Grief

Anaesthesia ( Greek αν- an- “without” + αἲσθησις aisthesis “perception”)

"The state should, I think, be called 'anesthesia.' This signifies insensibility."
William Thomas Green Morton

Things can go wrong untimely , especially in Anaesthesia. Everytime one signs consent for an operation , there are two possible complications ; complications from the surgery or anaesthesia . However , many take it for granted that being under anaesthesia is safer than the surgery itself. An "A" will always be an "A" - first and foremost. Going unconscious for a surgery can be for eternity . More over if it was unexpected.

We lost a 1 month old baby yesterday. It happened to a colleague of mine - I only heard the incident when it was over ; myself trapped during that time doing a laparotomy in my emergency list. I was shocked to hear the news ; especially when the cause of mortality was directly linked to anaesthesia. The baby just collapsed and not revivable after induction. Everything just had to abide to Murphy's Law yesterday afternoon.

It was supposed to be a simple surgical procedure. It was an elective case ; where things are least expected to go wrong. It was supposed to be short and sweet. Clinically , the first child of a young couple was perfectly healthy and thriving as how a one month old baby should be. She was supposed to be fed very soon as she was crying in hunger before she entered the theatre.Her father signed the consent with humour the day before , asking my colleague.. " Nothing will go wrong right ? ". Who would have thought , the last smile the baby gave before going under anaesthesia was the last to be glanced by her mother.

The whole operating theatre complex was in a somber mood when i pushed my patient to the recovery area. Her parents were hysterical..unconsolable. My colleagues who were the carers were such in a distress state ; jotting down what had happened and filling in the post mortem form. The surgeons were left wondering on what went wrong as they witnessed the takings of angel of death.

I've heard stories before , but this incident happened so close to me ; scary and traumatic as it could have been me. Not just as the anaesthetist but imagine being in her parents' shoes.

People's life in your hands everyday... why did i take up this job ?

Shattered

I managed to sort out with my fellow surgeons to take a break ( well , we finished all our cases by 2 am anyway ) during the footie match. I was tired but hey , you'd never know if Liverpool might not reach this stage anymore in the near future. "It's heartbreaking.." Gerrard.
We lost to a top class team .. " Benitez.

The mighty scousers lost and Milan is the King of europe for the 7th time. Looking back at the game , they deserved it as Liverpool did not capitalize fully their chances.

"I don't watch football, I've a lot of things to do.Even badminton,I ask my wife to watch & she tells me if they win.If they lose,don't tell me or I cannot sleep.I've always said it is silly for 22 people to chase one ball. Buy one each" ~ Tun Dr.M

a happy thought...

I was doing my craniectomy ( Emergency neurosurgical operation ) during on call yesterday , when i received this sms..

" Dzaef looked kat bwh pintu n saw gate auto bkak when paklong dia balik. Gues he tot it was u , n said.. yeay.. bobo!! "

That was really sweet of my little boy !! miss you too dzaeffran...

Chillin it out..

the trail

the challenge

the picnic... :)

Of being courteous and good manners

After a tiring day yesterday in CHilling , I am back to work today. I'm the "crash"-man today - doing the elusive referral and "saviour" doctor for the whole of UMMC. Practically my job during on call today is to resuscitate collapsed patient in the ward as well as the emergency department if they have any problems securing the airway.In our KKM hospitals , usually the Anaesthetist MO in charge of ICU will have the extra burden to complete this task despite having a busy ICU. In UK or US - the actually have a team dedicated to resuscitation per day - consists of doctors from all discipline. We don't have this yet in our hospitals - except maybe the RED ALERT team in MAternity hospital , Kuala Lumpur. My Head of Department is very keen on providing Acute Care at its best and optimum type of care - not the ASAL BOLEH resuscitation. Therefore , this single man "superhero" call is a start in implying the acute care concept in the future.

In the morning , I will have to do rounds with patients ventilated in the wards. Basically , it is quite easy as all we have to do is check the ventilator setting - see how the patient is improving or not - and then review the arterial blood gas taken earlier. But then , it is difficult NOT to get involved with the overall management of the patient ; I suppose being anaesthetists we tend to see patient as a whole and everyday , ended up looking for the ward doctor to offer our opinion. I just cannot isolate ventilation as one partition and others differently. At the end of the day , you get a bit stressed out with the suboptimal management .

One thing that pisses me off a lot these days is when the closest relatives asking me about the condition of their loved ones. Not that I'm angry at them asking me ; they deserve to know !! but more to the primary carers who tend TO NEGLECT THEM and keep them in the limbo. I've always tried my best to explain to the relatives during my house officer days ; as we are the ones who slugs it out really bad in the wards. Unfortunately , I see this matter to be taken lightly and often enough ; they'll come and ask about their loved ones after I've changed my ventilator setting.

It is quite sad to know - the level of information they know about the patient ; eventhough they've been staying up day and night to accompany them in the ward. I do pity the family members who are left in such a state and as doctors we should be courteous and as informative as possible in updating them about latest developments. Coping with critical illness is not easy - and it is important for us as doctors to play our part to help them to calm down. Imagine if we are in their shoes ; how would we cope with that ? True enough , sometimes there are those who are difficult to handle ; but as doctors we should be calm in attending them and settle them . That is what we are trained to do- Multi-lateral human resource management ; not just to manage the medical illness but people who the patient brings in with them.

SO to aspiring doctors as well as house officers out there ; Be courteous and kind. It helps a lot ; and trust me - you'll feel very satisfied with your job.. ( and not complain about the low pay.. torturing working hours... etc... )

Blipppp...bliiippp.... My pager dah bunyi lagi dahh.....

Night of winners

I followed Azad for his company's picnic trip to Chilling today. Mafiz followed us as well , both me and him were the "sweeper" for the day. I enjoyed myself very much as Chilling is the place to go for a short weekend dip. Unfortunately , my phone made the dip too and if any of you are having difficulties contacting me these few days , I am resuscitating my handphone !!!

Pictures later... tak sempat nak download lagi..

**************************************

ON another note , we had 2 finals last night. AF vs FA !!! I shouted in joy when i flicked to channel 82 at 12.30am.. and... DROGBA ... goaaall..!!!! and that cry - woke Dzaeff up !!

Mila deserved the win.. and Chelsea.. thank you for making my night :) It was a treat seeing Ferguson's red cheeks blushing so much after the loss !!

p/s ( Can someone pass this message.. )
I voted for you... noni... always !!! but you were not in the finals.. camana tu ??? :)

Sympathetically inotropic

The results of Part 1 MAster of Anaesthesia was out yesterday..
Scary.. worrying... stress...
Arrrgghhhhh...

COngrats to those who passed.. and those who did not make it this time , it'll definitely be the next time around !!!

dot..dot..dot..

Kelmarin on call... then post call..
semalam on call.. then post call..
esok on call... then post call..
then hepatobiliary list.. and I have a major LEVEL 1 bleeder expected..

wow.. letihnye...

Precious digit

She was an independent 10 year old girl. Being the eldest amongst her seven siblings , she holds a lot of responsibilities at home. Being the child of Indonesian parents with PR certainly grew her up being more matured than most of her age group peers. Being on the lower social status group - I suppose its just a normal part of their life story.

It was at 9pm and she was doing her washing after settling her youngest brother. She did not realize that the spin function of her old washing machine was halted because of the laundry's irregularity. She thought it was done - and put her left hand in to bring out the clothes. She was tired as her youngest brother was caught with fever and she had to handle her the whole evening.

SNAP !! The machine made its turn and trapped her finger with the spin. To her horror she cried out loud in pain and when she looked at her finger.. it was almost amputated. Her mother came to look what was going on and then shouted for her husband who was having his dinner. Her father panicked seeing the index finger hanging with blood spurting out like a pipe.

They managed to bring their child to the hospital soon enough , the father was still undress and looking very worried - We started the surgery to reimplant her finger at about 1030pm ; still witihin the crucial 6 hours stage. She was hurting - but she maintained her calmness. She was not crying or shouting in fear - but instead looking composed and holding on. I was amazed by her courage and guts. After taking the consent from her parents - we pushed her into the OT alone.

She was very brave. I could see it in her eyes - as she was no typical 10 year old going for an operation.I was praying that the hand surgeons would be able to save her most precious finger. She was really calm - when instructed her to breath on my mask ; very cooperative . I induced her and it was a smooth procedure. I was so tempted to give my brachial plexus block , but she's too young to go through that ; making her sleep for a while would be a temporary relief for her worried young mind.

Initially the cut did not look too bad as her nerves were amazingly intact. Unfortunately , her digital artery was cut really bad - as it was a twirling injury - making the surgeons life difficult and challenged their expertise. 1 hour became 2 and then became 3 and so forth. I was praying that the op would be successful and did not mind staying up for her to do the case.

At 3.30 am ; the surgeons were going nowhere - the little finger looked dusky and unhealthy. There was no way for them to reattach the blood supply to the finger ; they tried a graft but it failed. The big decision was made - the had to AMPUTATE the finger as it was not salvagable anymore - and the surgeons tried all their might I must say on that Sunday morning.

I felt so sorry for her.. thinking about not just the immediate trauma but her future undertakings. Would she be able to cope her frustration of not being as normal as anybody else? Will she be strong to accept her fate at the age of 10 ? If it was because of fire crackers ; then maybe the sympathy would be not as much as how it is with this little girl.

I reversed her well from anaesthesia - and she gave me the " is my finger ok ? " look when she opened her sweet cherry eyes. I did not say a thing ; but just smiled. I asked her if there was any pain and she said nay. She was still dozy and sleepy - but i cannot imagine how she'll be depressed silently when she's fully aware about the fate of her hard working little finger...

A schoolboy again

My wife left me yesterday... uhuks..

Wei , thats why iti s dangerous to just grab the headline instead of reading through the whole piece ! This was what actually happened.

I was doing the plastic list yesterday - and looking at the cases posted ; did not figure i would finish late - Only cleft palate and lip repair mah !!! But do not underestimate the "skill's of a plastic surgeon. It took HOURS !!! It came to 5 pm and wifey called me up..

" Abang.. I'm done... "
" I'm not.. and maybe late kot.. you pick up the keys from me.. "

then I asked ..

"Can you pick me up later ? "
" What ?? balik naik cab jer la.... "

Haksss... I was left behind in the hospital. True enough , i finished at 7pm and decided to wait at the taxi counter - but there was none ! Then I decided.. hmmm... lets try the bus !!

God.. I've not been on a public bus like for 10 years ?? It was like a schoolboy again - being a bit nervous before jumping onto my bus in ront of UMMC. I didn't know the bus number. So i just jumped onto the first bus I saw - and managed to reach home !!! Hahahahha... Honestly , it was that feeling of being a naive little boy boarding a bus... at the age of 30......

Future

Its the exams month. THose in the final year are dreading the thought of passing their last exams of their life , while the beginners of the programme ( Mostly year 1 ) , will be wondering why did they continue studying ! My department is only half strength ; therefore the lack of workforce and hence the busy schedule of OT list and continuous on calls. But hey , I am not complaining ! In fact , I enjoy my calls !! ( a bit weird here... )

I'm freaked out really.. cause mine will this November and I have yet to pick up my momentum. Its the age i guess , the concentration power is less and my body easily fatigued when facing my reading materials.If you ask me to jog , Somehow the power returns but when it is time to hit the books , entah apa pasal tah... Hahahahaha !! MY study plan is so half hearted that I am feeling very worried now ; thinking can I finish my reading by August before my intensive course ? Waahh... dah cuak dah ni.. heart pounding etc.. I hate exams you know !!!

Well , I'm writing this out on my blog sort of to motivate myself. I suppose , one way to do it is to tell the world what I've been studying .. or maybe i can teach online.. on my blog ?? Hahaha.. as if i have the time... :)

COngrats to Jojo !!

Congratulations to Razman Yusof aka Jojo ( My silent blog reader !! and his bride , Sofia !! We are all happy for you !!! Jojo used to be our next door neighbour in Taman Tun - but he was more close to my younger brothers compared to myself. 6 tears difference Mah !!


My whole family attended his wedding in Mandarin Oriental during the 2 days mid week holiday. It was nostalgic to meet up with both his parents and elder brother. It was a smooth wedding and it went quite informal eventhough Tengku Mahkota and Tengku Muda Pahang attended the affair. I enjoyed the video show - done by the groom which was funny and kewl - he could not sing the song properly in the video - and walah - Andy of Flop Poppy was on stage to sing it to the bride... !!

And of course - The Lima of GAng Starz was there too and the whole family took a photograph with the group ! It was a bit funny later - when the Tv3 crew interviewed my dad about the group - and he spoke SO INDONESIAN !!!

" Papa ingat Tv from indon tadi...... "

Devils and blues ; only the Reds will not walk alone in Europe.

We/re in the finals again !!! Liverpool the everlasting champion of europe !! It was a heart stopping game the other night. I stayed up to watch it despite being on call yesterday .. but it was worth it. To see the scousers triumph especially during the penalties. It was worrying at times but Reina rose to the occasion with his brilliant saves during the game and the penalties. Such a good feeling to show the "other" fans how we maintain ourselves to be the TEAM to watch in Europe and not just European champions wannabees... :)

"Rafa.. doing the bomoh siam thingy during the penalties.. " Dil

And today.. as much as how Liverpool fans wants to see our team beat United in the finals , they faltered and lost to Milan. How typical of Jaguh kampung.. just like Chelsea.. hahahahah... MAri laa.. kalau berani kita lawan kat Athens !! but unfortunately , both of you are "premature"s .. not good enough at the Continental stage. hahahahaha...

23rd of May.. the day of further glory...