure that we are all consistent in our studies.Marks will be counted as part of our final exam marks.So tak boleh kantoi sekali pun.I used to hate those negative marking style of marking.Correct answers will be awarded one mark, but every wrong answers will be deducted 0.5 marks.Mahu dekat 100 kali exam in total masa pre clinical years.Mahu tak tumbuh uban masa tu.Jerawat pun bleh tahan banyaknye...Anyway, back to mentor-mentee tu, I used to senyap-senyap check my mentees punye markah yang diorang tampal kat result board.Kecewa kalau diorang fail.Rasa satu kegagalan dan kebuangmasaan( is there such word?Habisla A. Samad Said marah).Gembira dan bangga kalau markah diorang tinggi.

Why am I telling you all this? I still got a powerpoint to setel....adios!

Note 1: Ada cita-cita nak jadi Clinical lecturer nanti.Bestkan.Dapat keep in touch with basic knowledge.And at the same time bleh buat pahala banyak banyak.Bayangkan that pahala tu beranak-pinak once your students dah berkhidmat jadik tuan/puan doktor!

Note 2: Esok ada temujanji dengan sorang MO ni, Dr Dahlia.Nak buat temujanji kat OT.Its not just a temujanji.I'll become her first assistant for Cesaerian section tomorrow.

Note 3: I'll be officially attached to the Obstetric ward from tomorrow onwards.But that doesn't mean that I'll be missing all the action in the labour room.No way bebeh!Mothers, you will not see the last of me.beware...<--- habis la berlagak macam superhero pulak

A gentle reminder

I've just got to write something before I'm off to bed


Before medical school...
Is it important to be the best student during your secondary school? Would that be a pre requisite in ensuring success in medical school?Is it important to get the best SPM result in your state?

In medical school...

Is it important to get a straight excellent marks during every exams?

The answer to those question mentioned above is NO!

Yes, good result in every tests and exams during medical school is important.However, it must be combined with good attitude and excellent psychomotor skills ( eg: clinical examination skills, clerking skills,case presentation skill, procedure skills etc).And please... dont be a robot! medicine is actually logic! Tak gune menghafal membuta tuli and during exam just muntahkan segala-galanya and at the end of the day unable to apply your knowledge in the real situation.

I've got a few friends who are still in his/her realm of dream.They think that being the best during their secondary schools will ensure their success in medical school.To me, they have this inferiority complex.That they will always remind themselves that they were once a top scorer during SPM and that nobody is above them.This way of thinking will eventually comfort them.My advice:Please, hang those result at pagar before entering pagar hospital.That wud just be your recipe for disaster!

Just a sincere reminder.My 2 cents.Sekian...

Note 1 : Kpd adik-adik di luar sana, bila dh masuk med school nanti rajin-rajinkan diri k.Jgn malas-malas.Bersykurla sbb dpt buat medic.Bukan semua org apply dapat kan? Yang paling penting sekali adalah attitude kita...and of coz niat kita =) <---- More like a reminder to myself haha =P

Note 2: Episode manga Naruto terbaru dah keluar.Tgh happy nih...

Yatta~!!

Pic 1: Metal-cup ventouse ( a.k.a. vacuum delivery)

Pic2: Kielland's forcep

Yatta~!! I conducted my first delivery!It was easy becoz the patient was G3P2( meaning this is her 3rd pregnancy and have given birth to 2 children).It was quite fast, probably less than 4 minutes.At first, Staff Nurse A offered me to conduct the delivery not once, not twice but three times.Ditambah pulak dgn member comel aku yg sorang lagi tu yang bernama Burg, asik je menyiku-nyiku aku, 'Bil, pergi ar! Buat je, kau mesti boleh punye' . Hmm so, kite ni pun ape lagi laa kan.Terus amik sterile glove size 7, pakai and pergi conduct the delivery under the supervision of a nurse.The baby had a condition called 'Cord round neck'.Terkejut gak la memula.Alhamdulillah everthing went well.Perlu diingat disini iaitu delivery of a baby is not as easy as what you might think it is.It is an art!Did you know that there are as much as 8 steps during the Second stage of labour ( belum lcakap pasal the first and the third stage of labour).A lot of things to be assessed before, during and after the delivery. Terpaksala tunjuk macho sikit tadi sebab ada beberapa student nursing kat dalam labor suite tadi.Malu la kalau tak betul kan? =P

I also managed to witness a Twin delivery ( At last, doaku dimakbulkan yer) .This was a dizygotic, dichorionic diamniotic twin.Memang respek la mak dia.She really wants to deliver vaginally and not thru Cesaerean section.Twin 1 was in cephalic presentation ( kepala kat bawah), HOWEVER the twin 2 was breeched ( kaki keluar dahulu).It was footling breech to be exact ( There are a few types of breech presentation) .Doktor pakar was there.Again, delivery of a baby with footling breech presentation requires different skills and manouvre.The delivery of twin 1 was quite easy.The baby came out quite easy once the membrane ruptured.The baby came out at 2.25 pm.

The delivery of the second twin was a bit tricky due to the presentation part.The Obstetrician had to do an Ultrasound scan and later did a manouvre called External cephalic version, in order to maintain the baby's lie (twin 2's lie was an unstable lie, kejap dia pegi longitudinal lie, kejap dia pusing jadi transverse lie).Manouvre ni bertujuan untuk memusingkan baby dari luar dengan menggunakan tangan ,so that the fetus will have a suitable position for delivery.According to the book, the delivery of the second twin must be done within 30 minutes after the delivery of the first twin.Therefore, patient was given IV Pitocin to stimulate uterine contraction.After about 10 minutes, the Obstetrician decided to artificially rupture the second twin's amniotic membrane.There was a sudden gush of amniotic fluid.Tak ubah mcm waterfall.To cut the story short, Twin 2 was delivered by using a few manouvres.So dapat la aku tengok camne rupe manouvre Mauriceau-Smellie-Veit manouvre ( manouvre yg sampai skrg aku tak dpt nk sebut namanye).Stylo betul doktor tersebut.Kagum aku dengan dia.According to our professor,there are a lot of risk in breech delivery.You have to be fast and sure in what you are doing.Every second counts.Twin 2 was deliver at 2.43pm.The baby was born flat.She did not cry.A pediatrician was already on standby and she resuscitate the baby.Akhirnya, kedua-dua baby tu selamat.Cuba teka dapat baby ape?Twin 1 was a baby boy while twin 2 was a baby girl!

Today was a busy day.The PAC(patient admission counter) was packed with patients.Labor suites pun agak penuh.Back to back.Kadang-kadang sampai tak sempat nk prepare the instrument pun.I had the chance to do episiotomy suturing on 2 patients and 1 placenta cord traction.

Later in the afternoon, we had a teaching session with Dr S, a senior O&G specialist.We learn about Intrumental delivery using Ventouse( a.k.a vaccum) and Forceps.

Ok la bye.Nak lelap jap.I have on-call tonight.

Tumpah Darah

10 AM, Dewan Bersalin hospital

One of my patient had a condition called Post partum hemorrhage.Orang Melayu kita panggil 'tumpah darah'.Puan S had a prolonged stage 2 labour, around 45 minutes.Peneranan( is there such word?) tu tak brape mantap dan efektif.Ramai la yang masuk ke dalam labour suite pastu beri sokongan.Macam nk pecah je bilik bersalin tu agaknye.I was beside her, encouraging here to do this and that.Nasib baik baby tu tak lemas.CTG reading was reactive.I was surprised.

Later, I delivered the placenta by using the Continuous Cord Traction technique.Placenta delivery pun agak lambat.Agak-agaknye around 10 ke 15 minit.Slalunye 5 minit je placenta a.k.a uri tu dah keluar.Then she started to feel thirsty.Then she complained that she wants to faint and that her vision was blurry.Ahhh sudah, patient nak masuk hypovolaemic shock.Apa lagi terkejut la kami semua kat situ.BP was taken and the reading was 55/28 mmHg.Bayangkan diastole hanya '28' je.We run a lot of IV fluid both crystalloids and colloids(plasma expander) like mad - Hartman's solution, Voluven, Normal saline you name it.Specialists Dr S was alerted and she came running and panting.

This patient had what we called Primary Post Partum Haemorrhage( meaning excessive bleeding within 24 hours post delivery).The commonest cause is either retained placenta in the uterus or vaginal wall tear.Its unlikely to be from retained placenta.I've checked the placenta thoroughly- cotyledons are complete, 2 membranes, 1 vein and 2 arteries.Impossible.MO check.Check punye check, laa rupe rupe nye ade left lateral vaginal wall tear.Tear dia sangat halus dan susah untuk dijumpai.We sutured the the tear and the bleeding stops.Fuh, akhirnya stop gak pendarahan tu.Estimated blood loss for the whole labour is around 1 litre to 1.5 litres.Tuan-tuan dan puan-puan sekalian, darahtu banyakye.Jangan dibuat main-main

Oh by the way I had the chance to do episiotomy surturing just now.Seriously, the feeling of menjahit tu sangat best.Rasenye aku memang la berbakat nk jadi Surgeon <----- Habisla, puji diri sendiri tak bertempat.Oh well, takde org lain nk puji aku, so aku puji la diri sendiri hahaha...

Oh the best part was when Puan S said to me:

'Akak nak amanahkan adik Nabil utk mengazankan anak akak tadi yer"

OK.The keyword here is 'amanah'.Its such a big word for me and it was such an honour to do that.Bile fikirkan balik, kesian akak tu sakit sakit labour camtu tapi suami masih dalam perjalanan ke hospital from Perak.So bakal-bakal suami disana, jgn lupa temankan isteri anda yang nak beranak.In evidence based medicine, companionship during labour has been proven to lessen patient's pain during labour.

K chow cincau.Nak pegi On-call malam ni!

Sambung cerita...

Juz got back from the hospital.Fuh, penat.Rasa nk hilang je suara memberi sokongan kpd ibu-ibu/bakal-bakal ibu ni.Anyway, I went straightaway to the obstetric ward juz now once arrived in the hospital, dengan harapan nk jumpe Puan S tadi.Cari punye cari tak jumpe.Rupe-rupenye dia still labour room for close monitoring.Blood transfusion is being done in order to bring up her haemoglobin level.Dapat la berborak dgn dia dan ahli keluarga dia.Gembira teramat dia tu.Asik la cakap tenkiu sebab azankan anak dia.Part paling best bile dia cakap dia nak namakan anak dia Fakhrul Nabil.Read, N.A.B.I.L. Hehe...I feel honoured.

Note1: Nasib baik la aku bukan perempuan.Kesian gile tengok patient tadi.Memang betul betul in pain.

Note 2 : Ada midposting exam tadi.Ditunda ke hari Isnin.Ok la kut soalan dia.Yang tak boleh blah bile Prof kate ," Saya akan ambik markah midposting exam ni untuk dikira masa final posting mark ni nanti hanya bile lebih dari 50% daripada kamu semua fail'. One word that can describe that 'K.E.J.A.M'

Note 3: Baru tengok episode 1 cerita 'Code Blue', Japanese medical series.Terasa cerita tu tersangatla over.BUt at least ada substance.Tak mcm Ampang Medikal.

Karenah di Dewan Bersalin

9 Januari 2009 11.00 am Dewan Bersalin Hospital

Puan R Gravida3 Para 2 at 38 weeks period of gestation,came in with cramping lower abdominal pain since 7 am today.The pain is progressive in its intensity and frequency.The pain is also associated with leaking liqour.On VE, the os is already 7 cm and the fetal presenting part is already 3/5 engaged.Sudah in labour daa....

Semasa 'in labour'

'Missy, tolong.Saya tak mahu beranak lagi.Nak balik dulu.Missy menjawab, 'Macam mane tak mahu beranak ni.Bahagian bawah rahim ni dah bukak 7 cm dah ni.Air ketuban pun dh pecah.Slalunye kena tunggu sampai 10 cm.Puan, cuba bawak bawak bertenang.Bile dah rasa sakit sgt, puan berak tau'.

Lepas dah beranak

"Saya haus.Saya nak air milo boleh tak".

5 minit lepas tu Air milo pun sampai...

'Air milo ni tak sedap la.Tawar sangat'. Houseman jawap' Puan, lenkali saya kasi teh tarik k.Manis terus'

Semasa tengah menjahit luka episiotomy

'Adeh, sakitnya.Ni bukan sakit sikit-sikit ni'. HO bertanya ,' Puan nak beranak lagi pasni?'. Puan tu terus menggeleng-geleng.
HO menambah,'Puan,majoriti org yg kami tanya lepas beranak semua ckp gitu, tapi selalunya setahun lepas tu diorang datang balik kat kami".Puan tu tersenyum malu malu. 'Apa ni lambat sangat jahit ni, saya rasa saya nak terberak pulak la'.
HO menjawap,' Puan sebelum datang sini tak berak dulu ker?' Puan R jawap, ' Tak, saya takut nk berak td sebab dh sakitkan.Takut baby pulak yang terkeluar masuk dalam toilet bowl nanti"

HO jawap,'Hmm gitu.Hmm maybe sebab saya tekan kat bahagian tu masatengah jahit ni.Sebab tu puan rasa macam nak terberak.Puan R menambah," Owhhhh ek??? Kalau kentut boleh?" HO menjawap," Kentut banyak banyak pun takpe.Biar saya kat bawah ni dan adik-adik saya semua ni bau" (Adik-adik' tu was referring to us)

5minit lepas tu,

'Doktor, saya nak kencing la.Apesal lambat sangat jahit ni.Ni bukan geli geli tau, ni sakit betul betul'. HO menjawab ' Puan, puan hisap je la gas tu, nanti kurangla sakit tu.Puan jgn gerak gerak , nanti lagi lambat.Hah medical student, pegi masukkan Foley's catheter, buat CBD(Continuous Bladder Drainage) puan ni nak terkencing pulak.

Semasa tengah sibuk nak try masukkan catheter ke dalam pundi kencing puan ni.

'Eh, takpela dik, dah tak terasa nak kencing pulak"

Panjang lagi cerita ni sebenarnya.Bayangkan dewan bersalin tu tak putus putus orang nk bersalin setiap minit dan jam.Setiap org ade karenah masing masing.Ada yg extremely baik and peramah, ada yang banyak songeh and demanding.Ya Allah, kurniakan la aku satu tahap kesabaran yang agung bila aku kerja jadi HO nanti.Kalau tak jadik ikan keringla hambaMu ini nanti =P


Note 1: Actually saya sangat kagum dengan ibu ibu yang melahirkan anak.Tentu pahala mereka semua ni sangat banyak di sisi Allah SWT.

Note 2 : Apparently the staff here do not use the word 'push' or 'teran' when asking the patient to push the baby.Tapi mereka semua ni guna perkataan 'BERAK!' Bile ditanya, gaya push masa nak beranak ni sama mcm nak berak.Hmm...no comment

Makan tak kenyang, tido tak lena

Mak aii.....hidup aku semakin tunggang langgang.Bayangkang by 7.30am dh kena terpacak kat bilik seminar Labour room tu for Morning pass-over.After that, kena jumpe patient pastu clerk history dia so that beberapa minit lagi lecturer sampai and kena present case.Pastu barula bedside teaching bermula.So far, dah byk kali dah perut bernyanyi-nyanyi masa tengah present case and masa tengah buat physical examination kat patient depan semua org, kalah high school musical kut bunyi perut ni!Memula tu masing masing gelak antara sesama sendiri, tapi skrg masing masing faham akan nasib perut masing-masing.Perut mu bunyik, perutku pun berbunyik.Yang paling tensyen masa Paeds dulu dlu.Ward round dah la sampai ke tengahari.Masa tu makanan tengahari patient patient semua dah sampai.Bukan makanan cekai cekai.. ni sedap punye makanan.Ape lagi, berkeroncong lagi laa perut ni.Hmm takpe ar.At least tak makan byk sangat so that dpt maintain badan yg tough ni (tough la sangat!) But seriously thinking of going to Fitness First.At least I will have a gym instructor to monitor my fitness.Nama je medical student, tapi kesihatan sendiri tak terjaga sgt.
Anyway, terasa tersangat rugi tak beroncall malam tadi becoz apparently malan semalam labour room tersangat eventful.Ade dua case postpartum hemorrhage, failed vacuum suction eventually kena buat EM LSCS(Emergency lower segment cesaerian section) operation, baby with cleft lip and a baby without fingers on the left hand.Its 12.06 am now, baru balik on-call.Nak mandi and tido!Papai...

Note1: Entry kali menggunakan bahasa rojak.Main taip je.

Note 2: Makk aii, petang esok ade seminar.Dah la tak bace ape ape lagi ni

Labour room

Hmm..where do I begin

I'm officially posted to the Labour room right now.Its fun to learn manynew things.Its more exhilirating when you get to actually perform things that you only previously see in the texbooks.For instance, I did my first Vaginal Examination or affectionately known as 'VE' yesterday during on-call.It was aight I guess, though I was tired becoz it was midnight at that time.The pregnant lady is already on the Active phase of labor.The cervical os was opened at 5cm, occiput can be felt, station +1.Owh yeah, I also observed the amniotomy (artificial rupture of membrane) using the amniohook before that.
While in the labour room, there are basically 3 areas that needs to be covered - Patient Admission Counter(PAC), Labour suites and also the Maternal Operation Theatre.The idea is to see the whole process of managing the labour.Staff wise...O&G department is more inviting.The nurses,HOs and MOs are extremely nice.Be humble and always asked them questions if in doubt.You'll be amazed at the rate of knowledge that you are getting.They are also accommodative and obliging.They will encourage you to do this and that, even up to the level of conducting the delivery itself.As for now, I have not mustered all the courage yet to conduct a delivery.InshaAllah,one of these days.Do simpler stuff first such as Placenta cord traction, Episiotomy suturing, Partograms, Interpreting CTG, Inject IM syntocinon etc. muahaha...
I've already observed 7 deliveries so far.No complicated delivery except for one yesterday night when I was on-call.A baby was born flat ( ie- no crying, APGAR score was probably 5/10).We had to resuscitate the baby, alerting the Paediatrician at the same time.At the end of the day, we gave the baby Naloxone, an antidote to the opiod-analgesic which was given to the mother to relief the pain while in the labour.That drug must have significantly crossed into the fetal circulation from the maternal's circulation and eventually caused Opiod-induced respiratory depression.Seriously, baby tu nampak macam tengah high,mata terbukak mcm orang tengah berkhayal.Apparently, Serdang Hospital uses many expensive drugs which sometimes cannot be found even in private hospitals.Instead of using Pethidine, they use Nalbuphine( Nuban ).So who says HospitalKerajaan guna ubat murah?Try to say that in front of my face.

I went back to the hospital the next morning and arrived at 7.30am for Morning Pass-over.Its a ritual thing in this hospital to have a morning-passover.Not sure about other hospitals tho.This is when the MO oncall present the cases to the specialists and the head of department.He/she will make summaries regarding the number of deliveries,number of SVDs(spontaneous vaginaldeliveries),number of C section done and why it is done etc.A HO then must also present an obstetric related disease in front of the nurses,sisters, HOs,MOs and medical students.It's a good revision for me.

Note 1: I'll be having my O&G misposting exam tomorrow

Note 2: Kenapa orang tak berenti-renti beranak? Labour room tu sentiasa beroperasi 24 hours

Note3: Most big hospitals in Malaysia such as Hospital Serdang would have around 15-20 percent of Cesaerian deliveries each month.They will try to keep the precentage lower if possible.In a nutshell, never request for a Cesaerian to any obstetrician.They wont do unless indicated.

Note 4: Had two teachings today from Dr Zainurrashid and Dr Suhaimi.Dr Zain had twice conduct deliveries in a bathtub while he was in the UK last time at patients' request.Can u believe that?Evidence-based medicine shows that warm water is known to relieve the pain of labour.Unfortunetely we dont do that in Malaysia.I sure need to bring my swimming trunk next time if we do have that!

Expectation

I have been extremely busy with my O&G posting.Tomorrow is my last day for Gynaecology for this year.The common cases in the Gynae ward are

1) Miscarriage ( Missed, complete, incomplete etc)
2)Ectopic pregnancy
3)Ovarian cyst ( Ruptured vs torsion)
4)Hyperemesis gravidarum
5) Uterine fibroid

I'll be attached to the Labour room starting from this Wednesday.Previously,I had spent a few times in the labour room and Maternal operation theatre so as to get a glimpse of what will I be facing next.So many things to learn and perform.Definitely need to know how to do Partographs, interprate CTG, etc etc.A few of my friends (who are currently attached in the labour room)had the chance to actually do various procedures such as controlled cord traction, become the assistant in performing Cesaerian section, and also deliver babies.But so far nobody has the gut to conduct a delivery yet.I'll be the first one maybe? I'm definitelygoing to try my best.Really really want to do episiotomy surturing.According to colleagues, the nurses,HOs and MOs are willingly to teach and help.Ahhh yess, good prognosis that is.

Need to submit my long case write up tomorrow.c u...