pink or blue..sometimes you have to be brutally honest.

This section is sort of 'signature' for me as lookng from the 6th floor of HSNZ

Alhamdulillah..gerimis jugak time cuti weekend2 mcm ni di Kuala Terengganu..setelah musim monsoon tahun ni xberapa nak mosoon..panas terik je for the past few weeks ni..mmg sesuai cuaca macam ni buat blog sekadar mengisi masa lapang..

Time jadi HO dulu rasa mcm xsabo nak abiskan HOship sbb xsanggup dh keje yg menimbun tanpa erti kehidupan yg stabil..tapi bila dh jd MO sometimes i did miss my HO time..jd MO lama2 rasa sgt routine sehinggakan nak sambung belajo buat kepakaran pun rasa xde motivasi yg tinggi..

I prefer to share my experiences ..working in medical line rather than sharing my travel activity..so that in future,when i get older i still can 'revisit' my life during adulthood as a junior medical doctor in which so called 'embedded' in my blog..since in our years of junior Medical officer oncall time i used to be more than tired,"shattered" should be the best word

Seperti biasa,kebanyakkan kes yg memberi impact pada kita adalah kalo kita jumpa any particular patient for the first time.pada kita mmg sudah terbiasa jumpa patient kes yg probably sama before this but bagi ibubapa pesakit ni adalah first time mereka di'duga' tuhan cabaran anak yg sakit..

One-not-so-fine Maghreb .a baby was referred to us for ?heart murmur in which the impression was to rule out congenital heart disease..the mother accompanied the child till i met them at our casualty unit..

After a quick examination i found the baby is a straight forward case of cyanotic heart disease.without any doubt, the baby has to be admitted to our ward for further management..

Ibu : doktor so mcmana dgn anak saya (dgn tangan didada silang).-nowadays some peoples just forgot to practice mannerism perhaps..

Aku : Anak puan ni kami syak ada jantung jenis biru..biasanya sakit jantung jenis macam ni kena masuk wad dan kami akan konfirmkn dulu jenis spesifiknya.

Ibu : sakit jantung???dia ok je xnampak biru pun..(denial state)

Aku : ye mak dia saya setuju dengan mak dia..(honestly with the dry lips in which some normal babies can have it and the extremities looked rather pink than blue with my naked eyes).dari pemeriksaan fizikal and oxygen level kalo tengok machine ni memang jelas jantung jenis biru terutama kalo mak tengok dia tgh nangis ni(the child nearly have tet spell@cyanotic spells) cuma kami xpasti lagi jenisnya.biasanya lps kami buat echo kami akan rujuk ke ijn..

kalo anak mat salleh maybe senang nk bezakan blue or not-blue..but in our population cyanosis can be especially difficult to appreciate in darkly pigmented Malay infants.

Ibu : doktor anak saya ni dah hari ke 5 ni..aritu masa kat wad semasa lahir ada doktor check kata semua normal..macamana boleh sekarang baru detect(i sensed her voice signalling some dissapointments with the 'doctor' or to our care in general)..kenapa x check betul2..

..dlm hati aku syukur la ..at least Allah buka 'otak' doktor yg check n detect the murmur even at Day 4+ of life n referred to us for further management

Aku : mak dia..mak kena paham..dalam badan kita especially baby ada perubahan2 yg kita kena phm..sstghnya berlaku pada waktu tertentu selepas lahir..

Saya xhairan kalo doktor yang check sebelum ni xperasan hal ni sbb secara kasar awakpun x nampak anak awak biru.awak datang check arini pun utk kuning tapi doktor tu kira bagus detect anak awak ada masalah jantung..

....ni memang magrib2time paling best nak bagi lecture la ni..

Aku : (sambung lagi)..mak dia kalo baby biasanya doktor akan syak baby ada masalah jantung kalo berlaku 2 keadaan -1. Kalo memang baby biru secara terang2. 2.kalo bunyi kat dada dengan stetoskop ni detect sesuatu.

Ibu : tapi aritu pun anak saya ni dia check Xde plop detect kata bunyi jantung bermasalah.

Aikkhhh..bunyi makin lain macam..anak tgh sakit..dia plop sibuk nk tanya mempersoalkn why this why that seolah2kita plop buat 'dosa beso'...

i used to be very empathic with my patients..but sometimeswhen they ask me many 'weird' questions, i feel obligated to give them my sarcastic answers.

Aku : mak dia..xsemua org blh detect 'murmur' ni dgn baik.even sstgh keadaan kalo anak kita bukan jenis jantung jenis biru kritikal mereka maybe akan datang lewat ke hospital..ni kerana secara normal tekanan darah di paru2 akan start turun perlahan-lahan dengan usia baby.bila ada perubahan tekanan ni baru berlaku pergerakan darah contohnya melalui lubang dijantung baru blh hasilkn bunyi murmur ni.kadang2amik masa berhari2 atau berbulan2 utk tekanan tu turun bagi membolehkn doktor dengar bunyi murmur ni..(aku xpasti dia paham ke x)..mak dia paham??

Mak : mengangguk tanda setuju tapi aku rasa dia masih xsetuju.

i understood that some mothers who face this kind of situation will possibly show their worst emotion..crying,tearful,screaming n etc but most of the time they will be calm with proper explaination..Unless they constantly n persistently looking forward to blame us for the mishaps.

Assessment of the newborn to detect CHD(congenital heart disease) is focused on the history and physical examination, but several studies have shown that the newborn assessment can miss a significant number of patients with critical CHD.This was illustrated in a retrospective English study of 1067 infants (diagnosed with CHD by 12 months of age) born between 1987 and 1994, in which 82 percent were not recognized to have CHD before hospital discharge. Of these undiagnosed infants, 306 (35 percent) became symptomatic or died without a diagnosis before six weeks of age.tapi ni kat UK so long time ago, i just would like to share those figures.

tapi apa yang nak aku emphasize here..the importance of our junior doctors/HOs to provide better explaination for some 'difficult' parents since sebenarnya sometimes physiological changes that occur later afterbirth yang menyebabkan kesukaran utk kita detect any possibility of CHD early. More often our junior doctors tend to asnwer "Dont know" or keep themselves silent when asked by parents the reason for the late detection.

sesuatu utk dikongsi, sekiranya tiada bunyi heart murmur yang kita detect afterbirth but then suddenly noticed few days of few months after that we should know it is 'highly explainable' so do not answer "i dont know". sebagai contoh elevated pulmonary resistance in which normally yang memang berlaku for infnts afterbirth and can be up to months.. may limit the flow. The volume or velocity of flow across a ventricular septal defect may not be sufficient to be audible until the resistance has fallen.such an easy explaination should sufficient to give a good answer for the anxious parents.

 

 Informed medicine and proper explaination are really helpful..do not put your patient for unneccessary anxiety and start 'backfiring' you..

"sesuatu yg biasa bagi kita boleh jadi luarbiasa utk org lain"-SH