Poker face

How do you maintain a straight face while taking consent for a "no hope" operation ?

Its not easy facing the relatives you know. As much as how you feel like telling them the whole truth , you have to remain positive and reassure them elegantly.

5 am this morning - we received a phone call from the surgical team. 66y year old indian lady - who has chronic liver cirrhosis ; bleeding away from her varices in the ward. Her haemodynamics were very unstable and she is bleeding from all her orifices. They were resuscitating her by pushing in blood and fluids to accomodate the loss. They now want to open up to find the bleeder and hopefully cease the cause.

She arrived at the OT almost immediately - Very bloody indeed. The Sengstaken tube which was inserted a few days earlier during OGDS was refluxing blood out. A quick check on her pupils showed it was fixed and dilated ! Triple inotropes are on but her BP is so low that when you palpate for her pulse - it was so weak! What are we doing here??... Of course , the surgeon wants to continue as they cliamed that the patient never had any collapse episode - and i was entrusted by my senior to take High risk Anaesthesia consent from the family members.

"Saya Dr. M , Anaesthetist. Emak awak dalam keadaan yang sangat tenat. Pendarahannya tidak berhenti-henti dan kita perlu operate dia segera sebagai cara terakhir... "

When maybe you wanna say..
YOur mum is in a very - very critical condition. I'm not sure if she is still alive at the moment..

" Saya minta kebenaran untukberi bius dari awak bagi operation dijalankan. RIsikonya amat tinggi dan berkemungkinan besar jantungnya boleh berhenti semasa operation dijalankan. Namun demikian , kita akan cuba segalanya yang terbaik. Tapi saya ingatkan di sini , risikonya terlalu tinggi dan semua ahli keluarga perlu faham tentang keadaan kritikal ini."

She'll definitely die on the table. No two ways about it...

FAcing the worried faces of the relatives is a big challenge. Its not easy for them to consent for a big decision like this. And at all times on our side , we have to remain cool and not too pushy about it.

"Kita doakan sama- sama ya.. mana-mana yang terbaik..."

And true enough , the mother of 5 and grandmother to 8 was pronounced dead at 7.20 am. The bleeding was uncontrollable and her heart could not keep up despite the massive transfusion - replacing blood for blood...

And the hysteria outside the OT when it was declared to the family....

A relief

Wifey was so exhausted with work the other way , and she has had enough !

" Abang.. lets go for a holiday.. " she said.

Holiday ? Wow.. thats something we last did LONG TIME ago ! Since Dzaeffran was delivered , we never went for any holiday as both of us was not just busy with the baby ; but work and exams. Of course , I did went for my "tension-releasing" trips but with the family.. hmm.. I suppose this is the right time ! The accidental 26th of April holiday certainly helps with me being post call on the 25th ! 2 days off

So off we went ; and we were lucky to be offered by Pak Long to stay at his weekend chill out place in AFAMOSA resort in Melaka ! haks.. He and Mak Long joined us with Dzaeff and Qaisya's cousin ; Faris and Farha !!! It was a definite first for Qaisya - being 2 months old and Dzaeff being so excited to be on the car for more than his usual daily 10 minutes !!

The bungalow was cool as it had its own private pool ! The whole AFAMOSA looked a bit rundown but well maintained . Of course , Dzaeff had a great time in the pool ; conquering his fear of water initially and ended up refusing to move out from the pool !!!

looking confident with his swimming suit

conqeuring his initial fear

a happy baby !

water babies !
We went to the COwboy Town last night , and it was certainly colourful and enjoyable ! The parade was galant exhibiting their animals who certainly awed the crowd. We managed to have a photograph with the tiger cub and the fireworks display was wonderful !!

We wanted to go the the Animal Safari the next morning , but ended up lazing around and in the swimming pool !! I'm certainly tired now but it was worth the fun !!


family fun !!

the picture says it all !!

Parenting

Parenting can be tricky. It is the core knowledge in the cycle of life - and we learn it informally throughout our lives. Initially , being the focus of parenthood - as we grow up from a child into our adolescence and hence adulthood. Then , somehow we will take the role as parents whether we are ready or not ; growing up our own kids.It is an instinct instilled into us by god for his creations regardless.

The main parenting model in each parents would be the way we were brought up by ours. The benchmark of competent parenting would traditionally be the outcome of the child. Or is it ? Some parents live their lives through their child , some let them live and let die ! It is very variable and the searchfor the best model would always be subjective and unique.Family values are inherited . It is not something that can be easily learnt or be based on. It is something that the whole clan understands and follow instinctively.

As a new parent myself , I try very hard to build an ideal nuclear unit ; with my own intrepretation of a dynamic happy family. Of course , you'd want your children to be successful in their lives but at the same time upholding strong family relations. I used to criticise my own parents for their ways - but being a non-parent at that time , was my idealism justified ? Being one now brings a big dilemna to myself ; as the saying goes " what goes around , comes around". I am a very opiniated child and I'm not sure I want my children to be as how I was and maybe am..hehehe.

I believe that certain values are of core and violating it is a detriment. I hold very strongly to this principle and being a sensitive man ( hahahahah.. ) myself , when it hurts - it stays and haunts me throughout my life. And when i loose respect , then it would not be an easy task to regain it back...

atas panggilan

Let me tell you what anaesthetists do during our calls.

We'll come very early in the morning - looking at the emergency cases listed ; hoping for very small numbers of cases booked rather than few sheets of paper !

Fiddle with our GA machine - checking it to ensure that everything is in a working order. The above machine is only an illusion - It is theONLY canggih GA machine in UMMC and only to be found in the Dental OT.( You only need to press buttons to check the machine) Otherwise , it'll always be manual job of cabut sini.. & cabut sana..


Start our case - putting patients under anaesthesia and proceed with the operation. Monitoring the patient intra-operatively can be challenging especially ill septic elderly patients. Disaster management plays a big role in being cool about it !


Occasionally - well ... almost always ; things do not go according to what was planned - Look at the blocked tracheostomy tube ! Urrgghhh... no wonder I had difficulty in ventilation !

Or when things really go wrong like yesterday !! We were using the portable ICU ventilator to maintain the ventilatory setting of our patient undergoing operation..

And at the end of the day.... sometimes midnight !! Makan time.... :)

The new ride

Friday evening in the OT - I was doing a laparotomy when i received a phone call from Azad...

Telal.. free tak ? "

" I'm on call lar.. whussup ? "

" BArang sudah ade... kena amik cepat.."

" Damn....damn... I'm not free to go out.. "

" Bila boleh ? "

" After 12 kot... "

Well , I did not pick it up at midnight but first thing the next morning. My brand new bicycle !! Hahahaha... Its a real bargain - but i can't disclose where i got it and for how much. COnfidential lor.. :) UNfortunately , it came in a box so i had to assemble it myself. I'm not the DIY person so much.. but here goes..


the raw body


seperti tikus membaiki labu


almost done..

Haks ! My brand new PROTON : T-bolt !Memang dilahirkan to ride on PROTONS only ! Hahahaha ! Assembling the bike was not an easy job i must say. I had to fix the fork - handle and brakes myself ! Thanx Azad for the bargain - I guess we can go and have a ride this weekend !!

Orange run

Edrin and I joined the 9 km Orange RUN at the CURVE last Sunday. Azad was supposed to join us but he withdrew at the very last minute because of Kursus Haji. uckily my brother was available , so we did not waste Azad's number.

One big reason why i participated in this run was because of the promised POLO Sports small backpack that was given FOC once you complete the run ! Hahahaha ! MAterialistic eih ?? Anyway , I enjoyed the course as well as the crowd & IT WAS the happening place in town on that Sunday morning !!

ANd..somehow.. I think .. I feel .. I'm getting lighter.. hehehe

Dzaeffran punyer

Apasal sume muka perempuan pulak ? haks...

My lookalikes

My cool celebrity look-alike collage from MyHeritage.com



Hahahahaha !!!Gang , try this on !
I dunno who the 60% guy is.. but Clay Aiken & Usher ??? hahahaha...

He who consents..

Taking informed consent for anaesthesia is not as simple as ABC. One has to explain fully what is involved and what risks will the patient take while undergoing anaesthesia. Telling the patient that they may not wake up again can sometimes scare them off from surgery !

It has always been THE tradition to :
"Encik mau buat operation ? sain sini aahh.. ," while shoving the pen to the patient's face. Any tom dick and Harry would know how unethical that can be. It still happens yeah !!

Sometimes, it becomes a hassle to the medical carers to explain fully the procedure or things that are to be done to the patient. Few would take time and some could not be bothered and take the easy way out. At the end of the day , it depends on oneself on how to go about it. It is about ethics .. about thinking if it was you in their shoes.

I had a foreign worker today , scheduled for a major Op that may change his lifestyle totally. He can't even understand a single word of Malay or English .. and imagine me explaining him about anaesthesia. He would only understand Burmese ..and only Burmese.

I refused to take his signature , even when he was willing so much to just sign the paper. I'm sorry.. but I needed a translator to settle this matter. You know why ?

" Hallo.. Lin... "

" Yaa... yaaa.... " nodding his head.

" MAU MATI KA ? "

" Yaa... Yaa... " nodding his head with a big smile this time...

Recovering

I suppose when you get older , your rate of recovery becomes slower. I'm still having mega soreness over my two thighs ; therefore restricting me badly from walking like a normal person. I can't walk down the stairs without holding the railing and sometimes my knee just gave way - so i looked like Mr Bean !!

I really enjoyed my trip to Gap , Smangkok and Chilling. It was definitely a much easier track and condition compared the my previous climb. Still , being unfit - I ended up having cramps after finishing the trail ! It was only a daytrip climb , but I really loved the exhaustion ! At the same time , there were competitors form the Nomad Eco Xtreme race going on ! Gap and Smangkok were part of their checkpoints and we did meet up with the racers during our journey ! Well , initially my plan with Azad was to enter this race ( planned last year ) but after seeing what they had to go through.. Mak aii.. dunno which stage we would surrender !!! Imagine biking all the way up from KKB to Gap ... haiiyaa...

On our part , it was purely "santai" as we only did a day climb. Meaning just bringing our hydration packs and chocolates for the climb. No heavy burdens on one's shoulder ! And the Sunday trip from our campsite to Chilling waterfall... Haaa.. that was a treat ! I loved the water , the atmosphere and of course the company. It was pure fun and playing "slipper" racing in the river !! hahahaha.. CROCS vs ASADI challenge.... :)

Going outdoors certainly boosts one's spirit. I just love doing these activities and will keep doing it despite wifey's uneasiness about some of my plans.. hehehehe

Chillin Gap Smangkok

It was grueling... tiring.. penat giller... kaki cramps all over..
But it was worth it... :)


Gunung Gap


Top of Smangkok

Chillin in Sungai Chilling waterfall