Breaking bad news

One of the toughest job of being a dr is breaking bad news..
It really hard for me to do that even after 3yrs services..
I have one pt in ward at d moment..came with 5days history of bilateral leg oedema,ab distension and progressive jaundice..
Proceeded with ultrasound hepatobiliary system after found that his liver enzymes were grossly abnormal..
Turned out that he has hepatoma with multiple liver mets..
He is a very good pt with good family support..
I was looking at him and his wife for more than 15minutes thinking how should i tell them..how should i tell him that he has hepatoma with liver mets.worst,gastro team decided for palliative care..

So i went to both of them and my first word was maaf..
:(..then i explained to him regarding d condition and d prognosis..

Im so proud of myself today

Im so proud of myself today!!Couldnt really sleep last night...woke up at 230am and had to witness a very bad car accident exactly happened in front of my house..bunyi tu mmg kuat gile..i tot initially rumah runtuh..mmg terfikir camne la bibik bibik..kejutkan my husband yg dh bgn tp terkejut lagi and he wanted to call our bibik 1st..tah camne tergerak hati nak tgk kt luar lepas dgr pompuan menjerit so through d window i could see kete terbalik..terus turun camtu then baru teringat xpakai tudung sume so naik balik..my husband and my sis keluar dulu and ckp suruh call ambulance..d hospital is about 2mins walking distance je tp if ngan kete kene pusing2 dulu..tp b4 sempat call ambulance ade org dh bawak org tu pg hospital..tgk kete tu i rase confirm die ade head injury and barely survived...nak call my colleague kat redzone hrpz tp malas. hehe
Then lepas tu kul 4+ br boleh tdo..bgn blk 630 n pg keje..sampai quite early 745 sebab my husband drive laju gileee..the person oncall yesterday mintak tlg die buat caesar and patient dh already been pushed to operation theathre..ape lagi tekan minyak la kan.i pg blk oncall sambung tdo jap for 10mins then baru g round..sampai2 ward,ade pt gasping!!
And yes..another DIL issued...pt was electively intubated for impending collapse..then rushinh followed ward round yg mane ade sorang saje ho and mmg quite kalut lah.kul 10 camtu received a call saying that a visiting gastro consultant has arrived and it was my job to assist him today..
Letih jugak la berkejaran..intubate pt then referred then kene pergibscope room assist but ogds and guess whattttt????i had an opportunity to do my very first oesophagealgastroduodenoscopy-OGDS!!! Wow!!! And dapat sampai ke small bowel!!sampai d2!! A very good start he told me!!puas hatiiii gile raseee..
Aww aww seronok!
Die ckp bukan senang first timer nak buat sampai area d2!!hehe.
Yay!!!abis ilang penat kejap..
Then berlari2 ke klink and tgk pt gastro..then berlari2 ke ward clerk pt srbab pt tu elective admission and to be clerk by mo.huhu..pastu berlari2 solat and g cme..then berlari2 pg casualty intubate another pt...
Then berlari2 pg ward rv pt dengue..then 640 br dpt msk blk oncall smyg asar..huhu

Oncall

Oncall today..after a long break..hehe
Baru abis round 2 wards..ade 2 ho je-one in each ward..ade sorang el.huhu
Seb baek yg senior tinggal..so basically round sendiri jugak la kan.huhu.
Last night we had a bbq at my auntie's..wanted to go initially but then rase xlarat sgt with d backache sume so cancel pg..
Pastu kene paksa ngan hubby dinner..hubby cakap dah start perangai mcm 1st trimester ie xnak makan..hehe..
Memang malas gile nak makan..xde appetite langsung..
Even maggi pon xnak so mmg selamat la..tp kalau yg betol2 suke kasi 2 bungkus nasi pon abis hehe..
Tapi skrg baru tau nape at 36wks u xleh nak oncall dh..penat weii..even nak jalan pon xlarat sgt..
High heel sume dh tolak tepi dh..surrender..skang ni pakai scholl je..biar mcm org tua pon tapi ok la sikit..
Nak tdo pon kene banyak2 bantal sebab sakit belakang..pastu budak kecik ni ngamuk2 tendang2 kalau tido mengiring tak lapik bantal..
Mmg mcm mak die je perangai ni.hehe..
Ari ni plan nak scan tapi tgk la dulu kalau sempat..
My antenatal check up done unofficially je by my husband..haha
Kalau ade problem pe2 terus consult specialist/consultant..
Padahal mende kecik je..hehe..
Owh skang ni banyak dengue n lepto cases!!so careful ek..before tdo sembur la ridsect dulu..pastu minum air yg betol2 boil dulu eh..okie?

another pic..=)

me at 30weeks!!!

This photo was taken few days before i was admitted..=)

yay!

discharged home already!!given mc till sunday..actually he offered me a medical leave till monday but i told him no need..sunday is enough already..nak buat ape lame2 boring jugak..plus monday kene oncall pon..kalau x nak ganti camne..yang ari ni oncall pon i need to switch with my colleague and need to take her call next weekend!huhu..
demi sesuap nasi..hehe..but its ok cuz my specialist dh kasi green light!he told me that i dont need to ride on an ambulance anymore!yeay!!im pretty sure that rode on ambulance last monday for twice within 12hrs contributed to my sickness!hahaha..penat badan kene lempar dek ambulance tuu!!!!
anyway temperature settling..still having runny nose and cough..appetite improving..not dehydrated anymore..i had few episodes of BP 80-83/50-56!!!!

my precious

my precious!need a bit of imagination..hehe basically tangan die tengah pegang kaki die and bawak dekat mulut die..comel x?hehe

look at this!!

Look at my husband's oncall schedule..oncall for 6 consequtive days!!!!uhuk uhuk..=(

My husband is oncall tonight..
It sucks..
It really sucks..
Sacrifice that has to b done as a doctor's wife..
I know he doesnt want to b there as well..
Esp when he knw that his wife's blood pressure was 80/52..
But who is going to replace his oncall?
Nobody..
Sedih la kan..kite xsehat admitted siap but husband is not around..
:(

Strong

I tot i am strong enough to oncall after came back frm kl..apparently i am wrong..totally wrong..
My body couldnt cope with d stress so here i am-admitted in perdana specialist hospital..
Alhamdulillah luckily my baby is doing well..mommy die je ade high grade fever and dehydrated..
They have infused at least 1 pint normal saline already..i am that precious because i am pregnant..anything happened to me its going to be national audit.haha..prgnant lady kan so of course d attention is a bit more..
Sadly,my husband is oncall again today..so he wont b with me for tonight.
Sedey.:(
Hopefully he will have a calm oncall tonight..nyway hapoy birthday wan yusof!

Quality Hotel

Yay!!im going to shah alam in about 5mins!waiting for my husband to bersiap2.he finished his last caesarian at 8am so delayed sket..patutnye kul 830 dh nk bertolak tp ni x bertolak2 lg ni kul 850.tapi no rush pon..course tu tomorrow pon cume ingat nak g tgk movie n makan auntie anne's pretzel!yay!!
Alhamdulillah smlm oncall xdela bz mane..kul 12+ dh masuk blk oncall..just terima call je lepas tu xyah kuar pon..b4 that kene intubate n antar pt jugak lah..85y.o underlying chronic illness,premorbidly xcomel tapi a&e team proceed dengan intubation sebab gcs dropped n saturation xnak picked up..and no relatives around..ni satu hal lg..dtg2 ane dumped die punye mak bapak and balik buat mende lain..seb baek casualty team jumpe address so suruh polis g cari relatives..mcm dlm pnewspaper la hospital ni tempat buangan...lepas police called baru nk dtg..pastu masa dtg explained that we have to send her to kbmcm nk ngamuk2 lak..pelik tul manusia ni..
And one more thing ade satu pt ni chronic lung disease..akan dtg casualty and request admission padahal x sob,,kalau kite xadmit die akan dtg n xnak balik so kite admit je la..family xpenah nak ziarah..tp ade sekali we called them ckp nk antar that makcik to rumah kebajikan ngamuk2 kate jgn nk malukan die seba he is somebody..pastu expect kitela jd rumah kevajikan..if u r somebody,xkan that simple thing jaga mak pon xle??betol x?

Death

Maut ni x mengenal sesiapa..Allah dh tentukan bila ajal kita masing2. Jangan ingat kita ni muda lg lambat lagi nak mati so kite sesuka hati je nak buat jahat kan..
Yesterday pagi2 buat round i was informed that one dead body in my ward..then i asked who was it?i know each of my pts in ward without looking at their file..nama xingt sgt tp sebut katil i do remember dieorg punye problem..but that particular pt was my chronic pt..nama die of course i ingat..and xsangka die mninggal smlm..innalillah..hes not a muslim but i was quite close witg him and his wife..kesian wife die..anak die kecik2 lg..and paling xle lupe a day b4 that he was quite ok given his condition..was an elective admission pon..
Nyway 10mins after that i was called by staff nurse,"dr pt stop breathing.tp dil issued and family refused for active resus"..
So i went there just to pronounce it. What made me a bit terkilan was that his wife..i told her,
"makcik maaf deh kalau ade ape2 yg silap or salah ckp ke ape2 selama ni..and makcik waktu ni jenazah sedang bertarung..saye nasihatkan makcik pergi sebelah die baca yassin ke surah2 ke n jgn tinggal die sorang"..
Instead listening to my advice she just went to relative dpn pakcik tu and started talking about something else..im a bit furious..xkan la idup ngan org tu for more than 50yrs buat u xsayang die dh?dh fed up dj? Makcik tu mcm happy lak..perhaps diexyah jaga org sakit dh but still?husband kot?n anak2?tatau la ke mane...sedih je ngan dunia skrg...

Lupe lak hubby ii

Lupe la pulakkk.actually cite sal oncall smlm sebab nak cite sy lancarkan mogok lapar smlm..haha
Xdinner semalam..sebabnye pissed off ngan ong team.,hehe..eventho my husband xoncall tapi nak mogok gak., kesimpulannye smlm x dinner..pagi ni he came early so we had our breakfast b4 started doing rounds..
B4 that my husband took my blood to check for my full vlood count and fasting blood glucose aka modified mogtt.. I cant tolerate 75g sugar so my mogtt is basically amik fasting blood sugar and makan breakfast.2hour after amik la post prandial..muahaha..ofcourse la kan x valid tapi xpe la.at least my fasting 3.17 jer..so confirm kot x diabetes..hahhaa..and alhamdulillah my haemoglobin pon 11..kire ok la sebab i never took haematinics/iron tablet/supplement..hahha..yes my dear reader--doctor is d worst pt..haha
Dari dulu lagi advice org suruh mkn sayur la,vitamin bla bla but i hate vegetables and i dont take any supplements for my health.,cume ari tu first trimester je i amik folic acid..tu pon on n off..hehe..
I xsuke ferrous fumarate sebab it caused me constipation which i already have since early pregnancyy..so xde kejenyee nak exacerbatekan lagi my constipation tu..haha..but reader plsss..plss makan sayur n haematinics..hehe
Saye mmg dari kecik xle makan ubat..even panadol pon..so kalau i bgn tengah2 mlm cari panadol tu maknanya mmg sakit betol2 la and usually instead of 2 tablets i usually took one sebab bajet body kecik cukupla dgn satu je..hahhah
Okie nk sambung buat sudoku!buhbyeeee

hubby

hubby is doing a passive call today..so here i am..postcalll and still stuck in this bloody hospital.muahaha.i love u!haha
well..patutnye passive call dok rumah je kan but die kan budak baek.. mo yg buat active call kene buat 3 pending caesar so die cover labour room..
wife die?wife diee stuck kat sini lah-bilik oncall..doing what?-sudoku!!
anyway smlm for d first time i was oncall alone!!i mean without my husband oncall together..usually kalau i oncall die akan oncall jugakk.smlm die kene teman my MIL sebab my FIL antar adik die kat uia.so lepak sorang2.pastu ho ong sini punye la lembab..pt electively admitted from
clinic masuk ptg lagi tapi clerknye kul 7..pastu guess what?refer medical team for maternal pyrexia of unknown origin kul 10.selamat la kan?mlm2 nk kaco specialist..kalo yg urgent xpe la..ni nak kata urgent xmane tapi sebab obs n gynae punye case kan i takut sikit la..medicolegal banyak sikit..nanti xpasal2 msk paper mcm metro last week..chopp..xnk komen!sekian..sape2 nk surf sila la and u judge it urself la kan..huhu..

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welcoming third trimester

wollaaa!!hello third trimester!hello everyoneee!my name is raina!i have few mnths left before my mommy introduce me to d outside world!
had another detail scan done last week by ong consultant!lucky me!
alhamdulillah so far insyaAllah everything is ok except for d fact that im breech!!haha.
i love kicking my mommy's bladder so d best position for me is breech!!
my daddy told my mommy that they will proceed to caesarian section if i dont change my position before my due date!!
pap!!!
tian mummy..nnt later2 i will guling2 pusing2 and tukar position jd cephalic k??

breech by definition is d condition whereby d presenting part of d fetus in d pelvic brim is d buttock/feet..orang2 tua cakap songsang.muahaha.for d primigravida(first time pregnant) usually they will recommend for csxn.but of course it depends on d types of breech itself..still at 28wks baby have lotsa room to pusing2 and finalised his/her position.ngeee..for orang2 tua diorg akan suruh midwife "pegang2" or betolkan position tu..in current medical practice u can opt for ecv-external cephalic version..somehow my husband and i both agreed that we r not opt for both..ngeee..sebabnye masa scan tu nampak cord bnyk sgt depan muke die and of course myself takutla kan kalau pusing2 jadi cord round neck ke ape so biarla die pusing snediri..last choice caesar je la..huhu..tapi hopefully budak kecik ni pusing2 lg..
owh i have few videos and few pictured to share tp xle nk upload la pulak sebab pakai iphone..hehe..video budak comel dlm perut tengah minum.haha.pastu makan kaki diee.hahha.lapar sangat ni..tp budak kecik ni sgt tembam!!mcm daddy die!!hahah.mummy die x tembam.muahhaha

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jonah

jonah?penah dgr?jonah ni i think i had mentioned it before..jonah ni kepercayaan medical staff kalau org jonah maknanya kalau die oncall mmg bnyk la patient die akan admit atau akan ade la patient xstable or kene resuscitate..
me?ngeee..im in denial..haha.people keep on telling me that i am jonah but usually i will point it towards other people..muahha.denial kan..
but i have to actually admit la that i am pelaris jugee..bed usually penuh la kalau i oncall..and kat htm ni usually kalau i oncall and x hantar kes tak sah la..haha.paling idak pon accompanied patient pegi ct brain kat either hosp kuala krai or hosp kb..
ofcourse my parents against it la..tp nk buat camne kan?keje kan?stressnye naik ambulance ni if pt dh la x stabil then jalan jem pastu ambulance driver takut nk psg siren!
ok kat kelantan ni ade rules ambulance driver xleh pasang siren dekat traffic light.reasoning?sebab if jadi pape dlm ambulance tu doctor and paramedik ade..good job huh?mcmla sume mende ade dlm ambulance tu?
tu satu hal..satu hal lagi other drivers la yg kalau tgk ambulance bkn nk kasi laluan?boleh x fikir sikit kalau anda or relatives anda dlm ambulance ni camne?Awak ingt kami nk ke pasang siren?i am d last person yg nak pasang siren n drive laju..pening hoccay!!peningg!!dah la bau dlm ambulance tu dh satu hal..laju tergoyang2 pastu bising.mmg usually ade pening2 la and penah termuntah ok!yes termuntah!!tapi xpe utk patient kan..tahan jee.
this morning first patient i tgk gcs 12/15..breathing dh x comel dh..blood pressure dh drop..proceed with intubation..mulenye dpt maintain oxygen saturation.tp dlm ambulance tetibe saturation drop..bp dropped..ape lagi resus dlm ambulance la..brape kali jatuh terhempuk..sampai2 tercungap2 resuscitate pt and sakit perut jugak la sebab terjatuh kan.not to mention kepala trrhantuk ceiling atas ambulance n pening n nauseated..
orang xtau kan mende tu?org ingat keje doctor ni best..penat..tu x mention lg nak kene call cari ventilator..tu x mention lg all d sacrifices yg kene sacrificed kan?xleh attend family gath,kene layan komplen org yg karut, kene jaga hati patients,diorgnye relatives,our familynye hati, korbankan masa dengan family...
so adik2 yg cita2 nk j doctor fikir la dulu betol2.saye rase baek anda apply jd cikgu je,,gaji best,,keje rilek...weekend adee..duit masyuk.kerajaan sayang..ade masa boleh mengundi..ngeee..okla.sila jangan panaskan entry ni.tq.but seriously..i wish i am a teacher not a doctor..

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