Wednesday, September 17, 2014

And now the end is near..

After being away for almost a month, it is good to be back at work. I was away most of the time since mid ramadhan till Merdeka. Business was as usual in CTC UiTM as the cardiac list did went on with few high risk cases done during my absence. It is good to know that the service was not 100% crippled and things are done in its accordingness. I am happy to note that, knowing what you have built is going on strong. Alhamdulillah. Its about leaving your legacy, somewhere somehow and ensuring the seeds that you sow grow well. 
Coming back from my previous adventures, somehow the Pole Pole attitude is deeper embedded in me.haha not that i do things laid back but patience is an important attribute to have. We had an interesting case the other day when a patient who was treated for MI presented with a bad intestinal obstruction 10 days after the MI attack. He came to the hospital with an initial complaint of unmanagable abdominal pain and of course when the ECG became significant, it was thought as a red herring! He did have an MI which stunted his heart real bad, having failure symptoms with a heart ejection fraction of 15%!
And when the Intestinal obstruction became to clear to not be disregarded, it was confirmed by radiological finding besides the obviously faecal material which he vomited out.
The dilemma was the indication for surgical intervention. Having a bad injured  heart is definitely not good news for anaesthetists. There was a thought of perhaps he would have been better treated outside our centre but upon evaluation, NO ANAESTHETIST out there will accept the referral to induce GA in this patient! haha Honestly.. despite the clinical indication, none would take this as a transfer case :) Therefore me and my colleague thought since we are the experts in inducing patients such as this.. then we had to give him the chance. And the care for him post op should be ok since we have been training our ICU nurses for the past 1 year. This was a test!
The issue with this patient was not about whether we can do him, but the post op care where the heart may not be able to take the stress. Especially he was in a septic state. Me & Azman planned this case carefully to ensure that we have done our best to save him. The prognosis can be really bad and that was what we emphasized to the family when taking the consent.It was never for us to say no and for us to decide not. At the end of the day, it is god's will and Allah is most gracious, most merciful.
Honestly it was an exciting case for us to do! 
Alhamdulillah it went well, There was 2L of pus and slough collection and the surgeon managed to clean what needed to be clean. He was haemodynamically stable with the support that we have given.
Today.. i was pleased to know he is mobilizing and sitting down well on the chair. The heart still needs mending but he has escaped his trial of death.
All a day's work.. and at the moment, i have another interesting case going on. pure cardiac.. another blog entry it is.. :)

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