London 290907

I went to London today to do some shopping before i make my journey home in the next two months. Don't really want to rush everything at one time. I ended up buying clothings for my sister from dorothy perkins and H&M instead. Got a few pieces from GAP for my nieces as well. Then had japanese dinner with Chloe at Selfridges. We then head off to the London Eye to snap a few night shots. It was pretty windy and chilly tonite and i dread not bringing my Manfrotto tripod for this kind of shot. I did not really manage to get any great shots, but these are the few that are worth showing. It was about 10 pm before we head back to another high school friend's house where i will be staying over for the night.

Had a few glasses of wine and am ready to hit the sofa for the night.

My window...

Ever wondered how one would look through your window and see what you see every morning, afternoon, evening and night? I looked out from my window today as usual and thought to myself ' Will I will miss this view in about two months time when i am home?'.

I called home and chatted with mom about almost every single new gossips or happenings. We talked about how my cousin sister and her husband had been robbed on the NKVE a few days back. He is recovering from the 'parang' slashes and she is taking more days of MC to allow her bruised limbs and cuts to heal. My cousin sister had jumped out from the car whilst it was going at about 40 to 50 miles per hour after it was hijacked. She had been brave. Had she not done that, i am not too sure whether i would be seeing her anymore. I would have imagined the worst possible outcomes if she was still in the car.

I am quite surprised how unsafe Malaysia had become. I fear for my two nieces after reading the news on Nurin. The little girl who had been brutally abused and murdered. I had jokingly suggested to have CCTV installed in the house. Mom laughed and for a minute I think she did give it a second thought. I then remembered it was not too long ago fibrate had wrote about her in-law's house.

The cost of living has escalated I was told. Mom was comparing prices of raw meat now and a year ago. An example that she often used. She continued saying that an outing nowadays can easily cost more than 50 ringgit. I believed her. 50 pounds can keep me going for two weeks here. And that includes my car petrol.

I ended the conversation early as I had planned to go to town. Again i looked through the window. 'Yes, i am definitely going to miss UK'.

And yes, the window had nothing to do with my conversation.

Time

I have created this video using still photography of the blue skies just outside my window. I was thinking about all the good times i had in the past and whether i would be able to experience them again.

13/09/2007.... First LSCS of the day..Uterine Rupture..

I was on call that very morning. Made my way to the delivery unit and met the consultant and my fellow colleague from the previous night. She looked exhausted. Probably a busy night I thought to myself. In room D, the room that we were all paying close attention to. A patient who had one previous cesarean section and a successful vaginal birth after was in labour.
'Progress has not been good' i heard one midwife commented. 'The CTG looks suspicious' my colleague said. 'I think she need a fetal blood sampling to assess further' she added. I waited no longer. It's all I needed to know prior to gathering the equipments for what is coming next. Fetal blood sampling. A very safe procedure done mainly to access the pH of fetal scalp blood obtained from a few superficial scratches.

The test revealed a pH of between 7.35 to 7.37 in three samples. That is absolutely normal for the baby. Nothing could be better. CTG at this time still remained suspicious. The plan was to see how she would progress in the next hour. I had examined her and she was still about 8 cm dilated. She had been 6 Cm dilated for the last 6 hours. I had requested for her to be catheterized to empty her bladder.

A minute later, it was chaos. The fetus was in obvious distress. The heart rate dropped to a mere 80 beats and remained there for the longest 5 minutes of my life. I decided it was not a good idea to carry on with the labour. I made several urgent phone calls, to the theatre staffs, the anaesthetist, and the consultant. I had wanted this baby out now.... right this moment.

The panic and confused patient was rushed to the theatre for a grade 1 LSCS. My heart rate almost invariably can be felt beating against my chest in cases as such. Patient was in theatre at 0918 and general anaesthesia commenced at around 0925. I had noticed the abnormal hump on the patient's abdomen. I have always called this the 'camel hump' as it looks like the baby's buttocks is raised high on the mother's anterior abdominal wall. Knife to skin at 0927. As I entered the abdomen, a sudden gush of fresh blood and I recognized the pale body of a fetus. 'The baby is out of the uterus! Call the consultant this instance! Start syntocinon 40 units please' I called out in sequence. Baby out in 2 minutes from skin incision.

As usual I had my trusty Paediatric colleagues to help with the resuscitation. I scanned the uterus for severity of the damage. Tears noted extended to the broad ligaments but fortunately no further than that. I had managed to achieve haemostasis. My consultant was there to give me a hand with the remainder of the surgery. We had avoided a possible uterine atony or hysterectomy. Blood loss was less than what I had expected. 500 mls. 'You do like excitement don't you? It only happens to you isn't it?' my consultant joked.

Half hour later, I was told the cord pH of the baby was 6.9. An acute drop. Too close for comfort. It could have been a perinatal mortality case in next month's meeting but thankfully not.

Patient remained stable post LSCS and baby is fine in SCBU.

I had another call few hours later from delivery unit. A patient who again with a previous scar now in the second stage of labour and had fresh bleed from the vagina. My thoughts 'If this is another scar rupture, i will be very very very surprise!'

Here we go again.

Feeling Macro Dirty....

So...i decided to follow suit another blogger, Odysseys of George to show some macro stuffs which are considered as dirty. Yes the all mighty FLY! I had this little fella in my room one day and i literally followed it all around with my camera to get some pics. Well, i am not saying my room is dirty..err hellooooo.. but its just that this nosy little fly probably got into my room as its getting quite cold now approaching autumn. That's one of the reasons for other critters to be crawling into the house.


Its quite hard to get a good focus on this fly as it almost always senses that i am near or perhaps intruding its personal space. And i am sure its because of those super fine sensory hair all over the body. Cool eh? Bet you have not see a fly in this way or up this close before. Guess most of the time its either like 'ice kacang' after you had killed it or it had already escaped your deadly fly 'badminton racket killer'.



Here it is again... on my curtain. This is probably about 10cm away with a 105mm Nikkor Micro lens.

Koala Bear

My cousin is doing her PhD in Singapore and well i got hold of this picture which is supposed to be B cell under microscopy.I was told it looked like a Koala. And i think it does!! ehehhe.. just like staring at the clouds and imagining animals out of it.

Look away if you are arachnophobia

I came back after doing long nights (oncall) and was pretty tired when i saw this little critter roaming around my kitchen. Despite the fact i would lose an hour or two of my sleep, i grabbed my camera and took several shots of this spider. Initially up on the ceiling, it web-slinged itself to the nearby sink and sat there on my cleaning sponge.

Should doctors be oncall from home?

What does it mean when a doctor is said to be oncall? Watch ER or Scrubs and the first thing that comes into mind is that the doctor is working overtime in the hospital...and perhaps also over the night. Right? Well perhaps but not entirely true.

The doctors seen mainly working over the nights in most public hospitals (in Malaysia) are newly graduated house officers and their counterparts the medical officers, or sometimes registrars. So, what about specialists then? From my experience (and please do not quote me), the higher your status the less work it seems when you are oncall. Meaning? Put it this way, in medical field, specialist works from home and can be consulted via their mobile phones. Medical officers can be contacted via pagers/bleeps but they are on site and if needed will come to review. And finally the front man, house officers see most patients admitting or presented to the hospital. I wouldn't even want to mention consultants...as i believe you would get the idea now.

Having said that, this is not entirely true for some fields though, for example surgical/orthopaedics where surgeons are almost always around for theatre times.

So what you may say? It basically mean that the most junior and inexperience person is treating majority of the patients. Surprised? You bet! It may have changed over time but seriously this is definitely very true. Getting the seniors involved therefor depends on the insight of house officers, whether to refer or not to refer. Many a times, fear of disturbing a "specialist's sleep" (so called, but remember they are still oncall and being paid) or even the medical officer delays such decision till the early hours of the morning rounds. Patient would then suffer as a consequence.

Would senior supervision throughout the night help? Definitely. Would night rounds with the seniors be helpful? Definitely. Should there be fear of referring to the seniors? Definitely not! Should seniors be vicious, mean, inconsiderate, nasty to the juniors when they are so called 'disturbed'? Never.

Perhaps we take it for granted that litigation is not as rampant compared to the western world and take the risk of allowing the current practice to carry on. Perhaps we are short of doctors, but we are sure having lots of colleges producing new doctors. Perhaps we have been in such situation (as house officers) and hence felt that the new doctors should go through such 'so called' experience of working but wouldn't it then be a vicious cycle?

This is merely how i feel, what i experienced and it may not be similar to where or what others practice, but hey this is my blog and i think i can voice out my thoughts... hehehe.

Well, what are your thoughts?