What do you mean NO theatre?

I previously worked in a hospital in east malaysia where there isn't any dedicated obstetric theatre (am talking about a tertiary hospital). When there is a need for an emergency c-section, we simply call up the theatre, booked the case and several minutes later send the patient for the operation. There are times when we couldn't get a theatre because the two theatres are both occupied with other emergencies. And many times we manage to open the 3rd theatre just in the neck of time to prevent potentially fatal outcome. You can just imagine the adrenaline rush when situation as such arises.

Having worked in the UK for the last two years (well, almost), i came to realised the importance of not only having a theatre specifically tailored for obstetric patients but also an anaesthetist working full time for the delivery unit.

Why? Firstly, when any patient is to have an emergency section this can be done without any delay. If a trial of instrumental delivery (i.e. potentially ending up with a c-section) is needed, this can be carried out in the theatre. This won't be possible where i was working before. I remembered that whenever i had to carry out a ventouse delivery, i had to inform the GA MO that i may come to the theatre for a 'crash section' if i fail to deliver the baby. At this point, there will be two midwifes with a trolley bed all gear up for transfer and another with a shaver in hand. Sounds scary? You bet.

Epidural services in labour? Utmost important to help labouring women to control the pain. Would you be able to get this there? Never... unless you are a specialist labouring away perhaps. Or an anaesthetist. Reason? No one is able to monitor the patient if she is to have an epidural (or rather no one WANTS to monitor). No anaesthetist is in charge of the delivery unit to perform the procedure. Sad right? I had once felt so disgusted with myself as an obstetrician telling the patient that she can't have the Entonox as it ran out and she can't have another dose of pethidine as it was too soon after a preceeding dose an hour ago. Its practically asking the woman to bite on to her 'baju' and carry on with the labour pain.

I was hoping things would be better in the years to come. Alas...how wrong was i. JL in the last week had emailed me and told me that he was put on the 'center stage' and had some 'grilling' as there was a delay in a c-section for 3 hours. This was a case where a women had meconium (unborn baby's pooh) stained liquor and not in labour requiring immediate delivery. Reason for delay? you guessed it... theatre busy with other cases... This would not have happen had there been an obstetric theatre right? I strongly believe its the system at fault. Unless there is commitment of the anaesthetic team to provide the service of epidurals, an obstetric theatre and delivery unit oncall anaesthetist, there would not be an improvement in provision of care.

(me talking to my gwai lo anaesthetic colleague)

me: know what... the last hospital i worked in do not have a theatre like here... and erm..(malu look) no epidural as well...

gwai lo: What do you mean NO theatre? This is so @£$%! ridiculous.

Pictures with my new Nikkor 80-200mm f2.8

cat at abbey gardens

young duckling

canary i think...

duck again

a friend taking a snack while i snap


a robin....
i am in love with this new lens.........ahhhhhh

Awwwww....how cute

I get paid to see this awesome view! First class seat all with attire and limited viewers only. Special VIP seat. Aint that nice?

Waiting in agony

Its about 0746 now on a monday morning of 25062007. Just finished a Caesarean section about an hour ago. Reason? well, fetal heart rate went down to about 80-70 bpm lasting probably about 10 to 15 minutes. Rushed to theater for a grade 1 section. Baby is fine. Thank goodness... (another life saved)

Am just waiting to hand over in the next half hour or so.

Am waiting also for the arrival of my new gadget...toy....boy's game.... whatever you call it. I call it...my 'bazooka'! Its my new telephoto lens...a nikkor 80-200mm f2.8D ED.

And ....to add to this....my Crumpler Mcbain Laptop bag, to house my pearl white Macbook.

ahhhhhh.... i do hope they arrive before the planned protest and strike by Royal Mail.

Now its FIVE!!

When i said earlier that ectopics comes in three..boy am i so so wrong. Another two patient with ectopics was admitted over a 24 hour period. First patient was seen by myself and the other by my colleague earlier today.

I was oncall last night and about 330 hrs plus, had a call from the A+E sister saying that they are really working their butt off...and requested for me to see this patient who hasnt been seen since she came in around 2300hrs.

Me: Hello, its the gynae reg here..... (waiting for an answer)

Sister: oh...hi there... a+e is really busy and i was wondering whether you would be kind enough to help us see this one patient who has a positive urine pregnancy test and in quite a lot of abdominal pain. And she has been here since like 3 hours ago and none of the doctors here are able to attend to her... would you mind?

Me: Sure.. will be there in a second

Sister: you are a star....thanks....

Knowing that A+E is where you hardly get any help, i rushed (well, literally walk) over to the delivery unit...grabbed a few speculums (my plastic companion during my oncalls), swabs, gels and glove and went downstairs.

After a quick history taking and examination...i concluded that she had a ruptured ectopic. I admitted the lady and performed an ultrasound scan on her which true enough showed collection of fluid (very likely blood) posterior to her empty womb...and also all over her liver.

She underwent a diagnostic laparoscopy (keyhole surgery) and subsequently a laparotomy to remove an ovarian ectopic.

I saw her again just now...and she appears to be alright. YEAH!!! another life saved!!

Its Dad's birthday...

Its dad's big day today. I woke up late after an exhausting day yesterday. Stayed in bed till i can feel the warmth of the sun rays (am working nights tonight). I had intended to send a message to wish him yesterday but it was too early for him..and it might have just woke him up from his sleep. Anyways...send the message this morning. I know that sis would be bringing him out for dinner with the rest of the family anyways. Hmmm...it has been a long long time since i last celebrated with him. I guess its time for me to change that..and next year...i will be around (i promise)
Happy Birthday Dad...

(picture has nothing to do with title)

Can you read this?

am trying out the hindi fonts... so here goes

ई लिके हिंदी मोविएस

इफ यू कैन रीड थिस थें इट्स मोस्ट लिके ठाट मय हिंदी इस रेअल्ल्य गूढ़।

ई हवे अब्सोलुतेल्य नो आईडिया वहत थे हिंदी वोर्द्स स्तान्ड्स फ़ॉर!!

बुत, इट्स सो कूल तो बे अबले तो विरते सोम लंगुअगेस यू कांत सिम्प्ल्य उन्देर्स्तंद!!! हाह्हाहाहा

थैंक्स फ़ॉर रीडिंग अन्य्वाय...

Erm..can you understand them?? hehhe...neither can i... hahha..i do hope its not some bad words...

This is how my name is suppose to be in Hindi तन यिअप लूंग
8)

Ectopic pregnancies comes in three

I have always have these things with ectopic pregnancies and whenever i am oncall, it appears that almost always three cases would turn up in the entire week. I do not know why..but i guess its just superstitious. But heck, last friday there was one..and today there is TWO!! Yes two...both listed up for laparoscopic surgery. But alas... i am off work now..and the consultant will be doing it. Shucks.. wish i could have a go at them...

But its alright.. i had my share of surgery this week. Did er..lets see... one total abdominal hysterectomy, one vag hys and posterior repair, and saw one manchester repair. Not too bad i would say.

By the way...you should see the manchester repair that my consultant did. the cervix was so long that it protruded out from the vagina..and its so bizarre. Both me and the consultant stared at it and looked clueless.. hehhee...

busy busy busy

Oh my god..first day at work after my long leave and so so *@£$! busy. Firstly did my rounds in antenatal ward. Not too bad...had only a few patients that i need to see. Then off to gynae outpatient clinic. Saw patients from about 10 am till 1 pm..then accompanied my consultant to do pre-op rounds for cases in the afternoon.

Manage to grab chicken and prawn jambalaya for lunch...then went to theater at 130 pm and performed two elective cases. First case, diagnostic laparoscopy followed by a small resection of a possible endometriotic mass over the broad ligament. Next, did a hysterectomy for a lady with menorrhagia secondary to uterine fibroid. All the time looking at the clock so that i do not overshoot the 5pm mark as i am oncall..... then whilst i was writing up the operative notes...cun cun 5 pm...colleague hand over an emergency LSCS (caesarean section) for poor progress... alamak....

ok..ok...so introduce myself...and then JUST BEFORE starting...got a bleep!! Midwife from ward says got late decelerations on CTG!! aiyo.... howlah i can see the patient... hmmm then i arranged for the lead midwife to go see what the hell is happening. Appears that it was a pathological CTG post induction of labour...ok ok...so decision for back to back LSCS... (hungry somemore that time).

After second LSCS,,hurried to grab dinner...then aiyo...still got 4 patients to review in antenatal ward and one patient to have an ARM done... hurry hurry hurry...



by the time i knew it was 830pm and handover period, my bleep went off again. Its my colleague bleeping me and coming on for the long lonely night... sigh...what a relief...

i am oncall again tomorrow...

Nothing better to do...so much time!

mom and dad went back to malaysia today. I drove back to La Klo Yee after Heathrow and although initially had intended to go out to meet paul and vinna....but it was raining quite heavily (was in the car driving... @%!£% took a wrong turn as tomtom no GPS signal!)...so i decided to be 'lazy'...i stayed indoors instead..and started on my little project (and i promise you that more will come).

I have always wanted to make my own animation using still pictures captured on my camera (dunno why, at the same time...got a Mac magazine and they were writing an article on how to!! yippee!). So...i was like thinking hard on what object or subject to use. Then... blink!... i remembered CH had bought some...erm...erm...dunno what those dolls are called lah. From Prague...

So, all ready... camera out (my D70 Nikon), tripod...and then snap! snap! snap! .... but aiyo... battery run out. Forget to bring charger! Shit...

CH: erm erm... (cooking her porridge) use mine loh... i dont know whether can use or not lah...
Me: Can ah?
CH: Can..
Me: thanks (inside.....jumping up and down...boing boing boing like small boy excited)

Camera ready... Powershot S3..snap snap... I think i took about 274 pics to make this short film. Uploaded onto my Macbook's IMovie and then did some editing. So here it is...the end product. Cute leh... I call it...erm "THUN YUP LUNG" -meaning in cantonese..(direct translation bounce into hole!
MUAHAHHAHAHAHHAHAH

oncall on monday 18062007....

(will be back to this working environment.......)

my two weeks leave will be over this sunday. two weeks as a tour guide for my parents. hehhe...hmmm quite tiring. more like oncall 24 hours day after day. tomorrow i will be heading down to london again and over the weekend to meet up with my mates. i think we have plan for something but i cant quite think of (more like cannot remember) where we are going or what we will be doing. whatever it is...i am sure i will enjoy it. Joshua had wanted us to have our tattoos done over the weekend... but yet again i am not sure whether it would work out this time. I had suggested that we crashed La Klo Yee one last time before it is closed for good. Making sure we have got lotsa lager and wine (dont care whether red or white, just heck it and drink till vomit out all our gut juices) to last us multiple rounds of 'chor tai tee'.

I want to go diving!!!

Oh..how i wish i can go diving now... hmm its been so long now since i last dive. I have gotta get into those tight wetsuit of mine and breath some compressed air and to basically listen to my breathing and the sound of bubbles rushing through my ears....and frantically trying to capture underwater images with my nikon d70. ahhh.... how long more do i need to wait???? erm..HM, if you are reading this...lets plan to dive end of the year mate. And this time...can capture more of my picture ah? i was just going through my collection of underwater pics and i think i have hardly a handful of my picture.... sigh....

Venice (Italian: Venezia, Venetian: Venezsia, Latin: Venetia) Part 2

I just stocked up my fridge with lots of lager.. its so warm here in Suffolk during summer that i need some cold beers to cool myself down. especially during the night. Not as warm as in malaysia but still warm for me.. hehhe...Oh how i wish i am diving in some remote island south of thailand... ah....ah.... nice.....

Being Casanova....

We all know who Giacomo Casanova is. He was famous for being a womanizer but alas many didnt know that he was also a famous Venetian adventurer and a writer. He uses his charms to conquer women during the 18th century and the story is he had sex with at least 120+ women!!



I saw this shop and within it, a Casanova mask!! I bought the mask eventually...hmm perhaps in the near future place it in my apartment as a form of deco. But just prior to that i just had to take a picture of myself in it. hehhe... and mind you... there were lots of other mask to accompany me...

Venice (Italian: Venezia, Venetian: Venezsia, Latin: Venetia) Part 1

Night views at the Grand Canal.


A typical view encountered in almost every single corner.

Venice (Italian: Venezia, Venetian: Venezsia, Latin: Venetia)

Venice. A place where couples were very keen to explore and to experience the romantic scene, beauty, ambient, the carnavale. How untrue.. the venice today (from how i see it) is full with tourists...including myself. Left, right and centre...all over you will see people. There is not a corner, especially at the San Marco square that you wont find a homo sapien. But yet it still offers plenty of photography opportunity. For the next few post..i will be showing some of my best shots around Venetia. I took a very short trip to this part of italy...and love it!!!

Eggs

My mates got me a pair of eggs. Rubber eggs. They bounce when thrown onto the floor. They smelled like rubber. They feel like rubber. They weight as close as 'free range organic' eggs do. They looked damn real. But i cant cook them when i am hungry!

On-call

What do i do when i am oncall at night?

10 things i do....

1. I work for 12 hours straight shifts.
2. I work alone if i am working night shifts. Meaning.. i carry both the SHO as well as the Reg's Bleep (or pager and yes.. i work alone at night. No SHO).
3. I cover the antenatal ward, gynae, central delivery suite as well as any referrals internal or external (GP referrals).
4. I have to write up all fluids and medications.
5. I insert almost all needed IV access.
6. I do all the emergency caesarean sections, manual removal of placentas, extended perineal tears and attend all emergencies (well...i do call for help from the on-call consultant when there is the need!).
7. I see all patients coming into central delivery unit who are categorized as high risk.
8. I reviewed all non-reactive CTGs.
9. I get to sleep when i have the time. But, ever since October 2006, i decided not to...as i will still not be rested.
10. I make men cry by delivering their newborns.

the very first thing i knew about Zambia

Just prior to my two weeks annual leave to be a personal tour guide to my parents here in the UK, i was on-call. And during that hot saturday afternoon, I had a patient who is into her term plus 13 days of pregnancy. Erm... thats what we think she is..because we have absolutely no antenatal records whatsoever from her country of origin, Zambia. She left Zambia to be in this country when she was about 35-37 weeks pregnant and i have no idea how it was possible for her to escape the flight restriction.

Anyways, she was induced for post term and planned for an artificial rupture of membranes (i.e. erm...breaking the membrane at the neck of the womb/cervix to release some yucky 'pandan smell' of fluid to release some chemical substance which would then start the contraction... yada yada yada).

Problem!! We (midwife and myself) noted that she didnt had any antenatal booking blood results of HIV/RUBELLA/HEpatitis B or C!!!

That sort of makes things more complicated as Zambia, since the mid 1980s has been compounded by one of the world's most devastating HIV and AIDS epidemics. The statistics alone are shocking:

one in every six adults is living with HIV
98,000 people died of AIDS in 2005
life expectancy at birth has fallen below 40 years
710,000 children are AIDS orphans

The prevalence of HIV infection in women giving birth in London was 0.38%,compared with
0.06% in both the rest of England and in Scotland (RCOG).

and, and..... fetal heart rate is not the best as well.... BUT,

I dont want to cross infect her baby iatrogenically.
I dont want to risk myself or my staffs to possible infection by not knowing her status.
Heck, i dont even want her not knowing her status and then not getting any possible treatment...

We then manage to get an URGENT HIV testing (courtesy of the oncall consultant microbiologist) and got the results within 3 hours (how efficient!). IT WAS NEGATIVE. Phew.... what a relief. I did what needed to be done... i ruptured the membranes........yucks...


*Any women diagnosed HIV positive during pregnancy should be informed that interventions (such as anti-
retroviral therapy, caesarean section and avoidance of breastfeeding) can reduce the risk of mother-to-
child HIV transmission from 25–30% to less than 2% (RCOG).

Dad & Mom in Europe...

My parents are here in London!! Picked them up at Heathrow this morning. They have been around europe for the last one week and i will be their tour guide for the next two weeks here in the UK. Have planned for them to do some shopping tomorrow at Oxford Street, Harrods and possibly Selfridges. Then it would be journey up to Bury St Edmunds before a short trip to Venice. Hmmm planning to take some pictures of them on the gondola since erm...they make me so 'pei' by being SO 'LOMANTIC'!!

NiCoLe

Wanna know how cute my niece is? She danced to my fast and furious soundtrack...thats how cute she is.. hehhe

Oh and by the way, if you are wondering how old she is.... its 1 year plus. Yup... 1 year plus and the video taken in my car...

Pregnant?

"For 14 years I had my stomach stapled before they realised I wasn't fat, I was pregnant"
www.dailymail.co.uk


In my limited years of working as an obs and gynae registrar, i have encountered patients quite like the cartoon above.

Today, i met another who didn't know she was pregnant. She is already about 30 weeks into her pregnancy. Really...how hard is it to tell whether you are pregnant?? If you are to have sex and use absolutely no contraception at all, you stand a chance every single month to be fertilised (well, provided you ovulate every month). And as long as one is still menstruating, there is a possibility even if 50 years of age.

"Miss a period, check the urine pregnancy test!" is what i can hear my lecturers screaming when i was still in med school.

making men cry...

I made two men cried in the last 24 hours. One was yesterday when i delivered a baby via ventouse (or vacuum) delivery. Baby cried straight after birth and then the next whimper came from the dad!!! Surprisingly at that same moment, baby stopped crying...hmm perhaps trying to listen in to the father...

Next was at cesarean section today. Another dad cried... He was in the midst of taking pictures of his baby boy halfway out of mom's abdomen. Hehehhe... i manage to put up a peace sign when they were about to take a family picture...but ah..the consultant anaesthetist says 'looks like the doctor wanna join in but because of hospital policy...erm... NO!' sigh... never mind...