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… tapi sekarang…most people seems to think that they know better.

A patient for an elective operation drank before his scheduled time. It was not a large amount but fluids in an elective op is still fluids. I had a choice to just cancel the case or reschedule his time, after a discussion with the operating surgeon of course.

The agreed time to call the patient was 11AM, after other cases are done – to allow enough NBM hours. In a way, I was taking full responsibility of any inevitable things that would happen – if any. After all, as part of the anaesthesia team – we have taken every single measure the best that we could to minimise risk. Advice, preop assessment consultation and all sorts.

Frustratingly, my 11am instructions to call the patient was over ruled. BY SOMEONE WHO THINKS HE/SHE KNOWS BETTER. There are reasons why I called for 11AM. kalau tak faham, jgn buat2 pandai. Kalau patient ada morbidity bila induce awal, yang jawab aku tau!! 

I felt like saying,” hah.. dah panggil tuh induce lah sendiri “

But of course – since patients outcome and best interest gains the upper hand – Minci did whats best.

  • kept her mouth shut
  • did not vent on facebook
  • controlled her emotions because innocent personnel should not suffer and we don’t want to give the wrong medications, right?
  • shifted my focus elsewhere

Alhamdulilah, the op went fine.

Retirement

Killing two birds with one stone.. 

Our trip to Kuching, apart from as an annual balik kampung thing – was purposely planned to coincide with my Anaesthesia Department HOD in my previous tertiary hospital’s retirement party. She was to retire after serving the community in Sarawak for  15 years. And she was not even a Sarawakian.

I remembered stepping foot into her office for the first time and was met with a lady who spells charisma as easy as ABC. Her voice was as loud as thunder but never far from dispensing an advice or two. Her knowledge of anesthesia itself was admirable but her understanding of life and death was eye opening. We not only began to appreciate the beauty of our vocation but were also disciples of life long learning for this world and the Hereafter.

She was never the one to give up. Never to say NO. Or cry impossible. She stands her ground but even so she would always find the middle path so more people would agree with each other to get the best results. A great leader must after all be prepared to be a great listener as well.

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A lot of people turned up for the event which was of no surprise. The food was served over 9 mini courses. Some were delicious, the rest were palatable. Being a mom of a kindie boy – I couldn’t help feeling glad it was over. I needed my rest that badly.

I managed to meet and salam some of my other beloved specialists. And of course held the hands of Yang Diraikan herself. Naturally, she would find it difficult to place a name on my face because well.. I was so young back then. This was like more than 5 years ago – a time when I was still skinny and not married? Ha ha..

I grabbed her hand and salam her. CIUM TANGAN okay!! I introduced myself as so and so. I let her know of what I am doing now (regardless of its significance). She was happy that I was still doing anesthesia although I see more of excision biopsies than say a laparotomy for an intra-abdominal injury or a Whipple. Just being there to be able to hold her hand and hear her say, “ok.. thats good.. thats good” was one of my best 60 sec in a lifetime. And you’d only feel like that if you treasure and respect a person dearly. Yes, I adore her a lot. Like MEGA much.

She is at the moment ranking as NO 1 on my list of favourite female bosses. I look forward to adding a NO 2 on my list and yes, I have spotted someone.

Nice demeanor

A colleague of a specialized discipline from a different hospital passed a comment to me today. He said,

” wow.. you guys are pretty ‘relaxed’ for someone who is part of the anaesthetic team “

When he said you guys – it was referring to me and my one and only working partner in the field – and when he said we were relaxed.. I kinda knew what he meant. That means in face of obstacles and unpopular circumstances in the operation theatre – my partner and I rarely exhibit aggressive behaviors like screaming or rolling our eyes at the surgical team and stuff. Or cancel a scheduled elective list like it can be done tomorrow sorta thing without a two way and mutual discussion.

My determination to maintain a cool hat and ‘being nice’ to other people stemmed from when I was a houseman in Kuching. One particular oncall night stood out. I was in my 5th posting as a surgical houseman (HO) and I was posted to the neurosurgical ward. I was oncall with a very motivated and nice Neurosurgical Medical Officer (MO). At the same time, coincidentally – most of the other Medical Officers of various discipline that night including the Anaesthesia Team had genes of a Saint. Everyone was so damn nice, polite and kind to each other which was evident during referrals. Even to this little non significant HO!!!! As a HO I felt confident, safe and urge to do more for my patients. I wanted to please these kind MOs working with me that night. Anaes required at least 2 large bore branula, I gave them 3. You want me to trace the result STAT .. I will bug the lab technician to run it fast. My MO even sat with me at the pantry while we have our quick 5 min meal and asked if I had prayed – he did not have to cause he is not muslim but he did! Although most of our patients that night were critical and semi-dying – none died and hung on to the dear life until the coming morning. I couldn’t help leaving work the next day at 7PM thinking how nice the world of medicine would be for the patients if everyone can work well with each other and stress more on them rather than thinking, “ayo.. that lioness is oncall ah.. susahlah nak refer” or ” aiyo.. she likes to marah people one.. you lah refer” and the game of ping-pong begins in ED.

When I became an MO myself in the Anaesthesia department – I find that by being accommodating – people can cooperate and work better with you. As an anaes MO at the time especially when working in ICU, I’d be receiving referrals to intubate a difficult patient or asking for a ventilator or to review a potential ICU patient in the emergency unit or wards. When we are ‘friends’ with those from other disciplines, it is easier to discuss options and demands. It is easier to refer earlier for the health and safety of the patient. It is easier for these friends to understand why the operations needs a certain amount of blood products or why ICU cannot accept a patient. There’d be less bickering and pointing fingers. Plus, naturally we would want to do more for our ‘friends’ kan. And we want our friends to have an equally good call.

On top of that, if we exhibit concern and educate our supporting staff accordingly, it is easier to get a message across.To share and idea or sentiment. Thus reinforces on patient care. If the environment is conducive and pleasing, we will then be able to see how various people of different levels respond – the lazy ones left behind but the opportunist would learn more and better themselves. I will hear more of my porters being able to report to me saying ‘hey doc.. this patients white cells are high’ instead of just collecting the results and staple them. I am always happy when my nurses are able to point out a patients potassium level is deranged when the results reach them first and not just file them for us to review later. I am more delighted when my medical assistants with many years of experience are able to guide me through a difficult process – medicolegal aspects of things and such.

I hope to keep this ‘menyenangkan demeanor‘ around for long time. I’m no angel. I have lost my temper before – I have raised my voice before towards staff, patients and relatives but towards late.. the incidence have decreased tremendously. Perhaps I’m getting old.

A toast to a nice demeanor. cheers.

Starting the day of gassing patients by switching on the lights

“Opportunity is missed by most people because it is dressed in overalls and looks like work”
Thomas A. Edison

Despite living 27km away from the hospital which is equivalent to a 30 – 45 mins journey to hospital, I am so far almost always the 1st person to arrive for work. Interesting, huh?

I however enjoy ‘opening up’ the Operating Theatre (OT). To switch on the lights, check the anaesthetic machine, prepare the drugs, call the patients to OT et cetera..

because…

I know I have set the pace for whats going to happen today.

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The Recovery bay

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The Operating Room

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My anaesthetic drug trolley

SEvo Effect

I was reminded once again of how a postcall life as a bius MO in OT feels like.

The effect of wearing and tearing automatically appears after you leave the air conditioned OT. Knees wobble, feet hurt with every step as you try to battle the calluses and the haggazrdness of being up the whole night. Eyelids droop slowly and every step felt heavier as the minute molecules of left over |Sevoflurane begin to penetrate through the cells.

All plans to go to the admin office or a short shopping trip to The Store diminished as all you could think of is a shower and a bed.

After a gulp of coffee and a hot bath, you sprawl yourself across the bed and within seconds – the Sevo effect kicks in.

While you hope for a peaceful sleep, you’re brought into another adventure in la la land. Fighting against enemies, fleeing from demons et cetera.

Arghhh… ari minggu tok kerja lagik.