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Monday, January 31, 2011

Telinga berdarah di ICU

I'm in ICU atm. Alhamdulillah its been quiet so far. Dah selesai 3 malam aku night shift minggu ni, malam ni (Isnin) adalah malam terakhir for this cycle habis pagi Selasa kol 9am. Then aku off, kembali kerja on Thursday, day shift until la weekends. Minggu terakhir aku kat ICU. Sob sob sob. Then back to ED, doing a junior registrar job. Sob sob sob sob sob lagi. Aku suka ICU. 3-month-term is a short term for any junior doc for any rotation, if you want to learn something.

On the other hand, lega dah takde kerja dgn si orang gila Timur Tengah tu. In fact, since minggu lepas until next week, aku takkan jumpa dia lagi. Harap-harap our paths will never ever cross again. Amin.

Malam tadi best, aku buat 2x internal jugular CVC. I kno most ppl my level will be like.. "Whats so big of a deal is that.. aku dah buat berlambak.. tak heran pon.." Oh, well, it is a big deal to me. First we are dealing with an unstable patient who needs a central line. At the same time a sick patient will make doing a central line insertion hard. Thirdly, looking at the anatomy itself, internal jugular is right next (lateral) to the carotid artery, a major artery supplying the brain. So ada macam-macam risks di situ, plus its an invasive procedure. Internal jugular is not the only access for a central line. Ada lagi: femoral vein, subclavien vein, or PICC (peripherally inserted central catheter). Aku dah buat PICC hari tu. And what has taken me sooooo long dah nak abis ICU baru nak buat CVC? Entah ngapa setiap kali aku on either its toooo busy that we could hardly breathe, or patients dah sedia ada lines, or my reg akan buat the important lines. Esp. kalau kerja dgn si Timur Tengah tu, memang takde harapan la aku nak blaja apa-apa. Haram betul.
Kesimpulannye, memang aku bangga dapat buat 2 skali gus malam tadi. Harap-harap la dapat buat beberapa lagi central lines sampai la aku abis ICU nanti. Ye la, tempat mana lagi boleh buat these important procedures selain dp anaesthetics & ICU.

Ops.. ada call from the ward.

Ok dah balik. Unwell patient on the ward, tapi di assess oleh resident yg malas & dodgy. Ngamuks registrar aku. Hahaha. Tapi terpaksa la jugak pegi assess the patient. And seb baik patient to okay. Tak perlu masuk ICU. ICU dah penuh malam ni.

Tajuk telinga berdarah tu saja je gempak. Takde la gempak sangat. Tapi saja nak citer, registrar yg aku kerja malam ni ialah ED registrar yg amik locum job coz takde registrar malam ni. Aku kenal dia. Pernah kerja dgn dia byk kali since aku start kerja kat EH ni lagi. Rajin, pandai. Tapi, ya Allah! Swears like nobody's business, all the time. Perit jugak la telinga aku dengar dia komen itu ini, esp. pasal politics. Semuanye negative. Adoh, kadang sampai bini dia pon dia panggil B*! Korang agak sendiri la apa perkataan berbintang tu. Hahahaha. Takpe la tu, tak kisah. As long dia suka kerja dgn aku, and baik dgn aku tak buli aku cam si hampes tu. And dia pon one of the many ED registrars yg dah quit hospital training coz of had enuf with the politics, funding & working conditions. Rugi lah, Australian government still biar je rakyat jelata fall behind in their health care pasal diorang malas nak improve the situation.

Tak sabar abis shift. Lagi 6 jam nak abis ni. Aku datang lambat coz the day resident covered for me 2hours tadi. Jumaat hari tu aku dah datang awal for night shift to cover her. So dia balas balik balik tadi. Bagus la, aku ada extra masa nak buang kat rumah before coming to work.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

5pm, kat rumah.
Sambung. Hampes, aku tak dpt lelap mlm tadi koz registrar aku dok bantai tido berjam-jam. Aku sebenarnye tak berapa kisah coz dia kena gi court hari ni kasi statement. Bukan pasal dia punye salah. Tapi as a witness utk pesakit gila yg jadi penjenayah. Pagi tadi sebelum abis shift dia dah tukar pakai coat tie semua pasal kena gi court.

Actually semuanye quiet until around 530am, macam2 review from the ward. 2 yg boleh dilupakan. 1 post-op patient dropped GCS, mismanaged by anaesthetic reg & resident & ED & the whole ward basically. 1) The last BSL was 8.7 by the ambo, cant find any more documented in the rest of the notes since yesterday. Bila aku suggest check BSL while waiting for the bloods to come back & further brain storm apsal dia ni dropped GCS quickly... wooooo undetectable by glucometer & finally on ABG showed 0.2!!! Kami kasi la glucose cepat2 before dia koma terus. Slowly responding. 2) The rest of the bloods showed critically high lactate, low pH.. hence severe acidosis. Kami rehydrate her with dextrose. Bawak gi ICU. 3) She had ~3litres of bile washed out during her laparatomy for cholecystectomy. So she is pretty sick.
Kat ICU dia deteriorated, ni semua jadi around 730am++ when dah nak abis shift. Serious kelam kelibut. She appeared septic. Kesian that poor old lady. She is very sore in the tummy, ye la post op kan. Then kami tak dpt nak buat artline coz very peripherally shut down dah. Tiba big bosses pagi tu, lepas hand over, terus diorang intubate her. Harap-harap she survived. Kesian sangat.

Oh ye, ada this new med student final year of post grad from Deakin Uni datang buat her rotation here. Ches, sibuks je. Hahaha.. ada tanda2 jeles di situ. Ye la, dah la lawa, appears confident plak tu. Great personality jugak. Dgn aku yg tgh takde self-esteem buat masa ni mmg rasa nak suruh dia balik buat kerja apa dia buat before dia decided to jump to medicine. Post grad course for medicine ni slalunye shorter than the normal degree, utk org yg tak dpt buat medicine as their bachelor.

Lepas intubate tu aku balik rumah. Ingat nak singgah Chadstone to order this cookie cake from Mrs. Fields. Tapi dah ngantuks sangat. Balik je terus pengsan atas katil.

2 comments:

LynN LoLa~~ said...

hey sis.u'r a doctor?
lynn 2nd yr medical student dkt usm=) (wakaka maaf la terpromote diri plakT__T )
lynn tasempat nak update blog.nnt da free mase lynn buat tutorial cipisan kat blog pasal disabled right click tuh=)once da buat sy roger sis yer=)

A~ said...

hello lynn. thanks for visiting. nanti jgn lupa kasi tau eh. me doctor cap ayam je :P

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