I Feel My Leg is Still There

September 14, 2018


I just feel like writing today.

This evening, when I was in the prayer room for Asar, I quietly listened to 'curahan hati' of a relative who is currently taking care of her father. She was actually sharing her thoughts to another random lady in the prayer room, just to lift up the burden in her chest, I guess.



Even though I am an Orthopaedics houseman and her father is actually in my ward, I am now in the peripheral team - which means my teammates and I are in-charge of all Ortho's patients in other wards in the hospital... so I don't know much about what is happening in the Ortho ward.

Okay, let's get back to that lady...

Her father was initially came with signs of inflammation of the right lower limb and our impression is necrotizing fasciitis. After further examination and discussion with the specialist, he ended up in the operation for wound debridement KIV BKA/AKA. BKA simply means below knee amputation while AKA means above knee amputation. BKA/AKA will only take place if the surgeon thinks it is better to do so and after approval of patient during the operation. Upon incision of the lower limb, there was A LOT OF pus discharge and slough - which means infection! The leg was really not in good condition and the infection was already ascending above knee. T_T

Only if you know how the slough / wound smells like.....

After explaining the intra-op finding and the surgeon explained the need to proceed with AKA, the patient was only keen for BKA at that moment. So, we proceed with that.

That was my first experience with BKA as a houseman. 

Limb amputation - it sounds easy to say. But if I put myself in that patient's shoes, I can't imagine to see my leg is no longer there. 

But, patient's general health is important as well. That limb can be a source of infection that can lead to sepsis / septic shock - many organs can lose their functions and eventually leading to death.

"Pakcik, saya minta maaf sangat-sangat. Tapi ibu jari kaki pakcik ni sebenarnya dah tak hidup. Kita kena keluarkan dia. Yang mati tak boleh bersama dengan yang hidup, kan pakcik?"

I still remember one of my MO's words towards another patient who came with gangrenous big toe, which means he need rays amputation of the great toe.


Yang mati tak boleh bersama dengan yang hidup, kan pakcik?


This sentence kept on playing in my brain. 

Same goes to life. There are some things or people that are not meant for us or things that are actually harmful to us no matter how much we love them. This is when we need to remove them in our life, otherwise they will affect us, physically and mentally - eventually can destroy us. 

It is hard to let go, but we need to try and live with the fact. And believe that it happens for reasons.

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I think I lose my writing skills much.
T_T

I miss blogging though.

SM, Perak, Malaysia
180914


Sisters at Heart

September 3, 2018


Both are the youngest in the family.
Both are the only daughter.

My beautiful cousin, Farah.

I am very happy for your marriage, Fa. :) Although I can't be there physically to help through out the plan towards your D-day, deep in heart I am wishing all the good things for you.

And I am ultimately happy to be granted with 3 days off just to be there on that day, to witness the akad, the reception and to be your bridesmaid :) Still remember the day when Mak Yang helped with video call on your engagement day when I was too far away. 

Thanks for being a good sister. 
Thanks for sharing ears to listen to my stories.
Thanks for praying the best for me.


azrenfarah

May you have a blessed marriage in this world and still be together, happily towards the Hereafter. :)
Ameen ameen!

M, Perak, Malaysia
190303

Just Because It is August :)

August 2, 2018

Time flies fast, honestly.

I don't even realised it is already 1 year since I finally arrived home for good, saying my farewell to Czech and goodbye to long haul flights. Gonna experience them again as soon as I finish housemanship, insyAllah ameen ameen. 

Things honestly changed a lot through out time.

Since it is August and turn out August is my favourite month (well, who doesn't love their birthday month though?) :D, I am gonna share this thing here. Well, it is actually the same piece I've shared on my Insta stories. But, I don't feel like describing much about it there. 



Reading this tweet makes me re-scroll of my review of 2017 and to re-check how did I summarize my 2017 and what I look forward for 2018.

Trying to correlate with the above tweet, let's see...

1. Stop complaining and appreciate how lucky you are every day.
To be honest, I complained a lot about work to my good colleagues - people who will also share their complaints but at the same time, will support each other to go through the day with good heart and hope. 

Alhamdulillah, despite the tiredness and uncertainty at work, I hope I can maintain the feeling of good to help others - no matter of helping patients, colleagues, hospital staffs or even random people I met without the thought of quitting.

I know it will be hard to stop complaining but I'll reduce it. Housemanship is a struggle, I am sorry to say this but I deeply understand housemanship's hard life is for my own good, for my survival skill when I will be left somewhere without proper facilities soon. So, bear with me if I complain anything, I am just trying to get the frustration out of my head in a good way and proceed with life as none of it happened. Haha.

Anyway, I am grateful enough with my life - blessed with understanding family members who sacrificed a lot for me. T_T I am lucky enough to have places and people to go if I want to share stuffs. Allah helps me a lot by with beautiful beaches in few minutes drive away. 

2. Commit to the goals you set and never look back.
I do have goals. But it was still hard to never look back to previous goals that I need to turn away from. Things will never be the same anymore.

Things changed.
People changed.
Our life changed.

Goals are changeable as well, to be honest, depending on what suits best at that time.

But, for me it is better to set goals and live our life towards them. It always feel good to go with the flow but I would still rather have goals and moving around with that goals :)




3. Saying goodbye to the people that don't bring positive energy into your life.
Yessss, this thing helps a lot! 

Keep in touch with people who you know will love you, including the one who will guide, scold you for reasons. I meant it. People who want the best for you will help you but in return, do the same to them. Support each other. 

Ignore those who bring you down, whom you feel you lost your self worth.

After all, don't ever bring them down, don't ever lose their self worth. They will get something in return eventually, just not from you. Allah will help doing so, to make them realize what they have done. Just, don't be the one who do bad to people. 


4. Sweat every day to boost your mood.
I sweat a lot while working through out the day. Can it be counted other than sweating via exercise? Hahaha.

Alhamdulillah, I am very grateful of my working hours in Ortho as I mentioned before. I have more time for myself and family. I even have time to play badminton after work despite the need to wake up early morning the next day. Adaptation slowly helps anyway. :)


Embracing uncertainty :)

SS, Perak, Malaysia
180802

Hello, Orthopaedics!

July 31, 2018

I just feel like writing today.
It's been a while, I know.

I have successfully completed my Obstetrics & Gynecology posting, alhamdulillah. :) Missing it the moment I am writing this post. O&G was my first in encountering almost everything. My housemanship basically started from zero, there. But, to complete these 2 years, I know I need to move on to another postings.


So, here I am, on my way to complete the very first month in Orthopaedics.

Honestly, I don't have specific postings in mind to choose what is going to be next though. So, I am gladly accepting this posting :) There are few life lessons I learned here (so far in 1 month).

1. I need to be physically fit.
Orthopaedics is more about musculoskeletal stuffs - involving fractures of bones, dislocations of joints, diabetic foot ulcers any many more. And this is a surgical based - so, expect operations every single day. Operations are almost 100% different than O&G. They took hourssssss (the longest one I have been in... was 7 hours straight - with 20 minutes break for me in the middle because I was hypoglycemic). But there was one time when there were 4 operations planned to be done that day and it was going one after another from 8am to 5.45pm and all of us there were basically standing the whole hours. 

MO: "Hanis, take a break, pergi makan kat pantry. You need energy to assist me."

Full respects to all of my surgeons, who are very committed to reduce all the fractures, to debride all the wound, to explore the area etc. T___T 

One day, I was helping the medical assistant to lift up a full right leg of a 150kg man to secure the best position of it so that the surgeon can have the best view and space to do operation on the leg. Once upon a time, I was a person who could lift a 30kg luggage up to 4th floor with stairs - but I assume not anymore. I don't know why but seems like I am losing most of my energy and strength.

So, back to the story of 150kg man.... my hand was literally shaking upon lifting the leg. The surgeon realized this and ended up asking a PPK to exchange with me.

MO: "Hanis, the moral of today, you need to eat more and exercise more."
Me: "Okay, doctor."

Thank you doctor for being considerate enough to a newbie like me.

2. Expect the challenging response.
There was one fine morning, raining cats and dogs at almost 6am, when I still remember the azan was berkumandang. It was time to take blood coming morning (means as an oncall person, we need to take any blood needed for the whole ward early morning that day). 

I pushed the blood taking trolley towards a bed - who was known to be very hard to take the blood. But, what could I do? Blood is like an identity to us. Other than physical examinations, doctors can know what is happening in the patients' bodies via blood - how the liver functioning, how well is the kidney, is there any chronic infection going on, are the antibiotics working out yada yada.

So, the uncle said to me. "Doktor nak ambil darah ke? Muak dah tengok muka doktor-doktor asyik nak ambil darah je"

I am so sorry to have this inner thought, "Ingat doktor tak muak ke nak ambil darah?". I proceeded to do so, because this is my job. No matter how much the patient hates blood taking, I am doing my job and trying to make sure to get my job done so that I can feel satisfied for my pay. Keberkatan gaji is very important to me. 

I ended my shift that day at about 2pm and later at night, my colleague told me that patient passed away towards the end of the evening. I was not in charge of him but I feel bad for my inner thought that morning... astaghfirullah T___T


3. Get my work done first and only then, help others.
In this department, we are assigned to beds - which mean we need to take care of the specific patient through out our working hours that day. The beds may be the same from the previous day or the next day, depending on how the oncall shift people distribute the beds.

I need to remember, other colleagues may help me but usually all people will focus on getting their carry outs done first. 

I need to do the same.

And I need to remember my favourite MO mentioned to me a long time ago, "Hanis, I know you are very nice to help your friends. Keep that attitude but in reality, most of the time, you need to save your a** first." 

Life is very subjective. There are colleagues you don't mind to spend your extra time to help them out, but there are some whom you will feel you need to get out of there as soon as you've done your job that day. 

Keep being nice, Nina. You can do this.


4. Ortho ward is full of patients with infections.
Honestly, I feel bad for all babies and kids who come to the ward. I am sure that there is a big notice in front of the ward that we don't really recommend the parents to bring the small kids and babies inside. I know you want the kids to visit their grandmother, grandfather etc.

But, isn't your children's health more important?

Trust me, babies and small kids' immune systems are not that strong compared to adults. They are still literally growing, their immunity is still maturing. If the infections are strong enough for normal adults, don't you think they are extremely harmful for your little buddies?



-------------------------------------------------



All in all, the posting is honestly full of dramas. Belum masuk kisah-kisah patients yang nak masuk wad tapi taknak masuk wad, nak operation tapi taknak operation. Hahaha. Adoi laaa.

Embrace them, Nina.
Absorb the best parts and let go of the bad ones. 

Nina,
You are still learning, try hard to avoid doing mistakes. But, if you do any, acknowledge and analyse the mistakes and try not to do them ever again. If other people blamed you for something not your fault, back yourself up with valid reasons so that they can't fire back at you. But, if they still blamed you for no reasons, then it is their problem, not yours. 

I love the working hours in Orthopaedics anyway. :)
One of the best things here other than very helpful senior housemen and MOs who are willing to guide and teach.

M, Perak, Malaysia
180731

My Different Version of Eid

June 24, 2018


To be honest, 2018 is my very first year to celebrate the first day of Eid Fitri away from my family. I had expected this to happen this year, so, my heart was well prepared for that. 6 years staying abroad, alhamdulillah I managed to go home every single Eid Fitri :)

But, life changed. I have new responsibilities, new environment and I look forward for more changes in my life, insyAllah with an open heart.




Night of 1st Eid, I was on call at the labor room. It was uneventful, I mean the oncall was bearable with few admission - tolerable much. Well, who wants to get sick on the night of Eid, you tell me. -_-'

I had something I could not forget, two different cases that really caught my heart on how people perceive the hospital admissions.

1st case.
There was a lady, primigravida (first pregnancy) who came to Labour Room (LR) at 0200H (2am) with complaints of contraction pain and show. Upon further examination, the CTG (reflect baby's condition in the womb) looked reactive (means normal), the os was already 2cm and time contraction was 2x in 10 minutes that last about 30 seconds. 

Based on my previous experiences, we will admit this patient to the ward for further observation - in view of:
- she came at 2am
- her house is quite far away from the hospital. 

Even though she was just primigravida (the labour process is usually  longer for primigravida), she could still deliver the baby ANY time!

But, she was really keen to go home instead of being admitted.

Well, I do understand she did not want to celebrate Raya at the hospital, but this was out of her control. If it is fated that her baby to be delivered on 1st Syawal, let s/he be. So, my MO allowed her to go home and asked her to come immediately to the hospital if the contraction pain becomes stronger or if there is any leaking liquor (air ketuban pecah) or if she feels any reduction of fetal movement. 



2nd case.
After the previous lady left the LR, another lady, G7P6 (means she is currently pregnant of the 7th baby and already delivered 6 babies) referred from the Emergency Department for PV bleeding (per vaginal) with diagnosis of incomplete miscarriage.

Incomplete miscarriage means:
- the 'baby' or better to be called as product of conception - POC (hasil persenyawaan) is already out 
- but some of the POC still remain in the womb

We need to evacuate the POC otherwise patient will continue have a lot of PV bleeding and abdominal pain. 

Upon per speculum with the MO, we managed to remove the POC at the os and upon TAS (transabdominal ultrasound), the endometrium thickness (ET) was <10mm. Usually, we need to proceed with ERPOC procedure (evacuation of retained product of conception) if the POC cannot be removed from the os and if the ET >15mm.

In this patient's case, our final impression was complete miscarriage - she did not have to undergo the ERPOC. However, we admitted the patient for observation and told her if her bleeding is minimal, we can allow her home that morning. She agreed with that - 'saya ikut apa yang doktor rasa terbaik'.

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Here we can see how patients perceive admissions to the ward. Trust me, no doctors want to admit patients to the ward without reason. Most doctors care about the patients even though admissions will increase the workload. But, that are for patients' sake and our responsibility.

And to make the night more interesting, the first lady delivered her baby just few hours after she left. Luckily she managed to return to the hospital T___T. 

Birth before arrival (BBA) to the hospital is another issue. 



--------------------------------------

On the day of Eid, I was in charge of post natal ward and guess what, the ward round ended at plus minus 7am! And the housemen managed to settle all documents for discharged patients as early as 10am! Wahaaaaa. The MOs were considerate enough to allow patients home very early so that patients can celebrate Eid with family. :)

My shift ended at 1pm and I decided to drive home immediately after that. Arrived my aunt's house at almost 4pm and I ended up sleeping for the rest of evening. T_T

Went to my uncle's house that night and I ended up with sleeping on the sofa. 

The end of my first day of Eid. :D




2nd day was better. :D

Selamat Hari Raya everyone!
Although this maybe quite late, but I wish you have the memorable Eid :)

If you are reading this, please pray for my success for tomorrow's assessments. I will be leaving for another department very soon and hopefully I pass this O&G - Obstetric and Gynecology with good achievement. Ameen. 

M, Perak, Malaysia
180624

Good Things Today :)

May 24, 2018


After working 105 hours straight, finally I have an off day - which was spent for another medical program called Neonatal Resuscitation Program (NRP) 7th Edition. Haha. Although I was a bit sad at the beginning to think that I didn't have time to drive home to visit my parents or have a day off from the hospital... however at the end, alhamdulillah, it was a good off day. :)





1. I woke up feeling fresh after 10 hours of sleep yesterday.
Being a doctor, I need to train myself to always search for opportunity to eat and sleep whenever I can. To be honest, it was a bit hard from the beginning. During my first few oncall days, I felt bad to sleep at night thinking I am paid to take care of the patients at night. But, I learned that I need to take care of myself too. Doctors are still human being and we can't function well without enough sleep. 

I must say that most of my MOs are excellent doctors to be able to think wise in the middle of the night and that is something I need to learn as well. 

Still finding tricks to function well under sleep-deprived condition. Haha.  

2. I passed my first Neonatal Resuscitation Program (7th edition).
Neonatal Resuscitation Program (NRP) is a program that must be attended and passed by all housemen to be able to attend babies either freshly born or the one in the Special Care Nursery (SCN) / Neonatal Intensive Care Unit (NICU). 

As a houseman in Obs & Gyne, this course is important too. There must be at least a reason to call Paediatric team to attend newborn at the Labour Room or Operation Theater - like babies of mothers with diabetes mellitus, meconium stained liquor, fetal distress etc. Paeds team will not always be there to stand by in advanced if there is no indication. 

So, doctors and nurses of Obs & Gyne need to know at least basic stuffs of what to do with babies if suddenly they are born flat (not crying, no muscle tone) before Paeds team rush over to attend. 


3. I had iftar with good friends (although they are leaving the department soon sobss)
It is not hard to know new friends but to maintain a good relationship is not that easy. There are people you know you can rely on and you can also put aside your own problems just to help them as well. 

Working in this field is energy and mental consuming. I am glad that I can still survive so far. It is not easy but insyAllah let's just pray hard Allah will guide us throughout everything. 

I am a bit anxious to think about the seniors who are leaving in few days - as I will be one of the most senior housemen in the department soon. There will be colleagues (from other departments) coming in and I hope I can help them to adapt efficiently plus all of us can work in a harmony environment - though I am still adapting myself to work fast. 


4. I received a postcard from Lithuania.
It has been a while since I last exchanged postcards. I miss writing my thoughts on them and share with others but it was a bit challenging to find time to look for good postcards around. To be honest, I went into lots of book stores and came out with nothing. Fortunately, I decided to visit the Tourist Information Center (my current town is a tourism site) and the lady gave me 12 pieces of postcard for FREE!

And sending a postcard from Malaysia is EXTREMELY CHEAP I AM TELLING YOU! only 50 cents for the stamp! It was at least 25kc (RM4-5) just for the stamp back then in Czech :D

5. I received my 2nd salary!
Gaji dah masuk oh yeah. Haha. I don't really put much thought on the salary to be honest but... I just knew it is a beautiful feeling to see the account balance. 

M, Perak, Malaysia
180524

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