Alhamdulillah bulan ni berada dalam ward yang tenang. Walau pegang banyak patient pun, tapi just dengue fever. So, simple history and simple review. Just, QID Review leceh sikit, apatah lagi hourly, or 2hourly. Poke without tourniquet quite byk kali fail T.T. But alhamdulillah learnt so many things already with good sp, consultant, MO and soooo nice SN, yg mmg macam kawan. Dengan dah already 2 ptns with positive bfmp found, one plasmodium vivax (logic la because just arrivedd from pakistan), and another was plasmodium knowlesi (no history of travelling, or jungle trekking weh, which meant got in cheras, scary takk?) Dan many cases of leptospirosis with multiorgan involvement. Half months yg best dgn the best collegues :)
Cuma semalam banyak cerita. Dan suka untuk dituliskan agar tak lupa susah2 waktu HO.
Semalam pegang ptn medical mostly yg transfer from other ward, and just one ptn with viral fever TRO dengue fever.
2 ptn PTB, but already smear negative, one waiting for LTOT, another with DILI, just being rechellenged back with pyrazinamide, the last drug to be rechellenged in drug-induced antiTB.
The other was a ptn 36 yo malay gentleman, with underlying nephrotic syndrome secondary to DM, and recurrent admission caused by fluid overload secondary to non-compliance to ROF. So this ptn presented with bilateral LL swelling and pain, which caused him unable to walk for 2/52 PTA. Ptn already planned for CAPD, due to ESRF.
This patient kan, selalu mengadu sakit2 pinggang, sakit2 kaki, dan pernah sekali cakap, "Kalau saya boleh jalan macam pakcik tu kan best. Takde sakit2 macam ni."
Sebab dia muda lagi, ujian untuk dia and family mmg sangat berat. Dan dalam lama2 dia kat ward tu, itu je satu2 kalinya dia merungut. Nak tau tak, amik darah dia sangat susah, edematous, fluid overload, poke keluar air. Nura mmg akan minta tolong senior la, lagi2 kalau blood C&S yg need 20cc. Bygkan setiap hari byk kali kene cucuk, tak boleh gerak, dah ad DFU dan tak lama algi on regular dialysis. Sebenarnya banyak lagi tapi taknak mention.
Dan untuk ptn ni kene request U/S LL TRO DVT. Already started on S/C Clexane as prophylaxis but just 20mg OD i/v/o anaemia.
Selalunya mudah je untuk request u/s but yesterday, the radiologist make it difficult for me. Lagi2 bila tahu kita first poster, make me learnt in a hard way. Made me have to call my MO to ask why it can/t be done as outptn as ptn already on prophylaxis. Asked me to run to pharmacist to get the real management of DVT Prophylaxis, renal dose etc. And alhamdulillah pharmacist was so nice, i got pamplet too after a long explanation from them. Alhamdulillah, request accepted.
You know, at this time, nearly i gave up, i have many others active plans and I want to go back on time (at 2 because got oncall)
And then, amazingly, at lift i've met sp that i have to inform something requested by consultant and got his sign for hepB and HepC form easily.
During taking blood c&s, informed that another sp was searching for me to do assessment.
Haha i didn't prepare anything. You know what, I target to do ACS case as my long case assessment, and already started to read cpg, but when it was so sudden, i just take my clerking sheet for the viral fever one and run to pejabat pakar. Tawakal habis. Tak prepare langsung.
Sampai2 je, ok present the case. Nak start baca case, sp kata, you already 3 months here, didn't need that script. Okay find, nasib ptn tu aku clerk sendiri, bukan ptn org lain, nasib dia takde issues, except presentation dia fever and vomiting. Memang habis la dr viral fever ke semua infectious disease kau kena. Malaria, thypoid, dengue, UTI, pneumonia, meningtitis, etc. Management how can i forgot the most important one, nak cakap kat sini pun malu.
So, i failed, and i was informed that i have to get extended for 1 months because i'm tagging for two months, when Ho actually has to work independently for 3 months. Please pray for me, i passed the repeat one, so i'll not get extended for so long in this super exhausted department, and difficult to get leave one. You know along my time in this department i only took leave once, mc actually, but not got accepted counted as EL, because mc can only got in ED.
So, i went back at 4.30pm and have to come back at 9.30pm oncall with the most malignant MO T.T
So at night, no so many issues, just dengue QID Review, susah la benda2 kecik pun kene marah teruk. Tapi relaks je sebab mmg dah biasa pun dan memang doa sangat2 keajaiban berlaku takde admission. Subhanallah for the first time in my life, got no admission. Zero weyhh. In this dengue ward, when we expect many ptns will come after finished raya.
Sebab orang selalu kata nura J, more then 5 admission la selalu, up to 7 in dengue ward, active ward lain up to 9 je la, dengan dalam passive ward pun boleh byk issues, ptn bleeding, delirium, hypoglycaemia etc, dgn kene tumpang MO ward lain waktu tu. Tapi this call zero. Subhanallah, Allah bagi rehat kejap. Dengan esoknya just runner, sebab selalu kene pegang ptn, yg confrim nura takkan dapat balik at 12 sharp.
Sebab after raya hari tu, cukup la dengan 2 MO yg penat nya asyik kene marah. Seorang MO tu dekat setiap ptn yg nura review kena marah memanjang, tapi mmg expected je, dari dulu dia suka jerit2 kat kita depan ptn pun selalu.
The next day, with MO and specialist yg tak habis2 nak ugut retag semula, extended until 8 months la, transfer to another hospital la, just because date and time not written. Actually, because not me started clerking that ptn, and my friend missed that thing.
Now kan, kalau kene marah, fail ke, knowing that got extended ke, MO ugut nak retag ke (ni mmg berat kalau org tahu nura tagging mcm mana dulu, nak mati dah rasa huhu), memang akan senyum je, sebab tak larat nak seksa diri untuk deppress pada benda2 yg tak perlu.
Semalam curhat dengan SN ward waktu oncall (free sgt kan, haha) baru tahu kerja SN lagi susah untuk medical, byk double shift, takde off, dgn dia dari sarawak tak dapat tukar. she's not a muslim, but when she said that prev she thought that Tuhan tak adil, org lain mudah, dapat tempat dekat2 dengan rumah, department mudah, tapi untuk dia, sangat penat, family jauh, jarang2 dapat balik. Tapi bila semak balik, ada je hikmah yg kadang mungkin masih belum nampak lagi. And i got to know her crush, hehe another ward, handsome and nice man. And i started to tell her how i felt so inferior with my friends, so fast in learning, good in handling patient, and in skills. And how i got extended, when half of my friends already passed assessment. How i scared to be left alone. T.T
Ya Allah. First time diuji macam ni. Ada hikmah Allah akan datangkan insyaAllah.
Dan today, dengar my collegue men'jemah' dan mem'bawang', heard a story about a patient recurently admitted due to sepsis secondary to grade 4 sacral sore. They said that the family didn't care much about that ptn, baru discharged 2 hari, masuk balik, sacral sore dah ada lalat. T.T
How eh the family treated him, and when one of family members claimed they will send him to nursing home as soon as he's being discharged.
Melayuu tauu. Kalau Chinese tu dah biasa. Tapi they are muslims. How can eh, when Allah says, wa bil walidaini ihsana, they can do this.T.T
Moga Allah bantu kita jadi anak2 terbaik, berbakti pada ibu ayah dunia akhirat.
Allah, so many things to learn la in 1 day.
Already many things before, but not being written.
Among the memory, when someone close to me left the department, left the HO life. You know, almost half of my heart went with him. May Allah gave him a better life.
Moga Nura tak give up, terus berjalan, dan datangkan orang2 yg membantu sepanjang perjalanan ini. :)