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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.

That 4AM talk with God

It was 4 AM in the morning. I get to rest much earlier than I usually get to during my oncalls. I’ve just completed my Isyak prayers at 330AM and examined a gentleman who was assaulted in that early hours of the morning. The observation area had a few patients which would require a review later.

I curled up on my cold oncall bed with a thin blanket to cover half of me. I didn’t even bother to get another layer because well – I rarely get to catch a nap during my calls. Not even a towel for I fear my quick shower would be cut short by a phone call and I’d have to run out wet to pick up the phone before it stops ringing. I left the lights to the bathroom on and stared at the dark ceiling. I liked the quietness of the room.That calming effect it brings so I could just rearrange my thoughts as I figure out what to do with a difficult case. Or a rare one if it ever comes in.

I remembered literally ‘talking to Allah” begging for Him to allow me a few minutes of rest  -at least for the next hour – since He controls Time. I even made a twinky promise that He could send in as many resus cases He wanted after 7 Am if I could rest for a while. I was not feeling well myself. I badly wanted to swallow an antihistamine to ease the stuffiness but knowing its horrible somnolence effect on me – I had to think twice. Should I compromise sound judgement in making medical related decisions or just suffer as a sick human being. I chose the latter.

Indeed if only I’ve managed to really shut off – it would’ve been a great 2 hours of non interrupted rest. On the contrary, I was constantly switching my positions.. having delusions of hearing the phone ring or my assistants calling my name. At times, I’d felt a sudden rush of palpitations and I’d be checking my pulse to see if they are regular. I even have thoughts of ‘could it possibly be thyrotoxicosis? ‘ but nehhh.. I’m not getting any slimmer so it couldn’t be.

Before I know it, the azan for Subuh was already in the air. Time to get up, brush my teeth, wash my face and wait for my 1st ‘promised’ critical case to come through the door.

Leak and Seal

My thoughts resonated with the words by my physician today.

Of how in the medical line, it is very important to not take things too personal. In short, we should have no hard feelings towards another individual.

I gathered that there will be times when we kena marah for our shortcomings or for no reason at all. If we allow the negative thoughts to linger on to ourselves for too long – we would feel burdened. We’d feel hatred. Dendam, maybe? So if say, a colleague or supporting staff is not performing to our expectations. Or patients refusing to take their meds and yet have to nerve to defend bogus alternative therapy. Inevitably, although one has all the intentions to shove death statistics and what not to the person in mind, I tend to now take a step back, inhale, jaga emosi and say all the nice things I could think of. And put on rewind in my head, “maybe she had a bad day” “she’s just being difficult today. she will be fine tomorrow” and let the matter slide today so we could achieve more the day after.

Furthermore, if we were to take an eye for an eye – wouldn’t the whole world would go blind? sikit2 nak balas balik. nak bambu balik. 

Like it or not, I have learnt to lower my ego and work with people in a personalized manner. It is not perfect but it’s a lifetime learning process. My expectations remain the same lah tapi– thou shalt not compromise with quality.

So for instance if I want a patients blood pressure to be monitored on regular intervals, after documenting it on the patients card – I may need to approach my assistants to further explain and reinforce my plan. This is because some may not take the time to read on the card and just go about their ‘usual’ way of doing things. Sebab dah biasa <– a very dangerous idea to harbour in ones mind for life.

Afterwards, I may or may not need to put on the chart the scheduled times for these blood pressure to be taken. I don’t like having to do you know tulis time satu2 of when you should measure these vital signs when some individuals on the other hand could easily understand what every 30 mins mean. But I have to and despite after reprimanding these people, I still need to be on the same page with them the next day. Or the next hour.

Because if you keep hoarding these hard feelings within yourself – it will be an obstacle to effective team work. And when people cannot work together, patients suffer. So sometimes I feel like a leaking aneurysm. I ‘leak and seal’. Leak and seal. Multiple times. Selagi I can keep my shit together, it should be ok.

 

A poll to call..

The dreaded last call of the month is over and I couldn’t be happier although the cycle will probably start again in 1 week time. Recently there have been proposals to add on another form of oncall on the roster. Initially I was one of those who strongly agreed to it but now have changed my mind. Because that would mean another extra 4  – 5 calls.

Which translates into my son whining of how his mom comes back home late at night or the next day as opposed to his aunt who is home at night everyday. Which also means solo drive to work in mid morning upon being summoned to come to work. Only to of course continue the normal work shift the next day. While Mr Husband could still cope with his studies and my reckless inevitable routine – I feel bad because I’m supposed to be that stability, that fixed variable in his life so he would not have to worry about minding Ee nor of this wife commuting 27km to and fro to work everyday.

In response to the said proposal, a poll was created. The results came out as a tie. Which was not helpful. The demand of the service however is not something one could easily sweep under the rug. Because in the end the ones who benefit are ourselves and of course, the patients. Either way I have to be prepared to make unpopular decisions. Don’t get me wrong, I love what I do.. but coming from a workaholic who has to consciously make an effort to make my family my first priority – any decision is a huge step to making them matter. And a sacrifice on my part.

You are not a tree, MOVE!

One of those moments when I had total Tawakal to Allah …

Tawakkal (Arabic: تَوَكُّل‎‎) in the Arabic language, is the word for the Islamic concept of reliance on God or “trusting in God’s plan”. It is seen as “perfect trust in God and reliance on Him alone.”

I just had another moment betul2 tawakal last week when I managed a lady with dengue. A severe dengue. And she was pregnant.

It’s one of those cases when even the most bad ass sinner would turn to God seeking help. For all we know, there is no antiviral nor magic concoction to battle the disease yet. We could only provide supportive treatment until the virus weakens, as our antibody fights it off.

If you confront in with an already impaired health status – meaning for instance if you have diabetes or a pre-existing heart condition, it may mean you have to fight harder. Yet doctors and researchers remain perplexed as to why young, healthy individuals still succumb to death despite having nil medical condition.

In my case, I like to think that a pregnant mother gets their extra support to fight dengue from their fetus. Just like those pregnant doctors oncall who seems to have super strength doing their job even though they had to be on their feet and stay awake all night.

On that particular day, the moment the lab called to inform that her blood results were positive for dengue – I had cold sweats. My first thought was, what would my visiting specialist do? I used whatever insight and things I learnt from my boss from a case I consulted a few days before (also a lady who had dengue fever with very low blood pressure) and applied whats relevant in the current case. I kept reminding myself to document my actions and treatment plans properly because if other people do not see it on paper – that means you did not do it. Documentation has always been a problem for me because one, I am very slow in differentiating what is left and right. Secondly, my thought processes are so fast that my hands can’t keep up. However, it must be done for effective continuation of care.

I have been in a mortality case discussion before. Although no fingers were pointed (like, honestly!) – in retrospective, we always feel bad because in hindsight there was always that something you could do to hopefully shift the condition to a better outcome.

After initiating proper early interventions and consulting important people, I passed the baton to my more expert colleagues in the tertiary hospital. From what I gathered, they had a sleepless night too as they had to face several medical emergencies one after the other. But I was very hopeful because it was a strong team working that night. At that hospital.

My adrenaline and anxiety did not stop there. I actually made solat hajat and read Yasin for the patient that night. Which was something I rarely do. Even for those who are most ill. But I felt compelled to do so because during the last minutes prior to transferring her into the ambulance – I caught the face of one of her children. Her son, probably around 8 years old. Crying in the arms of his father who was also sobbing – worried sick for this wife who has bored him their  4 children and now carrying his 5th.

That made me very determined to pray to Allah that night. So this woman could stay strong , so she could return to her family and wipe away the tears of her crying husband and children. And that everything would be okay once more.

Alhamdulilah.. she is now out of danger.