Pengorbanan Kali Ini

Drama queen betul. Heh.

Okay, last night I had to through away my whole work attire (except tudung) to the bin. My top, pants, socks & shoes. They were cheap on clearance ones, but still I threw away my work outfits. All into the bin.

The last case that I saw last night prior going home was an epistaxis (nosebleed), a young professional who has been living with anxiety, which is causing their very high blood pressure & each time this will lead to a nosebleed. X came before my shift started & saw my boss, had their treatment & went home. X came back just before I finished my evening shift with blood pouring out of her nose. 

Normal practice is that I would put on my disposible protective gown & gloves (which are removed once you step out of that particular cubicle) and cover an epistaxis patient with some blue +/- gown, +/- cover the floor with some blue, get the suction ready, etc. It is an arterial bleed, yes, but that extra few seconds of keeping the area safe does make a big difference. So those were what I did anyway with this particular patient.

But of course X didnt bleed when I was attending them. No source of bleeding in either nostrils, other than the obvious 200/120 blood pressure. During the observation, I had to attend to another young hypertensive emergency that already had bleeding & swollen retina in their both eyes that we had to transfer out of the Eye & Ear hospital. And of course, X had to bleed massively while we were doing that. 

On the way to grab a new set of protective attire, X had to cough, cry, stress out. And in turn more blood gushing out of X's nose in response to the climbing blood pressure. And that was when some blood splattered onto my lower half of my front. Sheeeeeessshhhh... So much fun! 
Threw away the attire at home, and yes, I deserve to be a drama queen. 

I dont fully blame patients when this things happens. Orang kata apa guna jadi doctor, hey, kalau takut darah, kencing, tahi & all those disgusting bodily produce. 

Think about you as a patient, mesti u ada sket2 pandang slack kat doctors yg lepas pegang u dia terus basuh tangan, "macam aku ni geli sangat!". Well, think about this again, you as a patient, the doctor dah lepas pegang pesakit lain kat cubicle/ katil sebelah yang u tau ada penyakit u anggap geli or lepas exposed to some darah, phlegm, etc, tanpa basuh tangan terus periksa u. Best tak?

Healthcare is not only about caring & managing health, but also is about prevention. We as healthcare professionals should as much as possible not spread germs, also as much as possible to actually protect ourselves from contracting any diseases. Not worth it at all. In a controlled situation, a little extra of these simple efforts make a very big difference. Of course in real disaster, sometimes you cant avoid it. And nowadays we can actually afford that extra 1-2 minutes to simply grab a pair of gloves/ goggles/ gown. Based on these experiences, I always make an effort to have at least a pair of gloves in my pocket, bags, car, etc coz you will never know.

I dont really have to dwell into it much, just think of the basic. Setiap healthcare professional akan dilatih very basic: DRSABC for any clinical situation. And to me, the first 3 principles can be applied to any situation too.

D= Danger. Avoid, remove any danger.. SAFELY!
R= Response. Check for response.
S= Send for help. 
A= Airways.
B= Breathing. 
C= Circulation.

Yes, and yup, last night memang aku dah jadi a drama queen, tapi at home lah.. Takde kerja la nak meratap bagai kat ED sana nun.. hehehe.
Hopefully doesnt happen that often again. 

Karipap Sedap

Kat sini biasalah overseas students/ temporary residents akan masak-masak once in a while untuk duit belanja tambahan sket-sket. Especially bila time perayaan. Aku tak pernah lagi buat, bukan pasal dah banyak duit tapi pasal malas & takde masa. Especially now dah kerja sambil in training.

One of my friends make karipap once in a while. And given that our group of friends are mostly busy and kurang kerajinan nak buat this kind of thing untuk masa-masa kecemasan, we always order the karipaps from this friend. Alah, apa salahnye tolong kawan, dia bahagia, kita pon bahagia makan karipaps sedap ni. Aku & hubby selalu sangat order from this person, especially when I am working arvo shifts. Senang bawak bekal +/- breakie or sahur. (Nampak la kemalasan aku sebagai orang paling skillful memasak kat rumah ni.. ahaks!).

So the other day I brought a few during my arvo shift. Unfortunately while I was having them during my dinner break, the code blue was called. So I just left the karipaps on the ED bench, thinking and hoping I would come back to them lepas code. One of my ophthalmology bosses stole one of them when I was gone attending the code. He actually said to me before I left to the code that I shouldn't be leaving my yummy food lying around 'coz someone a.k.a. him might just steal them, afterall he says he lives to eat karipaps. Hahaha. During the code, he quitely came to me ingatkan apa rupanye mintak kebenaran to pinch one of the karipaps. Alahai... kesian dia. Aku kasi je la, walaupon dah agak sejuk & agak burned coz aku lambat keluarkan dari oven. So technically he didnt steal my karipaps. Hahahaha. 

Oh well, rezeki lagi for my dear friend whom I cant thank enought for sacrificing their time & energy making & jual the karipaps. 

New Rotation, New Hospital

Okay, it's been ages since I last wrote anything. And everyone knows ni semua gara-gara malas. Nak kata busy, saja mem-busy-kan body with nonsense.

It is the new working year for doctors around Australia mostly, and definitely in Victoria. We started on 2nd Feb 2015 hari tu. As for my non-ED requirements in my ED advanced training, and since I really needed a break from ED, I am now at the Royal Victorian Eye & Ear Hospital in East Melbourne, Alhamdulillah. However, my application for the 2nd half of 2015 at Neonatal Intensive Care Unit at Monash Medical Centre got the silent treatment.. well, dah call banyak kali asking about the status of my application but each time they said they still looking for a full timer, instead of a 6mo registrar that I applied, so, lama-lama tu paham-paham je la memang diorang reject dah. Kalau some job recruitment usually diorang akan hantar email/ letter of rejection. Sigh... bukan rezeki la tu. Sob sob sob...

Anyways, talking about the new term, I will be at the RVEEH for 6 months until raya puasa nanti. Such a steep learning curve. Rasa macam tak tau apa-apa pasal these very specialized areas: the eye & ear. So aku banyak tengok You Tube about eye & ear especially on history taking & examinations. Rasa macam medical student balik. My colleagues with ED training background pun rasa mcm tu. Serious takut. 

The people there are very friendly and supportive. They know that the ED registrars dont know anything and they teach you very patiently, 1 small area at a time. We are probably an expert in general medical/ emergency stuff but zero in eye & ear stuff. 

So far, so good. Am not as anxious at work now. Dah buat a round of night shifts hari tu, where we ED reg cover ENT stuff, codes & the wards (dah lama tak buat kerja resident ni.. sheeshh), and the ophthalmology reg covers all the eye stuff. Scary but I went through it selamat.. Alhamdulillah. A week of nights starting wednesday night & abis wednesday a.m. the next week. Then dpt around 5-6 days off. 5 days tu sebab tak kira the wednesday yg abis nights tu. 

So I will be working next this tuesday teaching je in a.m. then seminggu arvo shift.. huhuhu... 

Welcome to ED

Taken from webbie Confession of A Junior Doctor:
 http://confessionsofajuniordoctor.tumblr.com/post/102808909879/welcome-to-a-e

Even though I am no longer a junior doctor, more so now a mid-trainee/ early-advanced trainee, this pretty much sums up my life of an ED doctor.

 Confessions of a Junior Doctor

1. Welcome to A&E

   Posted by: tea-and-apathy on 16 November 2014
   I have no idea what it is that I like about Emergency Medicine.
   
   The hours are terrible. The rota is indecipherable. You cannot plan to attend a friend’s birthday or a family gathering. Your social life is non-existent. The patients are largely rude, drunk, smelly and irreverent. There are never enough staff on shift. The urgent care centre referrals are sometimes ludicrous. The GPs send in UTIs as renal colic, PID as appendicitis, persistent patients that they can no longer placate. The specialty doctors think we are either lazy or lobotomised. You spend more time than you should at the centre of “specialty tennis”.
   
   The four hour wait is a travesty. There are never enough observation beds. The pressure is immense. The clock never stops. There is always another patient waiting, another test to order, another result to check. There is always a diagnosis to be made, and treatment to initiate, a conversation to be had. You go from renal colic to brain tumours to heart attacks. You see depressed people, drunk people, old people, children. You see people at their worst. You see time wasters and hypochondriacs and then sepsis and deaths. You don’t have time to process. You don’t have time to think. You see, treat, refer, discharge.
   
   People complain about the waiting time, disagree with your assessment, believe google before they believe you. You go home at night paranoid about the patient you sent home; constantly questioning your decisions, your abilities and your sanity. You see multiple patients simultaneously, you are a porter, a nurse, a cleaner, a friend, a confidant. You tell people good news, bad news, sad news.
   
   You are charged with the unhappy job of treating people’s liver disease from excessive alcohol, lung disease from smoking, diabetes from overindulgence. People expect you to take responsibility for their lifestyle choices. You endure the abusive drunkards, the psychotic schizophrenics, the deranged elderly. You put up with the people who have neither an accident nor an emergency.
   
   You exhaust yourself looking after these people, so much so that you go without food, without bathroom breaks, without the most basic of human needs. You are vilified by the media, who feel you are paid too much for what you do. You are misunderstood by friends and family who watch too much ER and Casualty. You become unacceptably irked by poor resuscitation techniques on TV shows. You complain about unnecessary attendances and then carry out wholly unwarranted tests because you are scared of being sued. You will inevitably have complaints filed against you for merely doing your job. You will make poor management decisions and people will die. You will make excellent management decisions and people will still die. You will defy the odds: CPR will work; the patient will recover from sepsis; be discharged from hospital, and then die at home a week later.
   
   You will miss things. You will be wrong on a daily basis. Everyone thinks they know more than you. You finish a shift and barely have the energy to walk to the car; let alone drive home. You spend at least half of your days off comatose in bed. You don’t see your housemates for weeks due to opposing shift patterns. You do locum shifts during your time off because there are never enough doctors and you know how awful it is to work when they’re short staffed. The barista at Costa knows what sort of day you’re having based on whether you order a medio cappuccino or a double espresso. The packed lunch you brought 3 days ago is still sat in the refrigerator. Once you leave work you are unable to make the smallest of decisions because you have used up all of your brain cells.
   
   You are stressed out, overworked and rarely thanked. And I can’t think of any specialty that I would enjoy more.
   

Separuh Tahun Lagi..

Goshhh.. its July already!! Half a year has gone. Comes another half.


What have I achieved so far? Hmmm... rasanya tak banyak kot.. Maybe more of my disgusting fatty layers?

Okay what's due soon?


My research audit on trauma in our department is due next week on Thursday. Brapa banyak je yg aku dah siap?

This coming Thursday pulak ada Resus workshop. -!-" 

This coming weekend aku kerja arvo shifts, meaning abis midnight :( Tak boleh nak organize buka puasa ramai2 with friends here since most of them are working during weekdays. Then next weekends plak aku kerja night shifts :(

My structured references for advanced training still pending. Awaiting completion by the bosses. Sigh...

Have to work on applying jobs for next year. Ni tension. Every single year terasa mcm beggar pulak kena apply then go for job interview :(

Kena renew & pay our annual medical indemnity (insurance) & registration (lesen bekerja). Melayang lagi $$$$.. Sigh..

Tax return!!! Sigh...


Okay, since balik from cuti hari tu, aku dah kumpul sebulan punye June empties. Will post on that soon.


Housework.. kain baju, dapur, bathrooms, garden, etc.. Sigh..


I need to start studying in depth I guess. Primary exams dah abis last year. Now into advanced training. Most senior registrars start studying bit by bit at least 2 years prior to their fellowship (final) exams. Diorang kata sikit-sikit lama-lama jadi bukit. And I am doing that, but my sikit-sikit tu lama-lama hilang tanpa kesan... masalah premature memory loss gamaknye... Sigh..


Today I am working arvo shift, abis midnight. So hubby will be eating dinner by himself. Dia buka puasa in the car or at work since buka puasa around 1712hrs, then eat propper dinner at home. Aku pun sama will be having my meal at work.


Salam Ramadhan all.

Aku Jadi Ketua Sebentar

I was assigned to be in the red stream for Thursday afternoon baru ni. Red stream maknanye utk high acquity cases e.g. intracranial bleed, cardiac arrest, respiratory distress, major trauma, acute stroke, heart attack, septic shock, etc yg memang very unwell patients. Cant be happier than this. Was wearing red top, carrying my red stethoscope, red mobile phone, red pen & my red glasses. Hahahah.. mana la tau dapat kerja red stream masa tu. Tup tup memang pun. Woo hoo. 

Btw, yellow stream is for low acquity cases e.g. batuk, rash, sakit perut, migraine, falls, dizzy, etc which sometimes can be rubbish as well. Pulple stream is for those fast track e.g. wounds, sprains/ fractures, medication review, etc.

 So that evening, datang satu signal dari ambulance. Cardiac arrest man who had cpr, zapped a few times & intubated at the scene before coming to us. 15 minutes before arrival. Seperti biasa as this is a team work. The big boss & myself asked me if I wanted to be the airway/ procedure doctor or nak practise jadi the team leader. Aku tak tau apsal aku ckp aku nak praktis jadi team leader. 

Maka jadilah for that case. This is usually slightly different than metcalls & codes that I'm used to on the ward. And aku rasa ada sedikit kelam-kabut some, but it was good coz my boss was there to support me. Plus the patient was stable & definitive management was laid out smoothly. We had supports from the ICU team & the cardiology registrar, as well as the resus team in ED was superb. 

I need more practice. Time to go to work.

ICU Cover Shifts

Minggu ni aku cover ICU for 1 week. Night shifts Monday to Wednesday, 13hour shift each. Then Saturday, Sunday on call- maknanye sapa-sapa yg sakit aku akan dipanggil bekerja di ICU. Aku doakan sangat tak dipanggil kerja coz I have lots to do at home & socially. Well, I would like to believe that I have life outside medicine, like everyone else.

Minggu ni baru minggu ke-2 of the new contract year. So my resident pon ala-ala budak baru belajar. Alah, nak meyampah pon takde guna. Diorang baru start the year, baru start the rotation, & ICU is not an easy rotation. Aku masa mula-mula buat kerja as a resident a few years ago pon kelam-kabut gak. Mebbie until now jugak. Haha. Tapi skang aku dah registrar. I dont hafta do much of the paperwork. Semua resident aku yg buat. Another registrar calls his resident his 'monkey'. Hehehe. Aku takde la kejam gitu. Its a shame aku cover 1 week je coz kalau tak boleh aku ngajar the residents some stuff.

Minggu ni pon cover another registrar yg akan amik their primary ED exams next week. Seb baik dah ada pengalaman jadi ICU registrar last year. So takde la kelam-kabut sangat. Plus now dah abis primary exam, takde la rasa mcm menyampah kat satu dunia bila gi kerja. Kira mcm dah redha & lebih ikhlas buat kerja coz terasa beban primary ED exams dah takde. Mebbie this will change when I start my research project & studying for my fellowship exams.

Anyhow, first night was cruizy. So ada masa to teach & talk about cases to my resident yg baru lagi tu. Got to show him how to do an artline & a CVC. Each of us boleh tido about 1hour each, even though aku tak boleh tido when I'm working. Just pejam mata trying to tenangkan otak. Tak biasa tido on night shifts coz semua pon mcm terbalik kan. On day shift ada ke org tido, so kalau kerja night shift takkan nak tido kan. Cuma sengsara la kalau siang tu takleh tido before night shift starts. Seb baik aku ni jenis senang tido after night shift, & senang nak get to the other day/ afternoon shift cycles.

Second night was hell with sick patients around the hospital. Termasuk neonatal code blue in theater for emergency C-Section. Kesian my boss aku called byk kali due to all the referrals, codes, metcalls. Rehat pon tak boleh. My resident boleh la kot coz most of the times aku yg lari sana-sini. Its too early of the rotation to get the resident to go to the metcalls instead of me.

Third night, I was hoping it would've been a nice closure, malangnye busy ya amat not only with referrals, codes, metcalls bagai, tapi got stuck with lots of politics etc on appropriateness of  treatment of some patients. Pening. 

Each of those nights aku bawak food; chips, dips, masak brownies, chocs. Hey, you have to keep your team happy. After all they are the ones who you are working with as a team. Kalau environment tak best, moral kerja pon tak best, kerja pon jadi susah. 

2 hari tak jumpa laki. Had breakie with hubby on Monday morning. Monday night jumpa laki just before nak bertolak gi kerja. Aku abis kerja rostered 9am, but selalu abis handover ngokngek ngokngek sampai rumah dekat-dekat 10am. Hubby dah gi kerja awal-awal lagi. Tuesday night dia ada catch up dinner dgn his old friend yg dah lama tak jumpa. Aku plak start kerja at 8pm, so hafta leave house around 730pm. Wednesday night dia balik lambat coz of work. So jumpa dia on Thursday night after aku bangun tido. Seb baik dia balik awal 

So weekends ni on call for the sickies. Hope tak get called in. Amin. 

Respect Others..

This is another good read on the healthcare system in Malaysia currently. Well, looking back on Australian healthcare system/ environment/ culture, I can probably say that its not much far away from Malaysian's. At least at those hospitals that I've worked at/ been to.

Here is the link:

http://mofrust.blogspot.com.au/2014/02/nurses-are-humans-too.html?showComment=1391994201338#c1641015400099433556
 

New Contract Year Feb 2014

All doctors in Victoria started their new contract year on the 3rd Feb 2014. I am one of those that are continuing from last year to this year. 
Agak rollercoaster jugak last week with the new doctors starting, ramai yg from other hospital network, ramai jugak yg first time residents/ registrars. Interns dah start 2 weeks prior so the first slow-wave dah lepas, now the next slow-wave pulak with the new doctors. 

I started the working year with being on the senior registrar job. This includes being in charge of the yellow stream & being the rapid assessment in-charge. Sangat-sangat stressful.
Nanti-nanti aku citer. 

This week I'm coverning someone on leave in ICU. Starting today with night shift sampai rabu malam. Then on-call for ICU over the weekends. Such long 3-14hour shifts; kami start at 8pm then rostered to 9am the next day, tapi tak semestinya abis on time coz ramai org byk ckp during handover. Minggu depan aku go back to ED.

I just got back from seeing my colleague for a breakfast at Axil Coffee in Hawthorn. Lama gila tak jumpa dia. Now dah nak ready untuk tido. Hopefully I get a good rest so that segar masa kerja nanti.

And aku doakan satu rakyat Victoria ni sihat sejahtera this week, so that takde yg berpusu-pusu masuk ED, and those on the wards semua stable takde metcalls/ code blue, and those in ICU are not extremely complex. Hopefully this week will be cruizy for everyone. Amiin, Ya Allah. 

ACEM Primary Exams dah selesai

Alhamdulillah.

Sat my primary exams viva on the 19th Sept hari tu, and passed. Sangat-sangat lega dah selesai primary exams and now onto nak selesaikan the final hurdle of being in the basic training. Lepas tu I will be in my advanced training of Emergence Medicine, in sya Allah. 

In the meantime, I want to focus on getting that balance in my life. In the past 1 1/2 years right up to the viva, my life was kind of an upside down roller coaster. Aug 2012 sat anatomy & pathology primary exams. Didnt pass Pathology unfortunately. Then Feb 2013 sat the pathology, pharmacology & physiology pulak. Unfortunately didnt pass physiology. Emergency college changed the primary exam format for Aug 2013. Dulu for each subject you have to sit the written exam then dah pass, baru invited to sit for the viva pulak, which is separate for each subject. So 4 subjects (anatomy, pathology, physiology, pharmacology) equal to 8x exams. Now for each subject you sit the written exam like before, but after passing all written exams baru boleh sit the combined viva. The new viva format pulak, 1 station will have 4 questions (1 question for each subject), and there will be 4 stations in total. So in Aug 2013 I sat the written physiology exam, passed, then sat the combined viva & alhamdulillah passed.

My certificate yg kemek2 pasal basah kena hujan while in the mailbox

Bersyukur sangat-sangat. So traumatizing, that all the plans I had before passing, the plans of what to do once I pass my exams, semua still stalling lagi coz still traumatized by the primary exams. Lega, that now I can focus on my clinical & research aspects of my work & also my advanced training stuff, tak payah risau kena study the boring raw basic sciences stuff. I can start focusing on my exit exam, which will be in 3,4 years time pulak. I can take it easy with my everyday life & enjoy the warmer season now. Rasa macam kepala ni lebih ringan.

Alhamdulillah. 

Doakan daku..

Assalamualaikum, salam sejahtera.

I really need a lot of doa's & luck here. Friday will be my Primary exams (Physio, Pharmacology, Pathology). At these very last few days prior to exams.. yg aku mampu hanyalah banyakkan doa & berserah je lah. 

This will determine wether I go into my advanced emergency medicine training or still being a senior in my basic training (which means repeat lagi exams in Aug/ Sept nanti).. huhuhu...

Doa-doakan daku ye.. :'( And terima kasih banyak2 for the doa's.

Ni yg rasa macam nak tukar carrier jadi PA ke cikgu tadika ke.. Why am I leading this misserable life pon I donno la.. sigh....

InsyaAllah, hopefully all is well & I am strong... Amin.

Sawang November

Mid November dah. Spring is near to its end. But cuaca still ntah apa2. Nampak semakin panas but cuma 1, 2 hari dlm seminggu.. itu pon setengah hari saja, the rest still kena pakai socks & jacket/ sweater in da house. But my house memang sejuk pon. 
Tak lama lagi summer. Yaaahooooo... sun & warmth. Blisss! Study pon seronok time suam suam bahagia nih. Time for cherry picking before balik Malaysia to see my beloved family.

Anyways, its not that I tak nak tulis blog dah. But setiap kali menaip nak pilih2 gambar nak edit lagi mesti makan masa lama. Pas tu jiwa ni rasa bersalaaah je coz sepatutnye gi study. Padahal siang malam dok main internet.. eerrkkk...
2 more subjects to go (Physiology & Pharmacology- subjects yg aku nyampah sangaaaat!) before February & March 2013 then to advanced training in Emergency Medicine. Lebih berat dari Anatomy & Pathology yg aku amik in August & September hari tu. Taakuuutt seh..
Dah la kena study lebih sket untuk my ICU term now. Fuh.. 

Now back in ICU as a registrar, lebih berat tanggungjawab dari jadi resident in 2010 dulu. 3 minggu in ICU so far, aku dah turun 2kg. Penangan berlari sana-sini coz ov MetCalls & Code Blues, dan jugak stressed kerja yg sangat intensed, dan jugak coz long working hours when I'm working.. 13 jam satu shift either pagi atau malam. Aiiiii...

Time to sleep.. selamat malam.

Have a good week people.

VIVAs Tomorrow: Anatomy & Pathology

Esok final perjuangan for my Anatomy & Pathology. Its the VIVAs part of the 2 subjects. Tomorrow a.m. in Albert Park.

Doakan I will pass these 2 subjects with flying colours. Amin. InsyaAllah.

I just want to move on to the next 2 subjects: Pharmacology & Physiology. Then to advanced ED trainng. 

Then I want to re-learn to play my guitar.

Ya Allah.

Alhamdulillah.

Alhamdulillah,
I passed my MCQs for Anatomy & Pathology ED Primary Exams.
The VIVAs will be next few weeks in September.
Wish me all the very best all. InsyaAllah.

And, Selamat Hari Raya Aidilfitri 1433H. Maaf zahir & batin. Take care everyone.

Winter = Kejung!

Winter started 1st June 2012 as per calendar. Tapi aku rasa in the past 2 yrs we've been cold-wet-windy with very occasional sunshine all through out the year. 
Temperature biasa la minimum can reach below 5°c & max kononnye 15° kat most metropolitan area. Biasa kalau pagi2 buta dlm 3°c kejung beku la jugak. Some rural areas masih dapat sunshine & their crops masih mendatangkan hasil.

Hari ni weather forecastnye kata sunshine. Bila betul kuar matahari baru aku nak percaya. Now masih gloomy & depressing. 






Me & myself, been antisocial lately. Lagi 2 bulan nak primary exams; pathology & anatomy. Tension sangat bila fikirkan boleh ke abis all the syllabus. Dah la kerja full time. Dengan normal house stuff (masak, laundry, cleaning, gardening). Huhuhuhu...
Oh ye, hari tu lupa nak cakap aku passed my Advanced Paediatrics Life Support yg aku amik 3-day course kat city hari tu. Alhamdulillah. Berbaloi aku nyer blanja au$2000 for the course. Now I can go to all the paeds code blues. Hehehe.

Okay, now, nak gi sambung study. (I hate studying in cold, dark, gloomy weather)
I'm doing arvo shifts this week. Last week abis weekdays night shifts, uneventful, so best & not bad.


Ciao.

Autumn, and It's Time To Get Serious!!

Ni bukan dah kira bersawang lagi, dah berkerak-kerak, kena masuk autoclav for sterilization agaknye. I'm talking about how long ago I last wrote anything here.
Each time nak tulis something, mesti rasa bersalah coz I know I will take a long time to write stuff here. It will involve writing itself (+/- editing), gambar-gambar semua kena diedit/diwatermarkkan, etc.
I feel guilty coz I actually hafta really focus on my study, lagi 3months je nak start primary exams ni. I'm only doing 2 subjects but the amount of knowledge to know & be able to regurgitate memang massive!!! Tambah-tambah lagi stuff to do in relation to work, e.g. presentation, prep for pop quiz, teaching the kiddies, etc.
Stress.. stress.. stress...!!!

Wats been happening in my life: mebbie kalau aku tak rasa bersalah to write I will cerita more on each of these. Buat masa ni list je la.
- interesting stuff happening at work.
- my mistakes at work.
- my new phone: Samsung Galaxy Nexus, with me tanpa sengan silu re-activating my 3G/ mobile internet service. I am truly on the go now.. haha.
- my eBay purchases =P
- dr. HAK birthday dinner in the city early April hari tu.
- visit to Surfers' Paradise, Gold Coast, Queensland about 2wks ago. was soooo nice & warm. balik melbourne balik, jadi depressed. Now dah autumn... sejuuukkkkksss!!!! hate the weather!

Now, wat's happening next:
- night shift starting tonight, abis monday a.m.
- monday arvo, seeing my gastroenterologist for the first time, in view of gastroscopy, etc. due to my ED admission mid Feb hari tu pasal gastritis exacerbation.
- wednesday a.m., my turn to teach the kiddies. i was supposed to teach on ENT stuff, but coz I sed sth stoopid in front of my scary mem besar at work, now kena teach on snake bites in Australia. huhu.
- thursday arvo, mortality & morbidity morning. I have a case to present. big meeting coz will involve many people frm the big bosses to the kiddies to the nursing staff :'(
- friday until sunday will be my APLS course (advanced paediatrics life support), all 3 days will be full day course. kena abiskan baca the reading material coz aku dah bayar au$2000, so kena la pass assessment diorang.

So u can imagine, my schedule will be really busy :(

Dah 4 hari fm Tuesay aku dok makan nasi lemak :D nyam nyam. thought of cooking tonight but nasi lemak byk lagi. mebbie esok je la.
Tonight, harap-harap hubby bawak balik kebab, coz aku dah bosan makan nasi lemak tu lunch dinner since Tuesday.

And, now back to working on work. Tonight night shift..

Gambar dari ihsan google.

Berehat jap

Dah hampir seminggu aku berehat from bersenaman & study. Maka beratku yg dah elok-elok turun tetiba naik hampir 2kg, simply coz no senaman & sedentary life in a week termasuk kat spital. Aku rasa mcm each time aku period sure size seluar & baju naik 1 size. Angin satu badan, physically & mentally. Hahah. Blame it on my menstruation: Dysmenorrhoea & menorrhagia.
Letih jadi pompuan ni kan. =P

Alhamdulillah aku tak kena panggil masa aku oncall over the weekends. Got the day off on Monday as well. Then was working a.m. shift Tuesday & Wednesday. Not bad coz patients banyak tapi doctors & nurses pon banyak. So patient flow memang fluent. Then the doctors that I was working with over the 2 days were the cool ones. Termasuk my ED physician/ Intensivist boss who is my idol. Hehehhee. So memang mood baik je kot, despite sakit-sakit badan.

Ada category 1 patient datang on Tuesday, out of hospital cardiac arrest with long down time. Wasnt my patient but I was the procedure doctor. Was happy with my arterial line, didnt get to do the CVC because family & medical team decided to withdraw treatment, mainly coz long down time & patient was showing terminal signs already. Selamat, coz I was sooo sleepy that morning that I almost confident that if I proceeded with the CVC, sure miss & bazir au$300 for the CVC kit. So this patient went to ICU to pass away.

Some other interesting cases I saw during those 2 days: Acute appendicitis yg aku diagnosed clinically despite the odd history & findings (it takes guts to confidently diagnose something yg tak ikut black & white of medical textbooks). Compound crush fractures of a hand. Sepsis 2° to severe cellulitis, that we managed to exclude necrotising fasciitis.

Semalam pegi registrars' teaching kat spital. Cool gila kami ada this new fibreoptic camera laryngeoscope for intubation. We had a briefing by the rep on that stuff. I personally have used this to intubate a severely overdosed patient 2 weeks ago during my night shift, and I found that it was significantly easier & quicker using this. Great. Not much strength & lifting needed, and the screen to observe the airways is excellent. This gadget is great for difficult airways, trauma intubation, cervical spine precaution & to remove upper airway foreign body.
Tapi aku still rasa we still need the traditional intubation skills using the old metal laryngeoscope. Which needs a lot of left arm muscles, di mana aku punye memang flabby & lembek. :P

I think yesterday's registrars' teaching was one of the most comprehensive ones. Lepas glidescope briefing & practicals, kami blaja new guidelines on procedural sedation for children, in particular using ketamine & nitrous oxide. Most of the registrars dah guna these great 2 sedatives either in ED, ICU, theatre. Tapi yesterday, we had the briefings on the new guidelines & also ada practical stations.
Then my idol boss refreshed us on the details & hardcore stuff of acid-base/ blood gasses use in sick patients. Best la. But by the time abis glidescope briefing tu aku dah ngantuks & tepu. So tak tau brapa byk the rest of the tutes masuk dlm otak aku smlm.

All in all teaching smlm memang best. Hopefully I get to see these stuff in the near future for real life practice. Ntah ngapa now rasa cam semangat nak kerja plak with all these refreshments. Selain dp new cool doctors to work with in ED & ICU, my plate is full of work stuff. I'm going to this APLS course in a month's time (advanced paediatrics life support), then the primary exams in August/ Sept (InsyaAllah pass, then boleh maju ke advanced ED/ ICU training.. yay!), on top of the many presentations during registrars' teaching & mengajar for the medical students/ interns/ residents. Banyak this ongoing lifelong professional development stuff. Seems positive & hopefully stays positive & smooth. InsyaAllah.

Aku kerja arvo shifts this weekends, then straight to weekday nights Monday until Thursday night, abis pagi Friday, again with awesome docs. =)
Now kena sambung study.

Lama gila tak update

Gila lama tak update.

Now dah masuk minggu ke-2 of the new working year for 2012. Makin busy with work & studying. Skang aku dah jadi 2nd year ED registrar. Ada 2 org last year HMOs now dah jadi junior ED registrar, which means I'm no longer the most junior.. tak dapat all the attentions anymore :( jeles!! Hahahaha.. takde lah. Gurau. But that means aku lebih dipercayai oleh bosses & at the same time hold more responsibilities. Ada a few new registrars starting as well frm other hospitals, mostly are seniors. Some seniors are out at other hospitals doing their whatever rotations. One of the junior ED registrars that aku baik with moved on to Royal Melbourne Hospital buat her ICU rotation. Other senior registrars pergi ke Eye & Ear Hospital, Royal Children Hospital, & Monash Neonatal ICU, etc. Tengok diorang moving on to their rotation of choice buat aku berkobar-kobar plak nak study abiskan my primary exams cepat2, so that aku pon boleh buat rotations yg aku nak like the Children's, Eye & Ear, ICU, etc.

Talking about new year, new doctors starting all over Australia for the new working year. Plus the medical students. I've noticed with the new juniors in ED, some have a lot of attitude... berlagak, degil, malas. Mula-mula aku ingat aku sorang je yg terlebih sensitive. Rupenye most specialties are having the same issues with the juniors. Huh... generasi skang ni makin besar kepala eh. Aku dgr cerita hari tu dari medical registrars yg one of the interns kat ward was telling the consultant what to do with a patient... whooaaaa.... berani! Kami dulu masa students & interns tak berani nak bersuara, & sentiasa berusaha keras utk bosses nampak kerja kami bagus. Slalu kami sanggup balik lambat nak siapkan kerja & sampai kerja awal. Skang ni.. wooohooo... lain dah. In ED, kami cuma kasi chance the juniors nak get used to the first 1-2weeks, we'll show them around & make sure that they learn. Kalau masuk minggu ke-3 macam ni jugak.. kena la. Bunyi cam garang kan, tapi tu la, diorang ni kami tengok, the attitude memang tak bleh blah. Ada je yg baik, sopan, takut-takut tapi rajin. Those people kami kasi more time at the same time encourage diorang jadi berani & confident. Tak kisah kalau diorang dumb, slow, junior tapi rajin & polite, coz these are the kind of person that u want to be in ur team, and will definitely go far to success. Kalau dumb, slow, junior AND rude & pemalas... hmmmm silap besar...

Kaki bebel jugak aku nih. hehehhee..

Anyways, aku dah kerja 3 weekends in a row termasuk semalam. Hari ni aku kerja night shifts sampai thursday. Esok pagi kena gi jumpa GP for a f/u of GI investigations I had last week. Then kena jumpa specialist in the next few weeks. Jumaat ni plak lepas night shift kena gi service kereta. Weekends aku on call.

Bila masanye aku nak study nih?

Perihal Handovers

About an hour ago aku bangun dari tido. Seb baik sempat solat Zohor (Asar masuk 531pm nowadays). Working nights this week, frm last night 'til Thursday night. Aku kuar frm hospital around 9++am pagi tadi. Cam biasa junior reg looks after short stay uni (benci!!) & therefore the longest to stay coz of long handover for short stay, while still ada lagi patient on the floor to handover to the a.m. floor doctors.

Aku nak citer pasal how I made a HMO cry during a handover on Friday afternoon last week. Si HMO ni kita namakan dia "Dr. M". Dr. M handed over to me a syncope of unknown cause but stable, still in the mid of investigations prior to the patient being sent to short stay unit. I checked the medical notes written by this HMO, & when I noticed ada byk glitches, aku tegur la. Syncope = unconscious event, as an ED doc kita kena cover all basis. Meaning kena look at all possible causes: neurological, cardiovascular, metabolic. Then aku list down all the things yg dia kena buat before handing over to me: complete the history taking, tulis the drug chart coz patient tu punye regular meds dah overdue, fluid chart, anticipated short stay plan including disposition plan, etc. Haaa.. tengok tu, punya la banyak kekurangan. Mana boleh aku je nak buat semua kerja dia yg tak siap nih. Aku cam garang la jugak, kalau tak complete menda yg dia should have done earlier tu aku tak nak amik the handover.
Lepas dia buat menda tu dia got back to the doctors' room & nangis depan semua org including consultant aku & balik rumah.. Aku cam.. errkk.. takkan la cam tu pon nak nangis, bukan kasi patient mati pun.
Sebelum dia dok handed over to me that patient that day, dia ada handed over 2 terribly incomplete patients with bad consequences to me on Tuesday sebelum tu. Sure la aku hot sangat-sangat. Kisahnye: 1st surgical patient, dah accepted by surgical registrar over the phone & was going to theatre that very evening & plan was surgical registrar would see the patient before operation. In the meantime the patient should be fasting & having IV fluids, IV antibiotics, blood tests, pain killers. The handover was just babysit the patient coz kononnye semua dah settle. A few hours after the handover, nurses datang kat aku kata patient tu takde IV canulla hence tak dapat semua menda lagi, and he was getting more dehydrated. Apa lagi, panas aaaa kejap hati aku ni. Dah la when someone is sick, to get an IV access memang susah. Dgn si patient ni mmg susah gila sampai one of my bosses helped me using the ultrasound machine pon cam susah gila. Dah delayed dia punya treatment that could have helped in his recovery post-operation & reduced length of hospital stay. Seb baik kami berjaya buat semua tu before this bitchy surgical registrar jumpa the patient that evening, kalau tak sure ngamok abis dia. Geraaammm!!!
2nd patient ialah this poor 90yr-old lady functioning well lives alone kat retirement village unit, as per handover dia ni unconscious due to severe hypoglycaemia BSL was 1.3. Dia ni kononnye 'slightly' dehydrated due to gastroenteritis (surprise, surprise not properly enquired by this HMO). Dah resusitated by ambulance & now receiving treatment kat ED for hydration & for sugar replacement, before transfering to private hospital. Aku tengok notes.. hmm.. cam something missing je, most of blood tests cam tak complete & the initial resus management kat ED cam something wrong. Masa tu cam busy nak mati so on my side I missed looking into those during handover (silap aku). Then masa kat short stay tu patient tu deteriorated, lepas aku dah start my part of treatment aku gi balik ke dia punya notes. Memang banyak missing!! Aku yg memang ada anger issue ni lagi la panas je, tambah lagi baru je struggling dengan surgical patient tadi tu. Aku terpaksa order banyak lagi blood tests, rehydrate this patient, etc. In short she was actually in multi-organ failure way back in resus cubicle way before aku took this crap handover. Cam mana aku tau, aku tak order new blood tests, aku order retrospective blood tests. Meaning aku tak amik new blood frm the patient tapi order tests on the blood yg pathology lab dah ada 5,6 jam dulu tu masa dia mula-mula sampai ED. Seb baik ada sorang senior ED registrar ni baik hati nak tolong aku manage this patient. Aku risau la jugak bila balik rumah tu walaupon dah handover kat the night registrar. A few days afterwards, I heard from one of the bosses regarding this poor old lady. She deteriorated overnight, multi-organ failure, tak jadi nak hantar kat private hospital but terpaksa admitted at my hospital & very sick.
Grrr.. sure la aku geram gila. That patient could have died that night. Yeah, sure, she's 90. But she's a functional 90yr old & she absolutely didnt need to die due to medical mismanagement. She could have gone to the private hospital where she really wanted to go & discharged the next 2,3 days. Tapi dia admitted to hospital for 9 days. If she was my family member, I would want her to have a chance to be back to her previous function, given that she was functionally well prior to this episode. And I am a doctor & I am fully aware of the old lady clinical situation (which was initially simple to manage if the initial treating doc was aware as well).

In short, before I took the Friday handover frm this particular HMO, I talked to her about the 2 patients that she handed over to me on Tuesday & what she should have done right & what she could do better in the future. Dia cam tak berminat nak dengar semua tu.. just jawab.. "yeah yeah..". Aku sabar je lagi masa tu. Bila tengok another crap job of hers with that one, aku terus tegur dia lebih garang lagi. Good thing is aku tak yell at her, just slow monotonous firm voice & straight to the point. After all, dia dah HMO bukan intern lagi.

Memang all the juniors (HMO & interns) wajib discuss patients with the consultant in charge on the floor. So that takde missed care & this will be a learning opportunities for these juniors. Thats why its also important that these in charge consultant kena gi check all points of care with the junior doctors. Kalau the juniors malas/ miss stuff/ rasa cam dia pandai gila with their limited experiences, & unfortunately the consultant plak either malas/ super busy, memang akan jadi kes berantai la of missing stuff.
In that crap handover case, unfortunately the department was on bypass & superbusy so byk la swisscheese holes. And to me, whatever it is, the first clinician kena buat their job properly & clinically thorough (yg relevant je la). And after all, these clinicians are doctors not medical students. So sila treat patients like you are a doctor.

Kalau nak handover kat aku, aku kena tau semua since aku yg akan jaga these patients for the whole of my shift before handing over to the next person kalau diorang masih ada di ED. Aku tak nak inherit pts yg I have to go thru every single thing again myself & kena buat most of the investigations.. kalau cam gitu, patient's care is delayed & mungkin makin teruk. Its like cleaning other people's mess. Kalau diorang sakit aku yg bertanggungjawab nanti.. and kalau diorang sakit sebab unfortunate events/ natural course of the disease takpe, tapi kalau diorang sakit sebab the previous doc has missed lots in the patient's care.. memang aku marah sangat. Plus my time would be better spent to see the other patients waiting to see a doctor, than me wasting my time cleaning other people's mess.

Sabar je la...

Victoria Healtcare Crisis

http://www.theage.com.au/victoria/nurses-close-one-in-three-public-hospital-beds-20111111-1nbxi.html

Hmmmm....

Jom docs beramai2 rally jugak coz kami pon the lowest paid docs in Australia, DiTs get almost lower than some nurses n cleaners, against our most horrible workload n working conditions in the country.