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.

Hujan daaa..

Mengikut kajicuaca, sejak semalam hujan lebat thunder storm esp in the northern, western areas. Kat kawasan aku hujan non-stop since last night. Not lebat though. Gloomy. Akan berlarutan selama beberapa hari akan datang. Seb baik I did berbakul-bakul laundry a few days ago masa tgh panas gila, during the 35°c-38°c days.

Hujan. My pokok cili & strawberries yg berjaya diselamatkan buat masa ini.

I'm restarting my detox again. My way of detoxing myself. I was doing so well until about 2wks ago where I started eating junks again & no exercise. Guess wat, naik balik 2kilo! Grrrr! Sejak semalam aku start balik my detox plus senaman semula. Aku rasa this time aku tak nak yangyok senaman tapi tak nak overdoing it either, nak consistent bersederhana je. Supaya metabolism just nice & consistent, tak nak yo-yo lagi dah. Detox ni just nak kickstart again. Like I sed before, my detox is avoiding junks for a week, reduce food portion, balanced diet but more towards veg & fruits & simple protein, and my homemade detox juice frm my recipe books. Aku still makan nasi & lauk, but reduce portion & healthy replacement of stuff e.g. tak guna santan tapi guna susu, kurangkan garam, kurangkan gula, kurangkan minyak, rebus mana yg boleh asalkan lalu nak makan, etc. Just sederhana je, coupled with senaman. Even with these measures, my berat senang turun & badan senang tone.
This time akunyer detox juice made of grapes, blueberries, strawberries, blackberries & coconut water/ pomegranate water. Sedap!

So, I was working over the weekends. Started at a weird time ever: 5pm. Abis midnight. Not complaining, coz it means aku just kerja 7 jam je.

Sabtu: one of the bosses started a buddy thing, where a registrar buddies with a resident. I think in a way nak minimize interuptions kat big boss yg in charge of the floor, and also nak encourage registrars to take more responsibility/ leadership role. So aku dibuddykan dgn this resident. In a way, ok la bangga la jugak boss percaya kat aku, the resident percaya kat aku (or terpaksa percaya kat aku.. hahaha), aku pon dipaksa berfikir on the spot & praktis my listening/ leadership skills. Yg tak bestnye, seriously selain dari layan patients aku sendiri & layan those handover patients, aku kena layan my resident's patients jugak. Rasa cam all these interuptions just delaying my own patient's management. Unfortunately, tu lah dia tanggungjawab as u go higher up.
Cases yg best on Saturday: dengue fever in an Aussie who works in East Timor tapi pulang bercuti di Melbourne. Funny & almost embarrassing coz I had never seen any dengue fever in my whole life. Surely, I've heard of people dying of dengue haemorrhagic fever kat M'sia but tak pernah tengok depan mata sendiri. Now I know. Then ada this patient with myeloblastic disease with massive hepatosplenomegaly; liver & spleen dia besar gilaaa! Good textbook cases that day.

Sunday: aku was working in green stream. A locum boss was in charge of green. As much as she was being very supportive & nice, aku rasa cam dia kurang percaya kat aku. Semua patients yg aku d/c dgn dia, dia nak jumpa & manage kalau boleh. Hahaha, kelakar coz tahun lepas aku cam whinging that aku tak nak manage pt by myself. This year aku komplen plak boss nak tau pasal pt aku. Oh well, we need to have balance & check to ensure safe medical practice.
Anyways, interesting cases semalam: nasty distal radius & ulna fracture in a 7 year old boy, kami reduced kat ED under ketamine sedation. Somehow kat sini diorang berhati-hati guna ketamine. Not like in 3rd world countries where ketamine is readily available. Orthopaedics registrar datang buat reduction. Then this wound on a forearm of a 13year old. My boss suruh aku ajar sorang intern ni yg tak pernah buat stiching lagi sejak dia start ED. Its a straight forward 2 inch wound so boleh la aku suruh dia buat. Tapi lepas 2 stitches dia buat, si parent ni tetiba tak kasi plak, nak aku plak yg abiskan. Aku dah la busy dgn other patients. Tapi aku abiskan jugak la. Its a shame la parent tu tak kasi that intern buat. They have to learn somewhere & the best way is to do it themselves in an uncomplecated straight forward clean wounds like this, which we dont get all the time. Other cases are not so interesting but not difficult at all: suicidal lady, removal of a piece of broken glass from someone's foot, sprain toe, anaphylaxis, another wound in a 2y.o. girl.

Malam ni aku kerja nights straight until Thursday night, abis pagi Friday. Aku kena gi tido in the evening for a few hours so that tak ngantuk first night nanti.

Cuaca best untuk jemuran

Love the weather today & I love my house.
3 laundry cycles aku dah buat & dah jemur. Half dah kering in 2 hours time. Good dose of sunshine for my trees. Good dose of sunshine for my skin provided aku slap on thick & frequent layers of sunblock. Good dose of sunshine for my study mood =). And dalam rumah just nice & suam, walaupon kat luar tu lebih panas dari kat M'sia, temperature dalam 35°c. Best!. Aku belum pasang kipas lagi kat ruang makan/ ruang tamu ni.

Adelaide nampaknye hampir mencecah 40°c today. I think when it gets to 40°c, aku lebih rela gi kerja dp dok rumah. Coz kat rumah ni takde aircond & selalunye bila dah >40°c tu dlm rumah ni pon akan jadi panas semacam walaupon pasang kipas. And kami akan jadi lembik semacam coz tak tahan panas.

Esok akan panas jugak, so I think I will scout around on what else to wash. Mebbie selimut & linen & towels & some more floor mats kot. And InsyaAllah nak buat gardening & kemas rumah sket early morning before panas.

Nak masak apa for dinner tonight?

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.