1 Day Story -ho life

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. :)

The Beginner

~Do not give up. The beginning is always the hardest.~

Already 6 days of becoming taggers in medical department, changed my life a lot. Here I just want to share with those who are going to start their HOship later.

So, first day of work means you already have patients you have to take care of, means that you have to be function.

You have to clerk the case for new admission, review the patient for am and pm review, presented to your specialist, and carry out those things that had been planned for the patient.

If patient need to be treated with antibiotics and any other drug, so you have to endorse them in the system, same if your specialist want to do lab investigation for the patient, you have to order it in system, manage the order, take blood and send to lab via hand or pneumatic tube. If the sample is urine or stool, we just ask staff nurse to settle it Actually, I kinda like go to the lab, so that I can free my mind for a while from the hectic in the ward. Certain investigation you have to fill special form or get authorization from specialist.

The hardest thing is when your specialist ask you to refer the patient to other department or request radiology, either CT, ultrasound or radiology report. So you have to present the case perfectly and convincing, so that they will approve your request. My first experience of referring case was very bad and not confident, but the doc realized I’m the first tagger, so he gave me a chance to read back the case and recall them again. But certain doctor will shout over the phone when we presented it badly. Same for the radiology, the stress comes when you can’t complete your specialist plan just because they didn’t accept your request.

About the review, just imagine you have to change your cubicle everyday. So, you’ll see different patient everyday and have to understand their case as much as you can. So, because of that you have to come early. Some people come at 5.00 am to make sure they review their patient perfectly, so that they can present well in front of their specialist, that sometimes come as early as 7.00 am. Just imagine if you get the patient with too many underlying diseases, or too long staying in hospital. Nangis T.T

 

If the doctor discharge the patient, so you have to rush for discharge advice and endorsing their prescription. You have to settle the mc, the referral letter to other hospital (means you have to write them). After that you have to settle the discharge summary for the patient within 48 hours. Sometimes we stay back up to 12.30 am to complete them. If not, our name will be announced there.

The hardest one, if your patient has problem. The staff nurse will inform,

“Doc, the patient’s bp is high.”

“Doc, the dxt hi.”

“Doc, your patient fits!”

“Doc, your patient complains of pain.”

Then, you have to correctly manage them. If out of your capability, then you can only ask your MOs or specialist.

Senior Ho taught us how to deal with certain simple situation, what they call them placebo. For example if patient complain of pain (so many and same patient), just go, ask some history, do the physical examination, and gave paracetamol. And no more complain after that. Haha this is for those patient which we completely know it was nothing significant, and just want to attract our attention.

In a week of tagging, I’ve two patients need to be intubated (it was difficult intubation), and actually this is my first time watching how to deal with desat situation. And I only helped to take and prepare things je for the first and second time.

And dealing with dengue patient will be a lot different from other cases. I’ll update later insyaAllah. Haha the first time I reviewed yesterday just to get scolded because didn’t put how many hours of defervescence phase.

Once, the MOs asked me to take the patient’s blood in front of him and will have to pay the patient RM10 if I didn’t get in first shot. And know what? I have to pay him. T.T But manage to get in the second shot.

So, the first day of work I only able to eat bread for the breakfast, and no more lunch or dinner, going back home at 11 pm just to directly have a bath and sleep. Second day, I have rice for breakfast and no more lunch or dinner. Third day, I have my lunch box. Forth day, my collegue bought me a bread during lunch. Fifth day, he helped me to get wafer during my lunch. Sixth day I bought myself pau kaya and daging for lunch. So, there are advantages for those staying at home and has someone to prepared the food. My sister will cook or but me food everyday. So, I’ll have them before going to work.

Once, we stay-back until 11pm not having lunch and dinner just to present new cases to specialist to get their signature so that we can complete our off-tag assessment. And she started to ask three of us, if we are having meals or not. She showed her care and advice us to treat ourselves well. She also shared her experiences as Hos before covering 30 beds, come at 5 am but still wearing heels and feeling that Hoship is the most exciting time in her life.

And also when I finally can’t control my emotion and started crying in front of another specialist. She told that during her Ho time, she abled to manage MI as her first case although the symptom was too vague; patient just complained of bluish of toe.

And when my radiology request finally approved when she found me cried in front of my friend after being rejected. Because I have to get it urgently that time and had been pushed by the MOs.

Haha many more things to be shared but next time insyaAllah. J

Pray for me I’ll get off-tag on time and not having extension for this department.

 

Antara Tarbiah dan Siasah ~khas untuk anak muda~

Mungkin ketika entry ini ditulis ada anak muda yang sedang:
~giat turun padang berpolitik dan berkempen untuk parti pillihan hati
~berat fikirannya terhadap ummat Islam yang kian tenat lalu turun berdakwah dan cuba mengembalikan mereka kepada Islam yang sebenar
~menghadiri lecture di university, menyiapkan assignment atau thesis, study group, discussion dan sebagainya
~bekerja keras siang malam mencari rezeki untuk keluarga
~berhibur menghadap gadjet, menghabiskan masa dengan games, menonton movie dan hiburan melampau

Dan banyak lagi yang tidak ditulis. Ini sekadar sebagai introduction yang boring sebenarnya.

Jadi, marilah kita tidak men'skema'kan diri dan tulisan. Apa yang berserabut di fikiran atau melompat-lompat di hati untuk diluahkan hari ini adalah disebabkan topik yang saya rasa agak hot la terutama dalam kalangan mahasiswa dan mereka yang mengikuti usrah khususnya.

Mungkin artikel ni tak sesuai sangat pun untuk mereka yang dalam golongan kelima itu; yang masih lagi merasa dunia ini segalanya dan membunuh usia-usia muda dengan perkara sia-sia. Jadi, jika anda golongan itu, stop di sini sahaja! Takut nanti kerana ketidakfahaman, anda akan terus mencerca saya. huhu XoX

'Politik untuk orang-orang tua. Kami masih muda.'
'Tarbiah tidak ada kaitannya dengan politik.'
'Politik kotor. Jangan mencamparkan diri ke lembah kotor itu.'
'Politik menyebabkan Jemaah meninggalkan tarbiah.'

Okayy, kita pergi ke statement pertama.

Mari kita lihat sekeliling kita. Jika anda di university mesti lebih dari 90% adalah anak muda. Jika anda di tempat kerja mungkin lebih dari 70% orang muda. Mana kita nak jumpa tempat yang ramainya orang tua? Jawapannya, di rumah orang tua la! Haha, lawak hambar sebentar.

Konklusinya di sini kita nampak yang memenuhi kawasan-kawasan penting atau yang menjadi tempat berkembangnya negara itu adalah anak-anak muda. Dan masa depan negara seolah terletak di bahu mereka. Dan masa depan mereka turut bergantung pada keadaan negara akan datang.

Jadi, kenapa masih tidak peduli? Kenapa kita perlu serahkan semuanya pada orang-orang sudah berusia. Sedangkan mereka tahu yang tidak lama lagi tempat mereka bukan di dunia. Jika dikatakan negara kita muflis pada tahun 2030 contohnya, perlukah mereka peduli sedangkan mungkin waktu itu badan sudah dikandung tanah. Lalu, mengapa perlu mereka berhabis-habis tenaga berjuang? Untuk siapa semua itu? Tak lain tak bukan untuk generasi-generasi muda; anak-anak dan cucu-cucu mereka.

Dan kita biarkan seolah tidak peduli. Sanggupkah biarkan pakcik-pakcik dan makcik-makcik yang sakit lututnya, perlahan jalannya bergerak dari rumah ke rumah yang jauh jaraknya untuk meraih undi terhadap parti yang dirasakan mampu memperbaiki keadaan negara yang tenat?

Tidak malukah kita terhadap sihatnya badan dan banyaknya tenaga, lalu duduk diam di dalam rumah berehat sambil men'scroll' facebook, insta dan sebagainya? Sedangkan yang akan ditimpa bencana terhadap ketidakpedulian itu adalah kita semua dan anak-anak kita satu hari nanti.

Bangunlah!
Bertindaklah mengikut kemampuanmu, wahai anak muda!


'Tarbiah tidak ada kaitannya dengan politik.'

Usrah membasahkan hati dan menggerakkan amal, membuat kita bersungguh ingin meng'islah' diri dan orang sekeliling. Dan saya sangat respect pada jiwa-jiwa yang sangat faham akan tarbiah seterusnya menggelarkan diri mereka daie dan terjun kepada masyarakat untuk turut menarik mereka untuk faham islam yang sebenarnya.

Namun, terjunan mereka itu hanya setakat beberapa meter dan berputar di dalam bulatan sendiri. Mahasiswa hanya mengambil berat tentang mahasiswa di sekelilingnya, begitu juga ikhwah akhowat student oversea hanya mengambil berat tentang pelajar di negaranya.

Setiap minggu akan diadakan usrah yang sangat basah, membuat diri terisi dengan iman dan ingin terus kuat beramal. Malangnya, perasaan itu hanya berkekalan di 'comfort zone' mereka. Apabila perlu pulang ke tanah air dan meneruskan perjuangan di dalam jemaah mereka kalah. Mereka menginginkan keadaan yang sama seperti dahulu, tanpa sedar yang kini medannya lain, mereka perlu melangkah lebih jauh.

Politik bukan hanya tentang kepimpinan dan pemerintahan. Malah merangkumi masyarakat sekeliling, keadaan negara bahkan perkembangan dunia. Kita faham yang Islam bukan hanya terhad pada ibadah, tetapi merangkumi semua aspek kehidupan. Dalam Usul 1 daripada karangan Imam Hassan al Banna ada menyatakan,

"Islam adalah satu sistem menyeluruh yang mengandungi semua aspek kehidupan. Ia adalah daulah atau negara atau kerajaan dan umat. Ia adalah akhlak dan kekuatan atau pun kasih sayang dan keadilan. Ia adalah undang-undang atau keilmuan dan hukum-hukum. Ia  juga dalah material dan harta  benda ataupun kerja dan kekayaan. Ia adalah jihad dan dakawah ataupun ketenteraan dan fikrah. Begitu juga ia adalah akidah yang benar dan ibadat yang sahih."

 

 

 





Study Tips from Dr Nura ecece~

So, everyone has its own techniques of studying or conquering medicine. I just want to share mine, maybe these things are not applicable to some people but really, it helped me a lot through my clinical years.

Many people think that medicine is all about books and readings, so those who are bookworm are likely to excel in medicine. Is it right? Of course not. For me, medicine is about all; not just reading, but talking, writing, communicating, and so on. You have to make yourself skillful and creative in other to become a good medical student.

READING IS ENOUGH? This is the misunderstanding that many people have. Reading is NOT enough. What's the use of reading if you are not going to memorize it? Many people asked me, "How can you memorize this?" Especially when I can answer the doctor's questions. Some people said, "You're gifted!" Does that mean I didn't have my own struggle to achieve that?

I have my own style which doesn't suit many people. For me, if you want to memorize something, you have to create event, and this will make you keep the information in your head forever.

I taught people the things I learnt especially for my non-medical friend, that I can explain thoroughly to make sure I understand everything perfectly. For this, you don't need to have specific time. You can do this during cooking or having lunch and dinner together. Easy right? That's why I love having friends or housemates from other courses.

I didn't open the book during my public holiday, instead I went to the hospital to meet my patient. They are my textbook, I learnt many things from them and because we met them in person, so it gave me both knowledge and empathy. So, look at this, I see more patient, of course I will remember more!

I appreciated my ward round so much, that I'll try to memorize everything that doctor taught us. Some people tend to write notes of every words that come out from doctor, but what I did was staring attentively at doctor, and hearing carefully every words with my mind worked harder. I'll imagine every single information giving by doctor and create formula to remember it right away in my mind. I'll write and draw everything myself after round, if I felt that I was lacking in the information, then I will ask my friend which fast in writing the notes just now.

Simple right? Be fast, imaginative and creative. It will help you a lot in memorization. Study and search the information that you lack in understanding right after round. It's good to have motivated study mates that you can discuss together everything about the round right after finishing it.

In medicine, you'll have a lot of books, a lot of information and guidelines which some times you'll get confused which one you get to use. Look! Medicine is not about reading. So, here you have to check with your doctor. Ask them everything. If you feel like you are not a person who good in asking question, or you have no idea what to ask, then that's your real problem. Really. If I felt like that, I always blame myself for not studying before round or classes. Study more make you having more question in your head actually, except if you are studying by just reading through not analyzing and understanding it well.

It's okay if the question's not good enough for you to looked clever. Just improve slowly, but seriously, do appreciate your doctor by asking and discussing, because they will stress more on practicality, which is difficult for you to get it in the textbooks.

Finally, if I want to memorize some facts about certain diseases but couldn't found it in my patient's list, then I'll search it on Youtube. Just want to create event by hearing their story. Then, the information will stay for a longer period in my mind, instead of vanishing right away after finishing reading. Do watch videos for certain subjects that are difficult to understand and memorize because it will help a lot.

Finally, please don't assume that I never read books or I just read a little or whatsoever. Seriously, I read. I read to gather information to ask the doctor and involve more in ward round. I also read after rounds and lectures, so that I can arrange the notes well.

Hope you enjoy reading it!