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Saturday, July 03, 2010

Anaesthetics: First week.

Hari aku bermula seawal 530am untuk makan breakfast & bersiap-siap. Aku kena bertolak dari rumah around 7am. Jalan tak brapa jam, mungkin pasal awal lagi kot. Later I found out sebenarnye cuti pertengahan tahun skolah kat sini, tu la pasal tak brapa jam. OK.

Hari pertama aku merayau-rayau doing laps around the hospital looking for wat I needed to do, where to go. Finally went to the Department of Anaesthesia kat level 3 & jumpa the head of the department to get my timetable. Seb baik dia baik & emailed me the timetable. Orang kata dia ni.. hmmm... leceh sket, tapi so far hari pertama dia baik dgn aku. Mungkin pasal hari pertama kot.
Ye, hari pertama & kedua dah kena goreng bbq dgn anaesthetists pasal physiology & pharmacology stuff. The things that I remembered back then as a student but seems to dont care much as a doctor, unless berkenaan dgn kerja aku. Malu aku dgn semua org and especially diri sendiri. D'uh!!

Isnin tu went to bed super early ~930pm. Sampai rumah around 7pm, dan selepas tu dah tak mampu nak buat apa-apa lagi.
Selasa malam balik around 1030pm coz I was rostered for the trauma/ ortho after hours list. The anaesthetist on that list was my favorite. Baik & ajar aku byk menda.
Hari Rabu pagi list aku kosong pasal ada surgery cancellation. Aku merayau2 satu spital & join another list kat theatre sebelah utk Obs & Gobs list. Petang plak dgn this anaesthetist yg pendiam tapi baik hati & very quick. His first lesson with me is to focus on airways management, which is a skill that is very important to all doctors. Kalau tak tau satu hapah pon dlm medicine at least kena tau la our DRABCDE. My heart stopped once on Monday masa aku intubated a patient. Pernah buat dulu kat WhoopWhoop during my previous anaesthetics rotation in 2007, tapi tak ingat plak cam gini punye stressed nak masukkan endotracheal tube (ETT) tu.
Khamis ialah half day aku. Khamis pagi list dgn Dr. ptg Rabu tu, so kira cool la. Case pertama ialah seorang yg obese berBMI of 45. Cuba la imagine how hard it was nak cannula the patient, dia dah close to 12hours fasting & vasculopath. Heh. Anaesthetist hari Khamis ni sangat sempoi. Suka aku, tak tau la pasal dia ajar aku buat procedures or pasal dia tak grill aku byk. Haha.
Dia suruh aku baca buku or have coffee kalau kita tgh cruising with the case. Ptg Rabu dia suruh aku balik awal, & tgh hari Khamis pon dia suruh aku balik awal. Gumbira la jugak. Tak tau coz dia nak kasi chance aku study or dia mmg tak berminat aku ada kat situ. Terasa cam not needed plak (PD tak?). Apa-apa hal pon aku still gumbira dpt balik awal. Ptg Rabu tu ada sorang lagi Anaesthetist ajak aku gi Sim Centre ptg Khamis kalau aku free supaya bleh praktis airways management. Aku cam.. hmmm... nak balik la. Aku puasa & nak study kat rumah.

(Bila balik aku tak study pon... tido je manjang.. hampes je kan).

Things I learned in my first week of anaesthetics:
- Theatre sejuk nak mampus!!
- Anaesthetists boleh bawak masuk cawan kopi/ teh diorang dlm theatre. Aku.. hmm.. tak beranilah.
- Cannulation kena ikut case. The higher the risks of bleeding, the bigger the cannula needed. Examples of big cannulas are total hip replacement, molar pregnancy removal, bowel resections, etc. Kalau susah sgt nak cannulate sebelum theater start, bubuh je a small one. Nanti bila diorang dah under anaesthetic bleh recannulate guna big gauge cannula coz their vessels are all dilated already due to the vasodilatation effect of all anaesthetic drugs.
AND kalau nak put a big gauge cannula while they are wide awake... WAJIB bubuh local anaesthetic, according to 99% of anaesthetists. Aku yg dah biasa bubuh 18G cannula main cucuk je kat ED, find that I need to practise more on this. Aku missed all my pre-LA 18G, much to my embarrassment. Diorang kata its cruel tak bubuh LA before any large bore needle & in anaesthetics there's always enuf time to put local, not like in ED. And sorang lagi anaesthetist tu kata.. sebab sikit sgt time aku kat anaesthetic so dia tak kisah kalau aku tak dpt nak learn much of other stuff but one skill yg dia kata aku WAJIB memakarkan diri ialah IV access. Fuh!
- Stress level in Anaesthetics during my first week ni tak sama rupanye dgn stress level kat ED. Kat ED, I usually turn to food for comfort kalau aku tertekan, hence my constant battle with my weight. Kat Anaesthetics ni, aku stressed sampai tak lalu nak makan tak lalu nak duduk even. Stressed la coz terasa diri ni bengap semacam & takut dgn orang. Oh lagi satu, disebabkan tak berapa lapar during theatre, so aku kira-kira it wont be too bad staying in the theatre di bulan puasa yg semakin hampir ni.
- Airways management yg aku suka sangat. My heart stopped masa first few intubations, but Khamis tu aku dah more comfortable. Problem is my hands are small untuk mengaut muka patients masa nak secure airways & mask/bag ventilation. Imagine muka diorang yg kadang2 lebih besar dari bola AFL footy tu.
- IMPORTANT! When using the laryngeoscope, whatever u do DONT damage the teeth. Dental damage is one of most claimed against anaesthetists. During one of my intubations sorang anaesthetist tu kata, "I dont care if u cost bleeding to the larynx but I certainly care if u cause any chipped tooth."
- Whatever the surgery list is, aku kena senantiasa lebih awal dp anaesthetist consultant, even if I hafta sacrifice my lunch break. Sebabnye aku kena assess these pre-op patients and during the operation aku sentiasa akan ada a few breaks. So aku tak kisah sgt. Cuma yg sakitnye ialah bgn awal-awal-awal pagi.
- Disebabkan aku takde specific base utk theatre, either level 4 or level 2 theatre dlm satu hari tu, maka aku mmg kena ngangkut harta karun aku setiap kali tukar list. Sangap betul, rasa cam merempat plak.
- Aku akan bergilir-gilir dgn lagi sorang HMO3 tu utk kerja weekends & trauma/ortho list. Kalau minggu ni aku kerja trauma/ortho list maka lagi sorang tu akan kerja weekends. Minggu depan tukar giliran plak. Begitulah seterusnye. Dan aku akan dpt 1 arvo off on Thursday (COOL!!) & Friday will be my on-call day for the whole hospital (YUCKS!!).
- My timetable allows me to have breakie with hubby every morning (provided that he wakes up early enuf). And also it gives me the right to park in front of his car on the days I'm working. Hehehhe. Puas hati. But it doesnt necessarily give me time to cook dinner every night coz aku nak tido awal each night in order to wake up around 5+am the next day. However, on the days that I dont cook I will have time to go jogging/ brisk walking with hubby in the evening before dinner, if he comes home early lah. Not bad la my timetable.
Oh ye, it also means that I have to be bijak sket in making use of the limited time to read after work & main internet =P.
- Lastly, MOST IMPORTANT.. to know ur foundation: P.H.Y.S.I.O.L.O.G.Y. and P.H.A.R.M.A.C.O.L.O.G.Y.!!! Especially respiratory & pain physiology.

Kesimpulannye: aku MEMANG kena S.T.U.D.Y.!!

(Kartun kat atas tu tribute to www.cartoonstock.com)

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