Thinking Position

I stopped writing because I realized in dismay, that the people I trusted most manipulated my thoughts for their own twisted mind games. It broke me for awhile (a few years), but then I realized, I couldn’t begrudge them for their action. My words were out in the open for everybody’s eyes to feast on, so really, I had nobody else to blame but me.

I hope that explained my disappearance for a bit.

I don’t want to forget what happened on Tuesday night, hence the impromptu blog update.

It was a typical Tuesday night. I finished my extended-hour clinic at 1030 pm. By then I was ready to just die on the bed. The cases were typical URTIs with a few MC seekers in between. Balik, ate Aida’s fantastic ayam masak ros for dinner, changed and prayed, and ready to collapse at 11.30 pm. But as luck had it, I got a call from sickbay, informing a 94 year-old (bless her!) makcik, known hypertensive but defaulted, came in with sudden onset of shortness of breath. SpO2 80% under room air, BP was 220/150. In English, shit wasn’t too good. So I left my bed and made my way to the clinic…

Makcik was a delightful warga emas who could still laugh at her predicament. There she was… with a high-flow oxygen mask on her face, chest heaving, and she could still grin and smile at the staff. My staff were awesome… they knew what to expect. By the time I arrived, one branula was already in, ECG on the way. Makcik claimed she felt better on oxygen. Lungs were fulllll of fluid. It was as if she was breathing in a tub of water. Makcik said she had no chest pain, and shortness of breath started acutely while she was trying to fall asleep.

ECG revealed some ischemic changes with LV strain… BP was still rocketing, I was thinking nitrates. While my SN and MA were preparing for catheterization, I counseled the family member for referral to Temerloh.

Grandson: Saya nak pergi Kuantan. Saya duduk Kuantan.
Me: Encik, Kuantan 88 km. Temerloh 50 km je. Ini kes kecemasan, bukan kes biasa-biasa. Makcik ada kegagalan jantung, sampai buat paru-paru dia penuh air.
Grandson: Saya tak nak pergi Kuantan. Menyusahkan saya je.
Me: Encik, tolong faham. Bukan saya saja-saja taknak pergi Kuantan. Temerloh driver boleh hantar dalam 20 minit je in sha Allah dah sampai. Kuantan nak lalu jalan Gambang lagi, dengan lori lagi. Kita nak cepat nak selamatkan nyawa makcik.
Grandson: Tak payah la doktor. Kami dah bincang bawak je dia ke Kuantan. Saya banyak kerja ni. Susah la kalau dia ke Temerloh. Sapa nak jaga.
Me: Itu kita pikir nanti la, encik. Sekarang yang penting kena selamatkan nyawa dia. Nanti bila dia dah stabil kat Temerloh encik mintak transfer la ke Kuantan.
Grandson: Tak. Muktamad. Kuantan. Saya kerja.
Me: Saya bagi MC untuk esok. Encik settlekan masalah tempat kerja. Sekarang ni fikir yang terbaik untuk nenek encik.
Grandson: Kita dah fikirlah ni. Nak ke Kuantan je.
Me: Encik faham tak, risiko kalau pergi jauh2. Dia kegagalan jantung. Bila-bila masa jantung dia boleh berhenti.
Grandson: Biarlah jantung dia berhenti!
Me: (I lost my cool at this moment). Cuba jangan pentingkan diri! Saya nak encik ingat kata-kata encik sampai bila-bila, agar bila encik tua nanti, anak encik cakap benda yang sama dekat encik, baru encik rasa.
Grandson: (silence).

So yeah, I kurang hajar to the patient’s kin. Did I regret it? Nah. Am I afraid if he would file a complaint? Be my guest.

I asked him to document that he would take the risk of any unfortunate event (including asystole) that were to happen to his grandmother due to his request for Kuantan referral. He took his time writing down, he struggled with the spelling. It’s okay if you are illiterate. What’s not okay is how eff-ed up in the head you are.

I told my driver and SN to pick up the pace and slam a foot on the pedal. So public, please know, because of his arrogance, I had to put my driver and staff nurse’s lives in danger.

Alhamdulillah, makcik arrived in one piece, but I really hope she amended her will soon.

Drama swasta wrapped up around 1 am. So I went back home for a dreamless sleep. Woke up at 635 am (yes I subuh dinosaur here) from another phone call. This time MA Zana’s voice was of despair mixed with sleepiness. 50 something year-old Indian lady, brought in by family members for being unconscious. Son claimed she complained of chest pain and shortness of breath before falling unconscious. Zana said, pulseless, tangan dah keras, pupils dah dilated. Sigh… I put on my jeans (thought about going to clinic in my funky sleep pants but nah…) and sped to the clinic.

I reconfirmed what Zana had already assessed, patient was brought in dead. She lived somewhere in Sri Jaya and that is like half an hour away. I shook my head regretfully and called it, and the children wailed some more. Daughter in-law asked me to reconsider my finding. One son kept on shaking dead mother’s shoulder, asking her to wake up. My heart went out for them. I looked at her record, aunty was recently discharged from ward for MI (serangan jantung, not mission impossible). I wrote the memo necessary for the death certificate and called for one of the sons.

Me: Sorry ya. Saya bagitahu sama you ya sekarang. Jantung dia sudah berhenti. Dan otak dia pun sudah mati. Sudah keras. You mari tengok mata dia saya tunjuk sama you. (Showed how pupils were already fixed and dilated). Itu bermakna otak dia pun sudah mati. Kalau jantung saja berhenti, kita boleh cuba kasi jantung dia start balik. Macam dalam TV tu kita kasi pam sama itu jantung dia.
Son: Jadi memang mak saya sudah takda la?
Me: Ya, memang sudah takda. Saya mintak maaf. Saya tahu you baru sambut tahun baru.
Son: Takpala doktor. Kita penat sembahyang kasi Tuhan, tapi dia takda tolong pun sama kita.
Me: Aiyo. Jangan macam tu. Saya harap you bersabar.

Son thanked me and just gave me a watery smile and left to the police station.

It marveled me how God was trying to teach me in stages. Two different scenarios. Two different outcomes. Two different lessons. I lost faith in my own race sometimes…

So where did we go wrong?

Midnight Meanderings

Wow, it has been so long!

12.50 am and I still can’t sleep. I should be rejoicing as my call tonight seems fairly good… The last call I got from the clinic only wanted me to review patient’s vital sign, so that was all good. I am really lucky. Whoever said that district makes for a bad practice, you guys are wrong. I have some of the best, most experienced staff nurses and JMs around. I cherish them for their knowledge and input, and for without them, my calls are gonna be shitty. Trust me.

I’m getting ponderish tonight because I feel helpless. A friend is about to hit rock bottom and I am too far away to lend a crying shoulder. Should I skip work tomorrow and make the 600 km drive? I shouldn’t even be contemplating this, because if I were a good enough friend, I would have started packing and off I went! I tried to send a care package, but it seems to impersonal. I sent a prayer her way… Hopefully that’ll tide her by before I could meet up with her.

I am also getting ponderish because the best friend is finally getting married. And I am genuinely happy for him. Alhamdulillah, jodoh dah sampaikan? Sampai ke hujung hayat la harapnya. Amin.

On Friday I had multiple patients who came from the neighboring town. It gets you frustrated, you know… Government builds Klinik Kesihatan in each town to accomodate the growing population, so that the rakyats do not have to travel far for health services. But not in this case. When asked, they don’t mind the travel as the staffs are friendlier. What can I say to that lah?

Yes. Euro 2012. So which team is your favorite? I notice with growing interest that Sergio Ramos looks hotter with the new haircut. LOL. I’m pretty adamant that England shall not make it past semi finals. Other than that, I think France and Italy are looking pretty good. And I am on call on 30th. FML. Hopefully that night the people of Maran will be too busy watching football to come to the clinic. Hahha.

I should try sleeping… Yes. Good night.

Dengue Shock Syndrome

It was a cold morning. It was raining.

I have a love-hate relationship with morning shifts. I hate it for the fact I have to wake up too early in the morning to make it at the casualty by 7. I love it cause I’d be off by 4. Pretty good deal. But would be better if it was to start at 8.

His card was the first card I saw lying on the table. Couldn’t recall the number, except for the fact he fell under the G2 category. Mildly serious with stable vital signs. But I didn’t see any vital signs documented. I sighed. Lack of people, lack of efficiency.

He was wheeled in by his father. Clutching his stomach, he writhed in pain. Told me he was in pain. I could see as much. I scanned the referral letter, which was written the day before: AGE. I frowned. he wouldn’t be in so much pain just for a simple diarrhea.

Night shift people were such angels. They approached me with a vital signs machine. Together we set the patient up on a bed. Chap didn’t look so good. “Pain. Cannot tahan, doktor.”

I started the series of questioning. Deepa strapped on the BP cuffs while Jas was busy getting the branula. “How many days already diarrhea?” “Five.” “How many times per day? Vomiting.” “A lot la doctor. More than five. Yes, yes. Vomit too.”

Five days of being friends with the toilet is not cool. “Got fever or not?” “No doctor. Pain, doctor.”

“Okay, V****. I’m sorry but I have to ask you questions before I can give you anything. No fever today, you mean. Before this you got fever or not?”

“Last week got la doctor.” “How many days?” “Three days like that. I was in my polytechnic.” “Before your diarrhea?” “Yes.”

I didn’t feel so good. That was the time when Deepa chirped in. “Girl, can’t get BP.”

I touched him for the first time. Cold and clammy. Pulse, thready. I told Jas, be quick with the branula, girl. I’m going to get the stretcher.

By the time Deepa and I brought the stretcher to green, Jas has managed to get the branula and bloods. To make the day worse, FBC (full blood count machine) in casualty was not working. FML, I thought.

Pushing the case to yellow zone, I presented it to Dr. A, our MO. I was just following my gut instinct, hopefully he won’t chew my head for pushing patients unnecessarily to yellow.

I began the series of questionings while my colleague set the patient up in yellow. Father said, he just came back from polytechnic after three days of fever. Started having diarrhea on the fourth day. They had visited four different clinics. No attempts of blood taking done. Was given oral rehydration salts like nobody’s business. I wonder if it was due to the fact that family members and patient himself was poor historian, only providing me the fact that he had history of fever after much prodding.

Meanwhile, chap was quickly deteriorating. Becoming drowsy. BP recorded in yellow was 140/90. Pulse was 130. Fluids in with two large-bore branula. Deepa the angel tried her luck tracing the FBC. And what do you know, it was done. Puji Tuhan.

“Total white 2.2, platelet 11, hematocrit 49, hb 13.”

Goodness. It was dengue, plain as day. What’s more, he’s approaching dengue shock. I grabbed the phone as Dr. M issued the order, “Laily, page medical stat.”

He was becoming more delirious. Dr. M made a quick call, decided to intubate the patient. From yellow, off he went to red zone.

It was a flurry of activities. In less than an hour, a G2 patient was converted to yellow, and eventually to red. Intubated and boluses of normal saline run, as per ordered by medical. Anaes team was referred. Eventually, he was pushed up to ICU.

Breaking the bad news is still awkward, even after two years. “Ayah, I’m sorry we have to insert a tube to help him breathe. He was not doing so good. We suspect that it’s dengue, and he’s leaking his blood away. We are pushing him to ICU.”

“How come, doctor? He only had loose stools only.”

“Ayah, abdomen pain and persistent vomiting following fever are the warning signs of dengue. I’m so sorry.”

The next day, I was night shift. I went up to visit poor guy in ICU at about 3 am. Was still ventilated, dialysed twice. Kidney was gone. Liver’s transaminases and bilirubin was sky high. Heart went into myocarditis. Developed DIVC by 11 am, a few hours after being sent to ICU. Hb dropped to 7. Transfused 7 pints. He was only 20 years old.

V**** passed away peacefully on the third day in ICU. To say I was frustrated was an understatement. He was so young. Studying mechanical engineering. Loved so much by the family.

Dengue mortality is a national mortality. Being a HO, I was saved from being called for enquiry. Dr. A wasn’t as lucky, but he assured me we did all we could, and the blame wasn’t on us.

V****, rest in peace now.

Back!

Crap. Why the hell is this thing pink? But it’s quite funky coolllll mediynaaa like that. So maybe I’m sticking to it. Besides, I’m getting old. I need something with bigger fonts. No, getting old doesn’t equate to getting blind. Maybe to old me. Not you. Don’t fret.

Two weeks to MO-ship baby. I don’t really know what it means. Maybe more time for useless crap, ie: typing up a blog. More sleep time, of course. And no longer at the bottom of the hierarchy. Sure, we would still be stepped and stamped on by the specialists, but at least we have other people below us to step and stamp on this time. It’s a food chain. It’s ugly.

But I think I’m going to be a pretty cool, baik MO. Lol. I don’t know.

I’m not too ecstatic at the prospect of being your own boss especially if I were to be despatched to district, but life goes on. The baby birds (I have no qualms whatsoever in stating the fact that I have no idea what a proper term for baby birds are) have to leave the nest when the time comes. So I guess the time has come for me to the the first flight (plunge) down that tree. Let’s hope I don’t fall splat on my face, shall we?

I have a lot of stories. Some sad, some happy, some downright disgusting. I wish I had more time to write. Being a doctor is all about documentation, I guess that’s why I had three volumes of my life documented in a journal. I just like to crap. A lot.

I think that’s about it. Of course I couldn’t keep it short and sweet. 🙂

I don’t understand you.

You. I don’t understand you. You told me you respect me too much and you don’t think you’re ready. Two minutes later your FB status changed to ‘in a relationship with bla bla’. Screw you. Just tell me ‘I don’t like you like that’, I think I could take it like a big girl.

You. I don’t understand you. You never give signals when you want to make a turn. You drive your Kancil like an effin lorry. Aunty, stay in your lane before I honk you off the road.

You. I don’t understand you. You said it’s APO but you want to run fluids?? I don’t want to be the one filling up the death certificate…

You. I don’t understand you. You’re such a great girl and a great friend, and how does that guy manage to turn you into this, this weakening girl? He’s nobody, I keep on reiterating that to you, but you just wouldn’t listen. You are awesome. You kickass. When will you ever learn?

You. I don’t understand you. Your people ask to step down, you step down lah. You’d rather a bullet through your head, izzit? Kindly do the needful and listen to your country, please.

You. I don’t understand you. You think you’re the pengarah/penerbit/penulis skrip that you just have to add the pelakon into the resume. Your acting sucks, thank God your leading lady is cute, and the hantu is not too bad. Doesn’t mean your dad is awesome that it’s genetics. No, I’m sorry. Talent doesn’t work that way.

You. I don’t understand you. You had your half hour of fun (or 10 mins if your partner is seriously lacking), cooked up the consequences, and you have the heart to throw God’s gift to you the sidewalk/toilet without even a second thought. You are an animal.

Me. I don’t understand me. I’m pissed off at the world. I need tai-chi. I need iced lemon tea. I need.

Zzz…

Let’s Just Not Talk About It

So the whole lot of us were in kampung because a tragedy strike. In the midst of all the ruckus, my nephew was the silver lining in the proverbial cloud.

Tok Tam: Afiq minum air sirap ya? Tak puasa ya?
Afiq: Shh (complete with the hush sign and penetrating glare. And he is only two and a half).

I’m going to be homeless in a few days, weeks if the admin is being nice. I failed to give the proper direction to my own house to my brother. I am an epic fail.

I finally caught up with Bones finale. What a disappointment.

Went to Masyitah and Eddie’s wedding. One of the funnest moments I’ve ever had in a long while. Them girls didn’t change. I realize I am missing it all: being housemates, being able to reach out without the internet connection, having the utmost supports in everything.

Medical rocks my socks. OD review? Hell yeah babe!

Oh, I forgot to mention. Western Australia is a big fat checked. Ian Wright would be proud. It is one epic tale, can’t be justified with a measly blog entry. (Sebenarnya maleh nak naip. Hahha). Just know that we ran into the kangaroos, boomerangs, wombats, all sorts of birds and insects, SNAKES, without even visiting the zoo. And yes, the view was SPECTACULAR that humbled me had just have to type in capital.

Next in STP: Danau Toba.
Next in LTP: Uh. Umrah kot. Insya Allah.

Figuring our route out

En route to Jurien Bay

Kalbaari. God is great, too beautiful for words.

Yuppies too excited crossing the Tropic of Capricorn. Hahha. Oh, check out the clear blue sky.

=)

I’m quite restless. Valium anyone?