Groggy

I am so knackered . Mentally and physically.HAd a busy 24h call - Luckily wifey called me up before coming to UMMC. I was still sleeping.. Susbh pun burn !! hahaha.. Its wifey's first day at work and I don't want to make her wait in the car for me. I'm taking back the car and will have to fetch her later in the afternoon.

The call was punishing because of the stress - having the adrenaline rush gushing throughout the anaesthesia for the operation we provide. It did not help that upon arrival in OT - Laparotomy for an 18 month old baby - for intusseption. Doing paediatrics anaesthesia is a bummer because of all the precautions one has to take in ensuring smooth running of the operation. So many things to consider , from those small tiny cannnulation to the risk of hypothermia. Very-very calculative proceedings which needs a lot of anticipation rather than resuscitation. In the middle of that , the surgeon received a call... ANOTHER LAPAROTOMY for a 3 year old child - sepsis 2o peritonitis. God !! hahaha... It was a struggle inserting invasive monitoring lines for him !!

I had a Mexican next.. yes . from Mexico.. Arriibaaa !!! He was involved in a brawl the night before ; resulting his hand tendons cut - Obviously giving a brachial plexus block was my preference !!! It was tricky though , he was muscular and had a big frame ; therefore his anatomical landmark was altered.I do pity him as i did take quite some time before successfully injecting my local anaesthetics. He was cool about it though.. macho man la katakan.. Having electrical current stimulating your forearm and hand muscles can be quite distressing if you keep repeating it !! Thank you Jose !!


Next was a 61 year old man , who suffered from an infected disc on his spine , that caused him to have severe leg pain and weakness. We had to insert a double lumen tube , as the surgeons requested us to collapse one lung so that they can reach the infected area.YES , We anaesthetists are good in manipulating your body during operations !! To top it up , he had features of difficult intubation and my .. did we struggle...


After 5 hours , somehow we manage to extubate the patient . Funnily , i expected him to have a lot of pain after the operation but he was so comfortable. I suppose , by removing the compression ; he must have felt so relieved after having the excruciating pain for the past 6 months ! Hady laughed at me before the Op actually , as i probed into his "sexual" activities during history taking !!

After that , a laparotomy for an 82 year old lady - she was bleeding like mad because she over warfarinised herself.. INR: 9 !!!! Gilller... Dahlah she had cardiomegaly with a metallic valve! Sakit kepala woo.. nak fikir the safest anaesthesia technique !! It was constant movement during the op for me , resuscitating the old lady who had a very loving husband.

Ooh.. typing this out makes me tired again... aahhh... tidur kejapla...

To infinity and beyond

Wahh.. I've not blogged for more than a week ! Just dunno why i did not bother to type it down on the PC ; maybe the current nomad lifestyle which is affecting me. I'm still staying in my inlaws for now because of Qaisya - and not being in your own home is a real turn off for being in front of the PC. Being in the OT for the whole day does not help as well ; as the gases exerting their side effect to your conciousness at about 10pm ..every night !!

Qaisya is doing fine. She's one month today and certainly growing. Taking care of her is certainly different from Dzaeffran ; more demanding for wifey. Qaisya wakes up at night.. all night in fact ; when her eyes are really opened up wide ! She has nice eyes .. Honestly , i'm freaking out if she turns out to be a babe when she's older. Pening nak fikir ni... hahahaha..

I'm going to Gunung Gap and Ulu Semangkok early April with Azad and Mafiz. That would be a good break climbing another mountain. Dunno whether i can try out my new LAFUMA haversack. According to the organizers , there is a big possibility that it will be a day climb and we'll camp near Sg Chilling instead of on top of the hill. Haks.. Well , i can't wait for that. Its just great to be outdoors. I know Azad is as excited as I am....

P/S I've been added in the medicine.com.my portal !! hahaha.. more readers perhaps ..

Blogroll Update
Thursday, March 22, 2007, 11:32:29 AM dobbs

Congratulations to our bloggers Cyanide, Jel, Izah and Adeline Wong on passing their Final MBBS exams. I have moved their blogs to the Doctor Blogroll. If I have missed out anyone that has graduated recently, please let me know. I have also added 2 more doctor bloggers — Mafeitz and Docyana. A warm welcome to both [...]

Meeting wira negara

After a 3 year lapse , I managed to complete my 10km run in the AMBANK KL international marathon today. Another certificate for another year !!Congratulations to Azad and Edrin too for completing the race !! The three of us will be running again next month in the BHP run at the Curve.. wanna join us ??

I am glad i managed to finish the race and not getting myself injured with my usual crampy legs . I did not force myself so much today as i did not train for this event. It was a very leisurely jog. I was quite alright and the thought of if i had run harder - i might be able to rab one of those medals..! Hahaha... But i guess ; if i had pushed myself i might have ended up in the massaging tent !

* Check out my NOMBER !!! hahahaha... ( those who collected their number tags would understand this joke )



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I was at the OGKL AGM later that day. Felt a bit tired but it was a boring Sunday afternoon. There I was at 3pm ; off to Bukit Jalil to meet my fellow club members. It was a very hillarious session ! I really do admire the individuals running the club as well as the members . Most of them are really down to earth with lots of humour ! I enjoyed the meeting i must say ! Gua caya sama lu Deeno world !! ( the president )

It was an honour as well to have both Malaysia heroes ; Ravi and Muqarrabin ( Everest climbers) with us. Both of them were friendly and I enjoyed listening to their experience sharing session . Climbing Everest is one real tough cookie to tackle as was evident by Ravi's two amputated fingers due to frost bite. They mentioned that the chances for one to have morbidities or even mortality is high during this climb.Gulp..scary isn't it ? I do salute them for their courage , effort and determination . Good luck Ravi for your plan to conquer Everest from the south as well as K2 next year !!

*p/s Always remember to off the camera function after using your mobile ! Battery habis siut masa nak amik gambar with the two national heroes !! Isy..isy.. isy..... geram !!!


he brought his gadgets to show us..


kewl boots eih..


Internet pic of Ravi near everest

Ghost rider

To all diabetics and borderline candidates out there..
Please ensure good sugar control , healthy lifestyle eih..
You don't want to end up having your foot being debrided like the pics i took during my on call last night !!!

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"MAfeitz... please don't proceed with your case as we have a mediastinal mass case for intubation coming in... "

Alamak.. I was about to begin the first of my 6 diabetic food debridement , and it was 5 pm. I've promised the Orthopods man to start early !! However , you don't want to piss off your lecturer cum specialist on call by doing what you want. How bad can it be ?

There he was , 19 year old boy who has been unwell for the past one month came in today witha history of severe shortness of breath for the past 3 days. It was getting worse during work in McDonalds and was brought in by his friends to the Emergency department.

You could see him puffing away , with all his accessory respiratory muscles used up excessively. He was on high flow oxygen but his saturation only touched 88 - 90%. He was bending himself so much , looking for the best position to breath. His cough was very wet and not able to speak a single word without being very breathless.



Obviously , being presented to medical carers for the first time , there was no exact plan for him by anybody. He was referred to us for intubation ; airway protection by the primary team ; a typical referral to anaesthetist when one does not know what else to do. When we ask what will be the plan.. everybody just shrugged their heads.




A quick look... followed by a long sigh of the chest xray took our breaths away.We looked at each other , even Prof who was involved in the discussion was a bit puzzled wondering what to do now. Even the consultant Cardiothoracic surgeon was not able to offer anything . It is up to us now the anaesthetist to save the day.
"Mak ai... bloody big mass !! "

Thats one hell of a mass compressing the lungs and airways. You wonder how long has it been there as it is definitely not a 3 day story. He has enlarged lymph nodes all over his body ; making the provisional diagnosis of lymphoma being the most likely reason.

We prepared everything - all possible ways to intubate.The plan was to gas him down and have a look but he desaturated so fast as we begin to "sevo" him down. With this condition , fibre optic intubation was impossible because sedation causes him to not use his accessory muscles hence the direct obstruction to his airway.The trick is to maintain his airway while he is spontaneously breathing . Muscle relaxants are a no - no here ! We had to restrain him hard as he was struggling so much - being so exasperated for breath. At this stage he was very restless - being in a very severe hypoxic state. ABG showed PaO2 45 mmHg PCO2 122 mmHg ( normal 35 - 45 mmHg) .

"Lets just intubate him awake... " said Prof.
Wah.. tak pernah buat ni.. shoving in the tube with the patient awake ??

We sprayed some local anaesthetics into his mouth and gave him 100% Oxygen. His saturation maintained the same though. 20mg of propofol was pushed in to settle him down and the rush began . He was in a 45o position and that makes it difficult to laryngoscope .. not an optimum position.

Mak... tolong.. mak... toloonng.... he cried so hard. He was not ready to die.. not in this way.
His saturation just went crashing .. 70%... 50%....

" I can;t see the cords... He is fighting me.. " said my specialist. Damn..It must be so traumatic and uncomfortable for that boy having a laryngoscope shoved in . He was coughing and struggling violently.

40%.... 38%... 34%...

OK... got it !!

Prof ... I cannot bag him.!! Its too tight.. .
I can't hear any air entry here !
His lips are blue !!

Put him on lateral position.. now !!! I can sense that panic is taking over !

On my count... One.. two... turn.
ETT suction please... get the secretions out ..he is so chesty !!

OK better... better....

I swear to you , everybody was looking so anxiously at the monitor , watching his SPO2 and ECG , praying very hard that we will not lose him to hypoxia...

38%... 50%.... 65%..... 80 %.... 92%...
YESS !!!! There was an air of relief in OT 16 at that moment. Wow.. adrenaline was certainly pumped up really hard amongst us then...

After stabilization , we pushed him to the Cardiac ICU ; and there he was - so fragile and gullible. I really dont know what will happen to him.

The reason to go home early..

MDQs together


i just love the cup cakes


victory


sayang..or tanduk ??

Back to work

Its back to OT after a week's break and boy.. what a time to be back. I've been handling OTs on my own for the past 3 days - Most of my colleagues were either on study leave or in Genting for our Annual Anaesthesia conference. I wanted to go but I have to consider my presence here which is important to wifey; hence my delay in blogging ..

It was permanent fixture in OT13 fir three days doing ENT , Plastic and Maxillofacial . I reckon doing the 10hours breast reconstruction on Thursday was very interesting ; not of Nip and Tuck drama but of the anaesthesia technique showed to me. It was a relief to wake up and extubate the patient when the operation finishes which is very rare when one does a marathon.Keeping the MAC low with minimal muscle relaxation infusion ; at the same time on close monitoring of her awareness using "BIS"- a technique which helps to save ICU or PASCA bed for the really needful. I was amazed as well by the result of the op - the breast which was reconstructed looked "normal" and nice. I suppose doing one for a heart broken 29 year old lady with a bad breast cancer would really help to lift up her szest for life.

Doing the dental case alone yesterday was kewl as well. I was the only male in that theatre so I 'm not sure if that was a factor as well !! Surrounded by attractive doctors and nurses hhmm... macam best je tak ? hahahahahaha...

" Oh.. my favourite anaesthetist is back.. "

Wakey..wakey..

Alhamdulillah , Qaisya is 6 days old today. She went a little bit jaundice on the 2nd day but the traditional "jemur" by the window was effective ! Hahaha.. Initially I was tempted to prick her blood and send it for bilirubin level but then , hmm.. maybe i should not be overly concern. Let nature take its course.With her getting full breastfeeds ; I should be more positive. And it turned out well.

Qaisya is definitely the opposite from Dzaeffran when he was at this age. We're having sleepless nights ! She will take smaller feeds compared to Dzaeff but of increased frequency !! She will be awake after 12 am and will demand for her feeds every hour ! Hahaha.. Wifey is a little bit stressed but i guess not every baby is the same. We try to wake her up during the day but she would not be bothered by the noise or distraction !The 7 day leave is actually very useful as I am happily enjoying my break at home with the baby.

Dzaeffran is still confused wondering why his umi is not as free to "layan" him as before ! Mak has been very supportive in ensuring both her grandchildren well taken care off. Luckily Dzaeff goes to the nursery during the day so that everybody was able to catch some sleep. The massaging session for wifey certainly helps and I wish for one soon !!

On another note , I've managed to teach dzaeff kicking the ball ; the first of many training sessions to make him a gifted footballer !! ( this maybe due to the frustration of the "i knew it last minute" Liverpool loss to United during the weekend )

MDQ legacy

MYFTZAL DZAEFFRAN QAYYUM
( The Nobleman of success eternally )

MYRA DURRATUN QAISYA
( The Queen of pearls and affirmity )

Bundle of Joy

Alhamdulillah... All praises for Allah..

My baby girl came into this world on the 27 February 2007 at 7.52pm. ( not 7.48 as I've sms'ed earlier ). The delivery was smooth and baby's Apgar score was full at birth.

Alhamdulillah...

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( RETROSPECTIVE ENTRY ) 27/2/07

Wifey informed me before we went of to work that she had a bit of "show" ( the blood stained mucous to signal labour ) in the morning. Of course , she refused me doing VE ( vaginal examination ) because her contractions were still weak and irregular then. I did ask her whether she would like to stay at home ; but being her , she wanted to continue work to settle all her unfinished business. Imagine - she actually went to the Bank and Bukit Jelutong that afternoon to do some chores regarding our future home !!

We came back home from the work at 5 pm - then she was already having regular contractions. She was in pain but it was still tolerable. We picked up Dzaeffran from the nursery and quickly packed our stuff for the hospital. Suddenly she told me she can't move as it exagerrates her pain. During this time she still refused VE as she was sure that she needs to go to the hospital soon. I did it anyway because I needed to estimate which stage of labour was she..

Os : 5 cm. very thin. Membrane buldging. station : + 1 !!!!

Daammnnn !! Only now.. I started to panic !!


the distressed mother.. ( just had to post this pic !! She was not amused by my antiques then.. )

We rushed to the hospital and called Patrick ( her Obstetrician ) on the way. Obviously the traffic was bad as it was about 6++ pm. Wifey was by then so much in pain that she was hyperventilating.. puffing away. No communication was established but suddenyl she grabbed my arm.

" Abang... SROM... " *Spontaneous rupture of membrane

I was.. alamak... habis keretaku !! Hahahahaha... ( As Mafiz said.. luckily leather seat eih ?? )
We arrived at the doorstep and the staff there was very helpful. Wifwey was so weak at this time that I had to carry her out of the car to the wheelchair . ( The last time I carried her like that was during our wedding day - walking down the stairs !!! ) It was so efficient that when Iclosed my car boot she was nowhere to be seen. The staff had carted her to the SECOND floor within seconds !!



She was ushered to the labour room and the staff nurses there prepared her very well. Dr PAtrick was not around yet but Wifey was pushing hard. Of course , no epidural was necessary at this time and she was puffing away on the Nitric Oxide. The nurses told me her OS was 8 cm but I don't think so as they needed to wait for Patrick to come.

When PAtrick arrived and was she was being positioned lithotomically ; with just one push we could already see the baby's head. Haks.. And with another gentle push.. my little baby girl was delivered smoothly with a loud cry ..

Allahu Akbar. Allahu Akbar. Lailahaillallah...


first look on umi's tummy

We were discharged home within 24 hours of birth. The process was so fast and I could not believe that I now have another baby at home. Alhamdulillah...