Hari pertama Mujahid di Tadika

Hari ni hari pertama Mujahid di Tadika Little Caliph. Saya pula yg nervous. Tahun 2012, tahun baru disambut sederhana sahaja.... takde sambutan sebenarnya....buat mcm hari2 biasa je. Namun yg membezakannya, tahun ni, saya melangkah satu lagi era keibubapaan yg baru..new parenting era...anak bersekolah.

Persediaan sederhana sahaja. Beg sekolah dah beli 3 minggu awal yg mana Mujahid dah rasmikan di taskanya. sibuk setiap hari membawa beg sekolah ke taska...beg sekolah ben10. tak berisi apa2 pon, kosong aje. baju sekolah pula dpt masa open day di tadika 2 minggu sebelum sesi persekolahan bermula. alat2 tulis pon tak beli sbb nanti akan disediakan di tadika...mudah. kasut sekolah pon tak perlu sbb bukannya nak pakai kasut dalam tadika....pakai selipar je.

pagi tu, saya bangun seperti biasa. saya memang merancang utk bercuti selama dua hari utk memantau mujahid di tadika. tapi sbenarnya tak byk yg perlu dipantau sbb saya tak perlu uruskan kenderaan transit, Mujahid akan terus daycare di tadika tersebur. suami pula hari tu ada ujian utk master tp jam 2pm. jd siapkan mujahid jam 8am dan hanya ke tadika hampir2 jam 830am. setibanya di sana, sudah ramai ibu bapa berkumpul dan sibuk menghantar anak masing2. mujahid dengan seronoknya bermain2 di situ, al maklumlah byk mainan di sana. sehingga jam 930 kami di sana, menantikan sekiranya ada sesi orientasi utk ibu bapa, namun tiada yg diberi. pelik pula, selalunya ada sesi perkenalan dengan ibu bapa dan guru2 pengajar. jam 930, teacher dah suruh anak2 berkumpul dan ibu bapa pula perlu beredar. saya terpinga2 kerana tiada sesi perkenalan/ orientasi, tak diberitahu nama2 teacher, jadual pembelajaran anak2, bila aktiviti sukan etc.

disbbkan ibu bapa sudah disuruh meninggalkan anak masing2, kami pon menghampiri Mujahid yg sibuk bermain "ibu dan abah nak balik ni"... saya sangkakan mujahid akan tenang sahaja kerana sudah biasa di taska dan dr tadi sungguh asyik bermain, namun selepas memberitahu dia bahawa kami akan meninggalkan dia di tadika, mujahid terus duduk atas riba suami, menjebek. "nak ikut"

nasib baiklah tak nangis. dan nasib baik juga anak kakak saya juga turut dihantar ke tadika yg sama. kira sepupu Mujahid lah..mereka sebaya. saya menyuruh Hana memujuk Mujahid...dengan bijak sekali, Hana kata " Takpe Mujahid, nanti kakak boleh tolong jaga Mujahid" Hana membahasakan dirinya dengan Mujahid sbg kakak kerana walaupun lahir pd tahun yg sama, perbezaan umur mereka hampir setahun (mana taknya, Hana lahir bulan Feb, Mujahid pula Dis)... saya juga turut memujuk Mujahid dan akhirnya Mujahid bersedia utk ditinggalkan.... bunyi mcm lama nak memujuk tp sebenarnya tak lama pon. sekejap je.ada lah sorang budak yg menangis mengejar ibunya, tp saya tak sempat tengok drama tu smpai habis kerana terpaksa beredar sebelum Mujahid tukar fikiran.

lepas hantar mujahid, saya sibuk menguruskan hal2 saya dan suami pula ke uniten utk study sebelum exam ptg nanti. di hari pertama, pihak sekolah tidak menyediakan daycare, jd jam 1130 am, saya menjemput mujahid kembali ke rumah. tanya belajar apa, kata lukis2 je....hehe...habis cerita Mujahid di tadika di hari pertama.

alhamdulillah.

Selamat Hari Lahir ke-4 Mujahid

"Tepat jam 10.40 pm nanti, genaplah usiamu 4 tahun. Selamat Hari Lahir buat anakku sayang, Ahmad Mujahid. semoga menjadi anak soleh, hidupmu sentiasa di bawah lindungan Ilahi, diberkatiNya, dimurahkan rezeki. Wahai anakku, jadikanlah Allah matlamatmu, Ar-Rasul ikutanmu, al-Quran panduanmu, al-jihad jalanmu, syahid impianmu..inilah doa IBU buat mu, wahai Ahmad Mujahid. Ameen. (asalnya Ibu dan Abah nak bagi nama Amer Mujahid tp remang pulak bulu roma kami sbb nama yg cukup besar maksudnya)"

 4 tahun yg lepas, saya selamat melahirkan zuriat kami yg pertama. Penantian selama 9 bulan itu terasa cepat sahaja walaupun pada peringkat awalnya terasa berzaman. 

Antenatal

suami ketika itu baru bertukar kerja dr UTP ke TNBR...jadi perlu pergi Team Building di OBM, Lumut. saya ditinggalkan selama 2 minggu. Seperti biasa, saya due untuk datang bulan tp bulannya tak dtg2. Saya pelik, stress agaknya. tapi saya perasan suatu kelainan pd diri saya. beberapa selepas itu, saya seringkali sakit perut di waktu malam, mencucuk2 di bahagian bawah perut, awal pagi pula asyik cirit.Nak kata salah makan, tak juga. Selepas lewat seminggu, saya pon melakukan ujian kehamilan sendiri di rumah dan mendapati POSITIF. saya meloncat2 kegembiraan seorang diri. Tak sabar menanti kepulangan suami utk memberitahu khabar gembira tersebut.  Masa bagitau suami, suami tersengih lebar mcm kerang busuk.

seminggu selepas itu, mulalah morning sickness saya yg amat teruk. apa saje yg makan pasti keluar kembali. almaklumlah nih pregnant yg pertama, manja lah skit. tp memang pedih perut dan tekak sbb asyik muntah je. byk pula pantang larangnya. sepatutnya saya bermula bekerja sbg HO di awal Jun, namun selepas bekerja selama 3 minggu, saya tidak dpt bertahan disbbkan morning sickness saya. Saya HO baru, maka selalu dibuli dan oleh kerana tidak sihat, saya selalu MC dan tidak dpt fokus utk belajar dan menjadi HO yg rajin. Maka ramai senior2 HO menganggap saya pemalas. Saya berbincang dengan HOD saya dan dia bersetuju agar saya menangguhkan HO saya terlebih dahulu. Saya senang hati sbb tak perlu menyusahkan org lain.  

selepas tu, arwah mak dtg utk melawat saya, dan ketika itu, arwah jatuh sakit dan didapati menghidap kanser paru-paru. Saya yg tidak bekerja menjaga arwah mak saya di HUKM selama 2 bulan dan seterusnya sehingga saya bersalin.... full time. Ketika mengandungkan Mujahid, saya mengalami byk mood swing disbbkan hormon dan sering dilanda kesedihan melihat keadaan mak saya yg tidak sihat. Dalam sarat, saya seret diri saya utk menemani mak utk sesi kemoterapi. setiap hari melihat mak sakit dan lemah disbbkan rawat kemo tersebut. Bila sedih, saya mula jadi marah2 utk sembunyikan kesedihan saya. 

rawatan antenatal saya dibuat di Klinik Famili, Bangi kerana klinik tu kurang orang. Di penghujungnya, kami dirujuk ke Hospital Pakar Az-Zahrah, Bangi. 

seminggu sebelum saya due utk bersalin, mak pindah dan duduk bersama kakak. saya pula disuruh menyerahkan diri pada hari rabu 26 Dis 2007 utk di"induce" disbbkan Mujahid IUGR/ SGA. (EDD 27/12/2007). 3 hari sebelum bersalin, saya mengamalkan air selusuh, tp bukan air akar kayu apa2 pun, air bacaan doa dan Quran sahaja yg dibuat ileh ibu rakan suami yg merupakan anak murid Harun Din.

Labour pain

saya tiba jam 11 pagi. doktor datang dalam jam 2 pm dan hasil pemeriksaan VE (vaginal examination), pangkal rahim tertutup rapat, belum ada tanda2 bersalin, maka prostin pertama dimasukkan. Jam 4 pm, sakit mula semakin kerap. Saya gagahkan diri utk solat. suami membantu saya dengan membaca Al-Quran sambil menggosok2 belakang saya.Jam 6 pm, VE menunjukkan progress, bukaan rahim (Os) sudah 2 cm.  Khabarnya lepas isya', akan dibawa ke bilik bersalin. Maghrib pun tiba. Tiba2 lendir darah turun (show)..sakit tidak terperi. Saya mohon utk jama'kan solat maghrib dgn isya' namun suami kata saya sempat utk bersolat isya'. Menonggeng2 saya disbbkan sakit. Sudah beberapa kali jururawat datang dan menawarkan kpd saya utk mengambil epidural, namun saya menolak kerana ingin merasa kesakitan bersalin itu sepertimana ibu2 lain. Jam 830pm, saya di VE kan sekali lagi, baru 4 cm. Kontraksi semakin kerap dan saya semakin lembik. Solat isya' sudah masuk dan saya tertangguh kerana dek kesakitan. Jam 930pm, saya mengangkat bendera putih, saya mahu epidural. Namun jururawat hanya dtg jam 1015pm lalu menolak saya ke bilik bersalin utk diberikan suntikan epidural. VE menunjukkan antara 5-6 cm. tapi sakitnyer terlampau kerap, dah overstimulated...agak2nya disbbkan air selusuh. Bidan pun pelik sbb kerap sangat, maybe 5 in 10. sementara menunggu pakar bius dtg, dalam lingkungan 10-15 minit, saya rasa macam nak terberanak, menjerit2 panggil bidan. Bidan pula mcm tak percaya yg saya nak beranak sbb baru sekejap td dia VE saya. Tapi dia mula menyedari yg saya teramat sakit, lalu dtg VE sekali lagi.. alamak, dah fully...cepatnya... ketika itu, pakar bius baru tiba. Mereka tak sempat memasang branula, tiada IV drip, tiada CTG terpasang.. betapa tidak bersedianya mereka utk saya bersalin ketika itu. Precipitate labour lah kata kan. Tergesa2 mereka memanggil pakar saya. dalam menunggu tuh, air kutuban saya pecah, rasa mcm belon air pecah...brushhhhhh....sampai jer pakar, terus bagi laluan utk bersalin. Pakar suruh suami tengok kepala baby tapi suami saya tengok kejap je, tak sanggup tengok lebih2...dia kata ngeri. Dua kali teran, lahirlah Ahmad Mujahid....alhamdulillah.

2 weeks full of challenges part 2

Another week gone by and a fresh new week has arrived. I prayed really hard that this week would be better than last week. I was extremely tired with all the brain-consuming cases. Everyday i prayed that i work just for HIM. Work is also part of ibadah.....as long as our niat (all our intentions) is for Allah....LILLAHI TA'ALA. So this week, Allah still wants me to learn therefore he gave me more of exciting, interesting cases...2 weeks of intensive chronic illness course...

MONDAY 19/12/11

1) This patient was a one week affair patient. He was also my early bird patient for that particular day, came in complaining of genital ulcers for 6 months and wanting to screen for HIV. He said he confidently think that he has HIV. So after asking him a few questions, he said that he once had sexual intercourse with a prostitute who subsequently died of HIV, that was back in 2006. I checked his genital ulcers and it look like either gonorrhea or syphilis. His skin looks like as if he was about to have Kaposi sarcoma. But i wasnt so sure so i showed the genital lesion to my colleague and my FMS. My FMS was shocked, she did not say he has HIV but asking me his AIDS status...looking at his condition, my FMS sure he was already in the AIDS stage. So I sent him for the rapid test, HIV Elisa, hepatitis B/C screening, renal profile, liver function test, CD3, CD4. In KK setting with too many patients, I had very little time to counsel him about HIV. It wasnt fair to do one test without a proper counseling. His case did not end that day. After the rapid test, he went back home forgetting to come back to see me with his result. I called the blood-taking procedure room for his status...YES, his rapid test was positive. So we called him, and he came back the next day (on Tuesday) for a short briefing abt his condition. I completely prepare all the necessary to refer him to our HIV clinic. But he really look pale on that day. The next day (on Wednesday), I received a call from the IK (inspector kesihatan) regarding my notification of this pt's HIV status..he said this pt was already been notified in 2006. But when pt came in to see me on Wednesday for his CD3/CD4 blood investigation, he denied and claimed was not told about his status, so the IK asked me to inform and re-notify his AIDS once proven with lab investigations. Thursday, he came to see me, confused about the HIV clinic which was supposed to be on Friday. Then on Friday, he came in the morning and i told him his appointment is due at 3pm....planning to refer him back to PD.

2) Pt with underlying diabetes and hypertension came in for uncontrolled sugar and plus lumps and bumps at her underlying subcutaneous tissue. Maybe neurofibroma...??? pt was meant to TCA in 1 weeks time to review her sugar but apparently did not show up to me (maybe she went and see other doctor?

moral of the day - as doctors, we are exposing ourselves to high risk disease like HIV, hepatitis, tuberculosis...sigh...

TUESDAY 20/12/11

One patient referred from ED for repeat Potassium (kalium). She went to ED the day before complaining giddiness and noted to have hyperkalaemia (K+ 6.2) with no ECG changes. They wrote there "K+ 6.2 (lysed)", so patient was treated for "Giddiness secondary to electrolyte imbalance". No statement mentioning whether any correction was done nor any repeated blood potassium was done to confirm her potassium level.(to confirm the lysed sample). Pt was discharge and to come back at KK the next day to repeat her potassium level. Somebody at ED seem to be very confident about discharging someone with potassium of 6.2 without repeating it. If the repeated blood was a safe level of potassium, then it's ok to discharge and to repeat the next day, however, i assume they did not repeat it as it was not mentioned. patient can go into cardiac arrest if the potassium is too high. it must have been HO and that HO never discuss the case with her MO...sigh....so she came to me the next day with repeated potassium of 6.7. ECG no U-wave. Thank Allah as pt has no chest pain of sort. I called ED to refer the case as it was meant to be a red zone case. (need to call ED if it is red zone case or yellow zone cases that need special attention)..so I highlighted the fact that pt was "dangerously" discharged yesterday with potassium of 6.2....GERAM.....

moral of the day
1) dont trust your house officer....no no.. i was once a HO too... but we need to make sure  their training is adequate. Lately  we are hearing news about the increase numbers of HO but reducing quality of care from them as more numbers of HO would reduce their working hours and experiences hence reducing their responsibilities and so cultivating a negative, care less environment for HO to work. 
2) if you are not sure, please ask.... it's OK to say "i dont know" and there is no "stupid questions" when it comes to saving life. (Lebih baik kena marah sbb bertanya dari kena marah sbb tak tanya....kesannya lebih besar kalau tak tanya --> this is what i practice during my HO time)
2) MO must supervise more, so meaning MO have extra responsibilities.

WEDNESDAY 21/12/11

oww i sprained my neck 3 times (as per say in prev entry) yet i still come to work and yes, i saw interesting cases that day.

1) this pt came in the evening complaining of bilateral leg swelling for 2 weeks. She came a week ago, investigated by my colleague. ECG, renal profile and Urine FEME were done, at at glance, results were normal. So i planned to send her for a chest xray to see any heart enlargement. (3 importantg caused to rule out in a patient of bilateral leg swelling are HEART failure, RENAL failure, LIVER failure). Somehow, Allah wanted to show me something, so i took a second look at the investigation done the week before. I saw Potassium of 1.6...that was super LOW !!! (i had overlooked at it for the first time, in which i thought it was the creatinine that was 1.6 (creatinine of 1.6 is normal but potassium of 1.6 is super low - normal is 3.3 -5.1)....OH NO.....so instead of just a plain chest Xray, i sent her for repeat renal profile and another instinct told me to do one FBC (full blood count).....she was very cachexic, I asked her whether she had any significant weight loss and she said yes. so i wanted to do thyroid function test too. Anyway, she came back with a normal chest Xray but repeated renal profile showed potassium of 1.7 and FBC of pancytopenia (all blood parameters on the lower side - HB 6.0/ Hct 16/ TWC 2.1/ PLT 123. Vitals stable, afebrile, lungs were clear but her abdomen has ascites with some vague fullness over the lower abdomen query mass. So again, I called ED to refer the case for potassium fast correction and TRO malignancy (query gynaecological malignancy)....sigh... she really remind me of my late aunt who passed away from ovarian CA.

2) A neonate, day 5 of life came for neonatal jaundice. I saw the child has left preauricle skin tag. i wasnt sure with seremban's practice whether a child would be screened for any renal anomalies if they have skin tag/ pits over their ears. As i was unable to call the Paeds MO and my FMS was not too sure abt it also, so i had to discharge pt to come in the next day to repeat her TSB (total serum bilirubin). So that evening, I tried calling the MO again, and consult with her. MUST DO ULTRASOUND KUB, MUST REFER PAEDS.

moral of the day

1) must be very careful of what we are looking at

2) as doctors, we tend to LOOK at things WE KNOW. so can miss a lot of other things that we dont know
3) doctors still come to work when they are not well..sigh

THURSDAY 22/12/11

MC today, sprained my neck badly that I was unable to move it at all....however, because i was meant to refer the neonate today, i had to call my colleague to "catch" this patient. i did not write the plan about the paeds referral and ultrasound because i wasnt sure at that time and i had to discharge the patient first. So any enquries, i asked them to call me. But nobody did.....hmmmmmmmmm.....

FRIDAY 23/12/11

ALLAH'S PLANS ARE THE GREATEST. As i was worrying about whether my colleagues able to "catch" that particular neonate, apparently the neonate came back to me today..... i was happy.... so the truth was that the patient did not even turn up yesterday!!! Haha... ALLAH is GREAT.... so I safely referred the child to paeds and arrange an ultrasound for her. ALHAMDULILLAH

moral of the day - ALLAH IS GREAT. GREATEST PLANS ARE HIS

THE WEEK ENDS WITH EXTREME TIREDNESS BUT A HAPPY ENDING

2 weeks full of challenges part 1

Over the past 2 weeks, i have been awfully tired because of chronic cases that i saw in the OPD (outpatient department). I guess these are the challenges in the OPD. We are seeing different and variety of cases and have to make up the diagnosis, in which 50% who came actually plainly wants MC and majority of them has no proper diagnosis (because patients would come with "weird", made up presenting complaints). But among all challenges, the biggest would be TIME factor as we have very little time for each consultation. This is why many patients complaint that government doctors are not thorough enough. TIME CONSTRAIN has been the issue all this while especially when it comes to chronic and complex cases.

Most of the time, cases that I saw was a mixture of simple and chronic cases. Simple cases include upper respiratory tract infections, acute gastroenteritis and fever. Chronic cases include diabetic and hypertensive patients. But over the past 2 weeks, I have been getting chronic complex cases which require lots of time to think and squeezing my brain out in a very limited time frame. At that moment, I felt my brain was boiling and almost burst. The time limitation made things difficult as i need to focus on the condition and make a proper plan for the follow up. Despite all the difficulties, I felt satisfied because i was able to learn from those interesting cases i saw. Better than seeing same 'ol cases again and again.

MONDAY 12/12/11

I was doing my lunch call this week which means i had to work during lunch time from 1-2pm and my break will be at 2-3pm. As usual, the OPD card would arrive late...most of the time, the card will be arriving at us about 1hr to 1 1/2 hour late. Today, during lunch call, they "threw" me 7 cards at about 1.40 pm. Imagine seeing 7 patients in 20 minutes, meaning each patient will only has 2.8 minutes per consultation. Out of these 7 patients, 3 were complex cases. Dont expect me to see 2.8 minutes for complex cases. Really ridiculous.

1) Nepal patient came in without a translator complaining whole body ache. Denies fever. Other history were unable to obtain. This is really common sense. If you cannot speaks Malay/ English, pls bring somebody who does. The problem with this patient is that he brought in a friend but he too cant speaks any languages except his own language. That would not make any different, isnt it? This problem does not only occur in foreigners but also occur among our Malaysian citizen. So..what is it in 1Malaysia when even our own citizen unable to converse in our national language. Bangla lagi pandai cakap Melayu.  The problem with that is patients always believe that doctors have psychic power who can read their mind. "Cik datang sbb apa ye?/ Pakcik makan ubat apa?". The answers always sounded like these "Doktor lah bagitau saya sakit apa/ Doktor lah cakap saya makan ubat apa, saya mana tahu psal ubat2 ni".....  @#4#%^47 so ignorance

2) 2nd patient was deaf/ mute. i dont blame him for the language barrier. But it's definitely taking more than 2.8 minutes to see this patient.


3) the 3rd case was Philipino, just discharge from a private hospital with the complaint of palpitations for the past 1 month.(whom i guess was just recently diagnosed with a heart condition). She had been fully investigated at the private hospital and has her TCA with the private doctor but because of financial constrain, she want to continue her care here. But the problem was, i dont know the diagnosis, she came in without any referral letter from the Private Hospital. Not that i want to shooh her back to the private, I totally understand the financial problem..but at least informed your treating doctor first and get a discharge summary of your condition before transferring your care. This is really commen sence. Again, the thought that a doctor has a psychic power in play. When asked, she dont even know what was her main medical issues/ diagnosis, which further complicated and annoyed me. All she brought in was an envelope containing blood investigations and a few ECGs. If was like playing a jigsaw puzzle,muddling and sorting out little piece of information. Again, 2.8 minutes would not be enough for that, wouldn't it???I noted some blood investigations were taken from the emergency and few were from ICU..so there's a hint...so this must be something serious if she had been admitted to ICU. Basically, i nagged and nagged her for her ignorance. So to safe time, i asked her to do one ECG and to come back and see me after my lunch break. After consulting with my FMS, I referred her to MOPD. It would be easier if the private specialist refer straight to the government specialist. One problem of getting a good referral from private practice is that some private doctors were uncooperative in writing referrals.Some patients come to us to continue their medications as they could no longer afford expensive treatment but what medications, patients were  unsure, so i asked them to go back to their respective clinic to get the list of medications, so these private doctors would scribbles with illegible hand-writing, like as if they just not in the mood to write any letter. (baik toksah tulis gituh)

so for that day, i finished my lunch call a bit late. sigh... annoyed with the registration staff who sent those OPD card so late, annoyed for those complex cases of ignorance.

moral of the day

1) get discharge summary from treating clinic/ hospitals

2) bring translator if you have difficulties conveying your problem

3) time is always the limitation for a good health care in a government setting clinic
4/ doctors are not psychic

TUESDAY 13/12/11

Pt was just discharged from the ward, withholding her Atenolol and Gliclazide due to bradycardia and hypoglycaemia. On the day she met me, her sugar profile was quite high. Her previous OHA (oral hypoglycaemic agent) was only Gliclazide. I had very little information on why she was never been started on Metformin, But it need to re-start her on something for the sugar control. As in normal cases, pt would not be started on Metformin due to renal impairement. Maybe she has renal problem but i need to know her baseline creatinine and to confirm about it, I have to trace her NCD card (at her NCD clinic). At the same time, i asked her to do renal profile so i can see her current renal status. Apparently her creatinine was 149 ( in which increasing in trend), so she definitely cannot be on Metformin nor sulphonylureas (gliclazide/ glibenclamide) as she would go into hypoglycaemia, so i had to start her on bolus insulin. All these take a lot of my time....

WEDNESDAY 14/12/11

This patient was one of my early bird patient, came in with left sided facial weakness. A-ha, it was easy...it was Bell's Palsy, I was sure about it. Yeah but to confirm, i did a few examinations. The strange thing about it was the weakness was not all unilateral. Apparently, his upper part of his face was showing that he has left sided weakness (unable to shut his eyes, unable to wrinkles his left side forehead) but upon blowing up his cheeks, he was unable to blow his RIGHT side...if it was Bell's, he would be unable to blow his left side too.Something fishy about that finding. i was suspicious thinking that it could be CVA (stroke). So i called 2 of my colleagues to confirm, both of them said it was Bells. but i have this strong feeling that it was not as simple as Bells so i called another different 2 colleague and they think it was CVA....now that was confusing. Luckily i checked his BP and noted that it was super high so without any further delays, i referred him to A&E (Left facial weakness TRO CVA with possible Bell's palsy). Because I'm also practicing DEFENSIVE MEDICINE, every referral I made has its own reason. (before the ED MO chased me around for sending Bell's palsy to ED...ED MO loves to chase us here for sending crappy cases...tehehe), I elaborated, reasoned and justify  that the clinical examinations was not tally with Bells as Bells comes in with unilateral weakness (but not in the pt's case).  Thought pt has no comorbid prior to this, his arrival BP was high. And i did not serve him Nifedipine though he has high BP because if it was a stroke, that it would be dangerous to drastically bring down his BP especially in a clinic where we have no observation facilities. He would be better off in ED, if so they decided to give him the Nifedipine, he was able to be well observed in ED. Thank Allah that i did not receive any rejecting calls from ED that day. I wonder what happen to that pt......(if pt has normal BP, i probably treated him for Bells)

MOral of the day - do practice Defensive Medicine to save your own butt

THURSDAY 15/12/11

1) Bee sting case.. apparently i saw lots of bee sting cases where the bee stinged patients while they were riding motorcycle and the favorite target were the lips.Same goes as this particular patient who walked into my consultation room. This patient was special in the sense that his lips was super swollen, the biggest i have seen so far. Most of the patients, i send them back home. But for him, i sent him to ED. His lips were super swollen and that he also complained of breathlessness (though his lungs were clear). The fact that he said it wasnt a bee, that took my attention. The description suits more of a wasp than a bee. (it was bigger that a bee, it was black, not yellow n black striped). A single bee sting would be fine but a single wasp sting, very dangerous, pt need some observation. As my clinic did not have any SPO2 machine, so i reasoned with ED for my referral ( for observation and spo2 monitoring). Again, i was safe from receiving unwanted call from ED.

2) COPD patient, just discharge from ward a month ago, came in for his MDI. So I gatal2 and asked him regarding compliancy of his MDI. Apparently he was using Combivent BD dosing...(usually TDS) and so I was rather suspicious, so i asked him for his discharge summary to confirm his medication dose, so he took off his yellow MOPD booklet, noted that he was supposed to be on Combivent TDS with Budesonide BD dosing. In the notes, I saw that ward doctors have arrange him for an echo and TCA next month, date was not written in the booklet. So i asked for the TCA booklet and discharge summary to see when is the echo scheduled and at the same time, educating him for his compliancy. Relative agreed to bring in the summary for me. Pt wanted his meds so I said to him, "bring me the summary, only then i give you your meds" ( if i gave him his meds, he would have not come back). So pt was pissed off, left the room and made a statement full of sarcasm "kalau mcm ni, lebih baik jumpa doktor berbayar. Ambil ubat pon susah. Tak yah makan ubat  lah" I was trying to help him and this was what I get. Thank God that his relative was understanding and mentioned " ala, nak bayar duit wad pon tak mampu, nak bayar doktor pulak" So after 30 min, pt's relative came back with discharge summary and a torn MOPD booklet. So this pt was really angry with me that he torn off his booklet and threw into the trash can. His relative had to collect it inside the trash. Yes, as i would have guess, he defaulted the Echo TCA and MOPD too. So my assistant helped them back to get a new TCA...this time around, i really hope that he would not default.

moral of the day - some pt never appreciate your work to help them, they think you interfere with their life.asking too many questions, too thorough... yada yada. "tak tolong salah, tolong pon salah jugak".. so whatever you do, you are always on the wrong side.

FRIDAY 16/12/11

1) My first patient of the day. He came with severe bilateral leg swelling up to his groin (mind me,  his scrotum swollen up too)....YES i remember him, I saw him one month ago during my lunch call on a Friday evening, he came for URTI but because he has underlying DM and HPT, and was told by his relative that he defaulted his medications, I checked his sugar profile and BP, noted to have very high parameters. so I sent him off for renal profile for his renal status and urine to see ketones. Renal profile showed that he has some renal impairment. His relative informed me that he defaulted MOPD TCA years ago....so i asked him to come back in a week time to further follow up with his pressure and sugar - defaulted too!!! So that day, he came in with severe swelling for 2 weeks with shortness of breath. He even has ascites (fluid in the abdomen cavity). but his lungs were clear. His BP was high, sugar was high too.I nagged him for defaulting all his TCA....so i shooh him off to ED (CCF with fluid overload)

2) dengue case from Sungai Pelek. Pt was already seen at KK Sg Pelek on the same day, came back to us just to get a referral letter to go to ED as pt already being rejected by ED triage. For ED, why do you have to reject his case as he was very ill and if you check his dengue chart card, you will see that his haematocrit was increasing in trend. He was dehydrated. Worse, Sg Pelek, how cant you discharge pt with HCT of 50, i mean, his HCT was increasing in trend, at least this pt need some hydration.

3) old indian lady just discharge from ward, came in with a discharge summary but nothing written about the changes in her meds. Pt saying that the doctor in the ward changes her medications and to continue care in KK. The thing is that pt was not fully informed regarding her medications that she actually took Gliclazide, Glibenclamide and Metformin all three (N.B. Gliclazide and Glibenclamide are in the same class of drugs so they cannot be given together). She came in complaining of giddiness. Thank God she did not turn hypoglyacaemia. Maybe the HO in the ward did not explained properly to pt. Maybe because pt already old, she may have difficulties in understanding her meds.maybe maybe maybe (sebenarnya rasa nak marah tapi tak tau nak marah sape...sape punyer kerja nih...nasib baik pt tak collapse kat rumah....haiyaa), so it took me sometime to arrange back her meds.

4) end of the day, a newly married Indian couple came to see me, the wife having URTI.... well i have good ending seeing somebody dressed up in a wedding attire coming into my consultation room.very pretty.

moral of the day - 

1)some pt will only come to you when they are in trouble, when we give them proper TCA they refuse to follow up their care, only turns up when it was already too late. then by that time, they will come to you with issues that will EAT YOUR BRAIN

2) we're cleaning up other people's messy work like in case 2 and 3.

to be continued.....

sakit leher paling teruk

hari ni saya cuti...MC sebenarnya...boring pula duduk rumah...selalunya tak lah sebosan nih sbb mcm2 kerja yg saya boleh buat di rumah, namun sbbkan masalah "ni" saya langsung tidak dpt berfungsi dengan baik. cuaca di luar pun mendung aje menambahkan suasana kemuraman saya.

saya tak pernah terseliuh leher seteruk begini. semalam ketika bangun pagi, dah mula sakit..org kata salah bantal..tp saya masih boleh mandi dan buat kerja lain. cuma masa nak menyarungkan baju, saya tergeliat sekali lagi menambahkan kesakitan yg sedia ada. tapi saya cuba lagi....terus bersiap2 utk ke tmpt kerja. dalam kereta, tengah nak mengundurkan kereta keluar dr anjung rumah, saya cuba membetulkan lubang "air-cond" kereta saya yg paling kiri sekali, maka saya pon terseliuh buat kali ketiga dan ketika itu sakit tuh terus menangkap lengan kiri saya. terhenti seketika di dalam kereta. rasa mcm nak nangis. namun saya sangkakan takde apa2 cari sy terus proceed ke tmpt kerja.

saya mengalami kesukaran utk menggerakkan leher jd hal ini melambatkan proses sy merawat pesakit. di pengujung hari, leher saya menjadi2 sakitnya. bawa kereta pon tak boleh nak teleng langsung sehinggakan saya tidak dpt menoleh side mirror saya. di rumah pon sy tak dpt nak buat apa2. malam tuh nak tido serba tak kena sbbkan sakit...tak tahu nak baring mcm mana. asyik2 terjaga...sakit nyer tidak terperi....badan sudah lenguh tp nak gerak sangat, terlmpau sakit.

pagi tadi, leher saya langsung tak leh nak bergerak. nak bangun pun kena mintak tolong cik abang tarikkan. nak mandi susah, nak pakai baju susah...last2 pergi klinik amek ubat thn sakit dan muscle relaxant....dan amek MC...mcm mana nak memandu dlm keadaan sebegini. setelah makan voltaren dan orphenadol, saya pon dilanda rasa mengantuk akibat dek ubat dan juga kerana tidak dpt tidur semalaman. tak dpt nak buat apa2 kerja di rumah. sehingga kini, leher saya masih sakit terkehel...dah kurang sikit namun kena jaga elok2 sbb silap pergerakan, boleh menyebabkan kesakitan dan boleh terkehel lagi....

hmm....