making others happy is one of the best ways to have a great day yourself

HSAJB at night..really miss the red-bricks strong looking classic building...

Ramadhan kali ni kira genapla separuh dekad aku jadi tabib..pejam celik pejam celik (sebelum mata terpejam terus nanti)..dh lama rupanya memberi khidmat bersama kerajaan demi meningkatkn mutu kesihatan rakyat..huhuhu..time flies so fast.

back then,for the first time i celebrated Ramadhan as a very new 1st poster HO in HSAJB.. it was so memorable-sbb kena berjimat thp dewa,just because gaji yg xmasuk2 utk tempoh 3 bulan..so xde pilihan,oleh kerana mmg xde cuti jd 30 hari posa mkn mknn oncall..walking to the mosque which almost took me 15 minutes walk for terawikh on non oncall night since even we got no money to pay for the deposit of a new car..(but tq for the very friendly PPKs yg selalu simpan khas mknn utk aku wpun x oc.huhuhu..susah dh la ni nk tengok PPK tolong simpankn mknn utk doktor)

tp dlm byk2masa mgharungi bulan posa,Time Ramadhan yg plg sukar dilupakn adlh peristiwa oncall di mlm raya(semua HOs non johorian xdbenarkn cuti raya pertama,olh krn cuti max 3 hari sahaja maka aku putuskn x balik kampung thn tu-terasa raya mcm kt zimbabwe).

Mlm 1syawal tu adlh mlm oncall aku.. bezanya kali ni sbb raya sekali dgn deepavali so for HO mmg xcukup org yg oc..mmg sucks sgt time ni..dgn pt yg ramai tp beban kerja xpernah kurang(tp aku syukur la jugak..sbb byk belajo dgn adanya tekanan kerja tersebut).but we never complained since we understood that our MOs are far busier than us.

kbykn masa kami tengok pt then informed MO when we feel insecured with the diagnosis or our mx, then we just continue working n seeing another pt.but post oncall i used to check whether my MO did counter-check or not my works for that night n surprisingly all of the patients were counterreviewed by them(they used to come 'dunno when' once they believe in u..u must convince them your management to sound like up-to-standard level of care).thus,u do whatever u think essentials for the patient n make sure Do No Harm..n in fact during that time u also wont have time to wait for them n vice versa.

Then there was one uncle admitted.given his body built i
knew the problem that he might have-from the moment he stepped into our ward-typical DM,hypertension n hypercholesterolemia middle aged man.

A 50s y.o known to be a diabetic patient was admitted with a history of polyuria and thirst. He now felt feverish n ill and brought to the hospital by wife (he refused to come). There was a history of poor compliance with medical therapy.
on examination looks lethargic GCS full.Chest was clear. Circulation was good.Urinalysis: 2+ ketones, 4+ glucose. Biochemistry on admission normal BUSECREAT.discan 24mmol/l. Arterial blood gases were metabolic acidosis(even the student knows this spot dx result)..the blood collected at emergency n certainly the dx is clear DKA.no need to think other differential dx that can give other acid base disorders like this. So senang la hati sbg HO since i knew the dx..much easier for me to formulate the mx plans.

i did this n that..since it was already past nidnight..technically even from the Maghrib prayer time it means we r in 1 Syawal already but that night the air of Raya was so vivid..filled with breeze of takbir from the nearby mosque of sultan
abu bakar..

to make myself felt lucky enough even needed to be oncall that night i just kept myself busy n focused for my this particular DKA pt..Ok Iv cannulas 2 large bore set,CBD set,antibiotics prescribed n CVL subclavian checked..everythings seemed OK already n plans were told to staffnurse to commence the replacement of the fluid loss..and my ultimate mx of course to let my superbusy MO well informed..

I can see the wife looked so anxious..so i explained all the important things that she needs to know about her .. then she asked me "Jadi doktor boleh ke sy balik dulu sbb saya td dtg ketupat kat atas dapur,rendang dh nk tunggu masuk kuali,lontong plop fevret family pun saya dh start siapkn santannya..lemang lg n this n that"..i was amazed she cooked all those things for 1st Syawal..

me : "byk nya masak"?betul ker?tp ni suami dh x sihat ni..

wife : tp td dia ckp dgn saya mcm dh ok sikit.terima kasih kat doktor.

me:yer..td mmg dia lembik(even during CVL settings he was so cooperative possible partly it was due the fact that he was too tired)..dia baru nk sembuh sikit je ni.

wife : doktor tp saya rasa sy kena balik dulu la..anak sy ni akan tunggu suami saya..nanti pg sy dtg..

...given my capacity as an HO i was not so judgemental to force her to stay..so i put the bed just in front the counter n i sat there while waiting for my MO since my gut feeling was not so ok that time..i can see the pt threw a smile on me after he did the same to his wife who was leaving out from ward...

i waited..continue waiting..n waiting..n then i saw he started to be uncomfortable with the nasal prong oxygen..sigh,early signs..now almost 2am..i feel so responsible to let the wife went back home...

mana MO ni..adakah aku missed sstu..i did everything..checked.POSITIVE.

then suddenly he started to be more distress n encephalopathic..that's it.. time for step up mx : ventilation.
should i intubate him?.mana boleh sure anaesth kena ni.just then tnampak la bygn fizikal MO dtg dgn cool n saw the pt..he read my mx n then gave a call to anaesth team.

Nasib baik..akhirnya aku pun lega.tp rasa ralat sbb dia punya wife xder..yg ada anak lelakinya yg dr td duduk main handset(maklumla mlm raya sure byk wishes)..

oleh kerana pt pun dh transferred ke ICU so i dont have to be worried anymore.time utk balik mass n mandi
n tuko baju n buat routine round..tinggal 1 HO utk setiap ward.ada 30 pt so better buat round subuh2..

then datangla seorang pompuan yg mcm aku kenal..rupanya wife pt smlm.she didnt even know dat her husband dh masuk ICU??i was puzzled.

wife : Doktor ni sy nak bg mknn pg ni utk doktor ..dia hulurkn 1 mangkuk tingkat mknn..

me : i was so surprised..huh??xperlu susah2ni..tp tgn yg menerima ni amikla jugak sbb mmg aku teringin mkn juadah raya..mana ada kedai bukak..

wife : xper doktor mmg sy niat nk bg doktor sejak mlm td lagi..

me : tp smlm pakciknya xstabil lepas puan balik..saya pun rasa ralat jgk benarkn puan balik.

wife : xper doktor , doktor kn dh buat yg terbaik (she helped me a lot masa counselled psl CBD mlm td..sure dia tahu susahnya nk pujuk suami dia tu).

me : okla awak pi ke ICU tgkt 4..



the tiers was filled with different meal...from the bottom heart of the patient...



...aku buka mangkuk tgkt tu mmg betul la semua ada sprt yg dia beritahu apa yg dia nk masak..lontong lemang ketupat rendang..how come?dia xtido ke mlm td.

then aku xder masa nk follow up dah pesakit ni..till one day a man came n bersalam dgn aku utk bgtau dia dh boleh balik..mmg beza dgn nampak segak n bertenaga wpun stigmata of DM masih kekal..

terasa mcm dihargai bila pesakit mengucapkn terima kasih utk kerja kita yg xseberapa..

this single particular experience as a young HO makes me feel so blessed to be doctor..i was not that heroic but yet since i was the first person who saw the case they treated me like one.

i started to be more confident following that..the nearly-zero energy level for that day seemed
powered by the 'mangkuk tingkat n big TQ' for a small contribution of mine.

oleh kerana ni adlh very first encounter on call challenge..i felt boosted with the experience.seeing them happy was the top priority but seeing them happy with what u have done unto them even make me more than happy..

for this entry i would say : sstu yg mungkin BIASA bg ORANG LAIN,mungkin LUARBIASA bg KITA.

Be the solution, not the problem...may be u r not strong enough to settle a great problem but u might be good enough to encourage others to do so..