Soap

My last two calls were terrible ; my brain capabilities tested and stressed for that 24 hours - doing cases back to back ; complicated that needs upmost vigilance . Our job can appear boring and easy from a surgeon's point of view but truthfully , it is during this time that we dedicate our all to the patients. The best monitor are not US , Japan or German made machines but us anaesthetists. There were too many subsequent big cases yesterday and i was only done at 5am. My partner was so exhausted that he really really slept in OT while doing the case !!
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Believe it or not , it is in the OT that we get hot gossips and misfit endevours by our society.

" Dia cinta saya dok.. " said the Indonesian maid when enquired about her affair with the employer's son resulting an unstable ruptured ectopic pregnancy.
"Oohh..I didn't know why they attacked me " said the Indian fella on why he was slashed so bad. Apparently , upon reading the police report ,he is a murder suspect !!
"I cannot live with him anymore " answered a battered wife before induction.By fact , this is her third incident since last year which is related to domestic violence.
" No..no..i don't drink regularly. Somebody gave it to me.. " said a young malay chap who was involved in a bad accident causing intra-cranial bleed. His Gamma GT is damn sky high..
"Saya tak mau operation la doktor.. " said an old lady with a bad heart about to undergo GA forced by their family to do so..

And the best of all is...
"You ni available ke tak doc?
I suka your voice..so sweet... " Subhanallah..

p/s tahun ni banyak ego booster la.. Am i imagining all this ? Hahahaha

Orthopods Orgy

Pissed off face at 4am in the morning..
I was trapped in OT from evening till subuh- handling a polytrauma case where it was purely orthopod's project. The whole on call team was there and the "not so important" cases were postponed early. The man was badly slashed - alleged assaulted by few men with parang. He was lucky he escaped death but his upper limbs were , how do i describe it huh ? It was not straightforward and I was there in OT from 1700 till early morning today- Pt being under General Anaesthesia for that period . Gila lama bang !! It was an uneventful op - where the situation was under control but it took us like donkey years to settle the problem.
I was so groggy this morning and i am not feeling well at the moment.. Hahahaha.. And i have a major presentation tomorrow ; "Tembak" session...

and this was nothing....

Happy 1st Birthday Qaisya..

If we did not plan this earlier , I might have been in Rembau or Lembah Pantai..
but of course , family comes first !!
We celebrated Qaisya's birthday on a small scale today. Wifey woke up early and went all the way to Kampung Baru to get the famous nasi lemak.I was still asleep by then and then it was my turn to get the helium balloons from a nearby shop.

Pak Long special..
Elly came earlier to give her presents as she had class today. It was sweet of her to get presents for both dzaeff and the birthday girl. The rest of the family came sharply at 11am and when i returned most of them were already eating. Qaisya was not her usual self though ; having fever for the past 2 days must have irritated her and she did not appear to enjoy the occasion as how we expected her to. Nevertheless , she was calm during the cake cutting and of course Dzaeff stole the show when singing the birthday song. Instead of " TO YOU... " it was " TOYO !!!" Hahahaha...

Baskin Robbin's special

back from the balloon shop

Yeah..

The 3 muskateers..

cupcake bash

Atok high

Family pic..

Most horrible

Today was my most horrible moment in my entire anaesthesia career. Never say anaesthesia is 100% safe especially for the little tiny ones.
We nearly lost a 52 day old baby in OT - not because of the operation but because of anaesthesia . Until now we could not figure out what went wrong ; did she had anaphylaxis ? Did she had severe vaso-vagal response on intubation ? My specialist was very sure the tube was in but the capnograph was not visible ; and of course panic button was activated when the heart rate just went down and her face turned blue.
We had to start CPR immediately on her to help her circulation going ; I was praying hard to god that this will not be the last time i see her because otherwise she was well before the anaesthesia.( She had something though which needed to be investigated via anaesthesia but it was of no risk to the procedure ) Resuscitated all our might on this lovely 3kg baby. Thank god it did not take too long to get back her heart rate racing and the capnograph tracing. She was however very acidotic ; evidence of hypoxia and the near arrest . She was on the verge of losing her life !!!
Of course , nothing is ok for sure as she is now being observed in the paediatrics ICU. Went there directly after my other 2 cases today to see her progress . I am so worried , felt really demoralized and down . I remembered explaining to the mother on Friday during pre-med about the possible complications and it happened ;- if it could be well explained i reckon it is fair enough ; but neither me ,my specialist nor my consultant can pin point the direct cause. And that is a bummer because somehow it is related to anaesthesia..
I am praying hard that she will be ok , because i cannot stop thinking about the event , maybe lasted for 10 - 15 minutes but it felt forever. And the nightmare remains , i dunno whether i can sleep well tonight..

The cutest !

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This is fun..

Hyperactive neurons

I am currently having a "prolonged" bulb moment...
I hate it when this happens.My head will be full of ideas and plans ; to do lots of things. And really a lot ! No.. don't jump into conclusions.. I am not running in the coming elections !! Hahahaha..
Its just that , there are so many activities I want to do at the moment. I used to love these moments and really plan it out .Sit down in front of a computer and write it out ; proper time plan etc. Doing multi-tasking jobs with "nothing is impossible" limit... Perrgghhh...
What am i doing la cari pasal ?? hhahaahahaha

The jump..

I want to watch Jumper !! Saw the trailer and impressed with the rave reviews by friends and bloggers.. hmm... DVD or GSC ? hmmm...
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I've decided to make the jump this year ; running in the 21km category for this year's KL International Marathon. Not that i am fitter or leaner than last year , i just reckon that it is about time for me to do so. I've been saying "next year" , after every KLIM 10km run for the past few years. I don't know whether I am out of my mind but i guess i have to start somewhere !!! Hahahahaha I am not getting any younger isn't it ? I aim to complete marathon before i turn 40... ( lama lagi tu by the way... :) ) So sina , i expect you to snap my pics as i cross the finish line in Dataran !! hahahaha

I managed to get a good bargain for my new running shoes during the Pre chinese new year sale . This is definitely my first "specific" running shoes and i guess getting a good one would help me to achieve my goal this year. Who knows i might be sponsored like Stupe in the future . By the way, Good luck bro for the coming Ironman !!!
Started my training on Wednesday after work. Upacara perasmian kasut baru.. hehehehe.. I decided to run in UM campus this time , as it would be just stupid to go through bad traffic at 5pm in order to get to Kiara Hills. I was puffing and panting on that first run after a long hiatus! Thurdays will be my cross training day ; playing social badminton with the kamcheng gang in DU.
Did a further run today on a bigger loop - almost around the whole UM campus ! The uphill slope was a killer but i loved it because i was soaked with sweat ! A certainly good track for me to train up my stamina in about 1.5 months. Sempat ke ek? Belasah jer kot... hahahahaha

Deal or no deal

I gave gas to both husband and wife today - wife donating her kidney to her husband who's an end stage renal failure patient. Both are fairly young , the husband his early thirties and the wife late twenties.Why she decided to do it , for love i suppose ; till death do they part. Sweet isn't it ?

This is the third case I've came across ; where the donor-recipient are husband and wife . What a sacrifice huh ? Dunno about kickbacks if it is between the spouse. I only discovered today that nowadays , you don't really need to type-match the kidney as how we used to do it ( what i used to learn in the textbook ). The most important thing is the blood group match ; no reactivity against each other. Then , the new immunosuppressive drugs will handle the rest. These drugs are so potent and fairly safe that anybody's kidney may fit into your body for transplant ! However , in our country ; to avoid organ selling and abiding ethics , only family members or spouse are allowed to donate their kidney for transplant.. Interesting eih.. Subhanallah..

And to this , a friend said"Kalau perempuan , kerana cinta ; memang sanggup je derma organ dia .. Kalau lelaki agaknya , taknak and harapkan isteri dia mati cepat so boleh kahwin lain... "

Hahahahaha.. an interesting quote! Care to comment ?

A nite in KLCC

When else is the best time to be in KL if not the long public holidays ? The city appears exodus as not only those really celebrating the holiday is back at their hometown , those who co-celebrate would seize the opportunity to be with their loved ones. Of course , it becomes the best time to drive hassle free down town . We took the opportunity to dine and laze around in KLCC during one of the days.
I really do love the scenery ; to be below one of the tallest building in the world ( we used to be the one..) . Amazing atmosphere !! I've always wanted to bring the kids to enjoy the fountain as well to look up high ; and gaze upon the magical wonder of Malaysia ( though some might still argue the benefit of such splendour spending ).It was fun though seeing both the children enjoying themselves , one enjoying in glee and the other ; itching to jump out of her carrier !!!

curious young minds..

spectacular..

mother and son bond

father and son bonding while trying to squeeze in the magical wonder !!

Knowledge is ignorance..

I don't know which is better , to know more or to know less ?
It can be so easy isn;t it , to know less and be ignorant about it ; when things don't go the way we plan it we take it as it is. Unfortunately , in my profession we are deemed to know more because we are demanded to be that way . It can be disheartening knowing things done may not be as maximum as what we could do. True enough , at the end of the day it will be god's will whether the life is sustained or taken. We are left to wonder however whether what we did was enough or sub effort ?
We were called to protect the airway of an ailing mother , seems to be battling well with her cancer but the main problem at that time was her failing heart ; precipitated by uncontrolled fibrillation which is worsened by the mitral stenosis she had for quite some time . We know that protecting the airway may buy time , but if the heart rate is not controlled ; then we may not be doing any good at all !! Of course we do suggest and be aggressive on our part and we do realize our territory. True enough , she did not make it after few hours on the tube ; Innalillah.
Another foreigner , found on the highway and looked suspiciously as an absconder from another hospital ( no man would insert a CBD ( urinary catheter ) for fun isn't it ? ). He was severely shocked ; very acidotic ( which is incompatible with life ) and to salvage him an immediate dialysis is warranted or he won't last ! True enough , a laparotomy maybe needed for him at that time but if no efforts for acid clearing is done , we are not helping the heart to continue functioning! Strong suggestions will always be overlooked and it can be disheartening to manage the impossible. But we are always all out... never fear !! Bicarbonate infusions may correct your numbers but physiologically the acid is still irritating the body ! He was pronounced dead in recovery , not after an hour long of CPR and resuscitation ; being in his 20's a no-no mortality was expected ??
And my body is aching all over today because of that CPR. A quick warm up and stretching beforehand would have helped !!

Questions to answer

It was a cool day yesterday ; Gong Xi Fa Chai i suppose. I was a bit busy in the morning though , resuscitating a post Angioplasty fella who had a bad MI the day before. How he got the MI was a very interesting story which I think i should reserve it at the moment !! Hahahah

FASTRACH kit
I got a call from the orthopods team at midnight ; requesting my assessment of a young boy who was thought to be suffering from a possible fat embolism syndrome. According to her , he had became more breathless withconfusion and disorientation.His blood investigation certainly pointed to the provisional diagnosis. He had polytrauma the day before , found on the NPE highway and sustained multiple pelvic and bilateral femur fracture. He was unfortunate to have an unstable ordonthoid fracture displacement which is bad news. As if the severe lung contusion is not bad enough and now he is suspected to have bad V/Q mismatch !
Of course , if fat embolism is the immediate diagnosis , we do need to protect his airway before disaster beckons. His unstable cervical spine fracture complicated the matter and the oncall team had to brain-storm in thinking of the best airway management.

Fibre-optic intubation with our ENT colleague
Ultimately , he needed a tracheostomy as his recovery will take months especially with all the fixations. As the spine team were planning to fix the hangman's type of fracture ; we were left to intubate the patient fibreopticly while the patient is awake. His head was not to be mobilized at all and that is a big challenge ! We had doc Hisyam ( from ENT ) to standby , in case we had to proceed with emergency tracheostomy. He was a big help , assisting us with his expertise.
We had difficulties ,( broke one paeds scope in the process !! ) but managed to secure the airway as planned. We had to improvise and reached our goal. His lungs were deteriorating and we had few panic attacks when he desaturated. Luckily he is young and ventilation was never a problem. The fastrach was a wonder , having to help us maintain his oxygenation while manipulating the airway without destabilizing the neck.
Its good to have scenarios like this , but of course the management would be an interesting topic to be discussed during our weekly morbidity and mortality meeting.

securing the airway

Mind u..this picture was taken at 4am in the morning ;despite the fresh faces ! post adrenaline rush ...

Syukur

It was back to OT today this week. I've not properly done an elective list since September last year ! It was however good to be back in OT ; trying to retrace the old steps , old routine which is of reflex . You don't easily forget the things you do which maybe the routine for the rest of your life. ICU is a totally different scope from the care management in the operating theater.

I was in Paediatric OT today ; a difficult list which requires a senior person , Lecturer or Consultant with you when you are doing the list . It involves lots of anticipation and that will only come with experience.Its worrying , stressful handling these kids ; imagine handling them when they are active is a handful , anaesthetizing them is worse ! I've not done paediatrics properly before , I guess UMMC will be the place for me to learn the tricks and trades of paediatrics anaesthesia. Mind you , with them , there is only one chance and that one chance must be 100 % perfect and always on the forerun. It needs that extra bit of obsession and compulsion ; no wonder paediatrics anaesthetists ar usually the worse ones to be with in OT when you are very junior !
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Met an old friend from UK , Ady with Nurrun yesterday in Shah Alam. Its good to catch up and when we started talking it was as if we were never apart before ! It was fun sharing our experiences ; him being an Emergency Medicine trainee in UK. It was also enlightening to continue out intellectual discussion about life which traversed to country related matters , as how we used to do in Shrewsbury. Gosh , I do really miss the good old days !

Sendiri mau ingat..

One has to appreciate one's health , because once it is in jeopardy then we will start thinking of the the deterrants that should have been obeyed earlier. No matter how genius , how lucky or how smart you are , one has to be careful and try very hard to sustain the best of health.
After arwah Ben's demise , there was a sudden surge of incidents involving friends of mine- all in their 30s ; needing hospital care.Whether it is coincidental or just events surfacing , I don;t know. Dil was admitted for severe chest pain after badminton , Shah admitted for breathlessness and hearing Raja Faizal's battle with cancer certainly painted a worrying picture . I might be having illnesses such as these in the future!
It is a known fact that because of our lifestyle , we are getting patients with chest pain and MI in their 30s. It is not the typical 40s as textbooks used to put it , incidence has become younger. Few friends of mine are diabetics and hypertensives on medication ; and to think end organ damages usually surface after 10th year of the disease can be scary . Considering our lifestyle , the food that we take nowadays ; the damages are certainly accelerated. Once diagnosed , it is about damage control and curative is almost out of the question with these chronic illnesses.
Late night food binge , irregular exercise , smoking and Coke are certainly ways to fast forward the chronic illnesses. Unfortunately , I am a victim ( hahaha.. self sympathy ! ) of such lifestyle ; and i know that if i am not careful - My intention of having the DNR ( Do not resuscitate ) status , may be sooner than i think.

Get well soon my friends...

Shakira's engagement

We were in Shah Alam last night. It was my cousin's engagement ; it will be the first one this year which will be followed by my brother's next month. Its nice to have a large family affair as it will be the chance to meet up with relatives ; esp the ones from far away.Of course , it is also Dzaeff and Qaisya 's night out and they were very excited with all the happenings.
We had a big crowd ; it felt as if it was the wedding itself ! The other factor that made people came was also to "experience" the tv series ; Spa-Q ! Haks.. yes , they filmed the series in this house and to the fans they were like .haaaaaa.... hahahaha !

Papa as the spokesperson and I am currently his understudy !

The crowd

Kira down the aisle with Mama

Hantaran march.. Bersih !!

Dzaeff with Amin , my cousin .. ( to rebel bloggers out there , you know who he is !! )

Congrats Kira ! It was a lovely event.