:: post-call ::

1.25pg, 3rd September 2010..

'post-call'.... adelah perkataan yg plg digemari oleh doktor2 seantero dunia. ia bermaksud, baru je abes on-call, n aku boleh balik tido lerr.. hehe.. yes2! mlm ni adelah mlm on-call plg best sejak posting Internal Medicine ni.. sbb mendapat layanan yg baik dr MO yg oncall jgk tu.. best2 heheh.. xmacam mggu lpas pnye oncall, asek kna marah je.. Ade je benda yg xkena. Buat itu salah, buat ini salah. Xbuat pape pn salah. Hish! dahla hari tu ade teaching, n ak kna attack bnyk gileee soalan dr prof, smpai ak sakit kpala! huhu. dah2, tanak ingat, mggu lpas xbest

Balik dr wad pukul 12.30am td. Masa balik, lalu kt A&E, ade students Surgery, katanya kna masuk OT the operation theatre. huhu. Mmg terbaiklah kan, masuk OT pagi2 buta ni. Kalo ak sah2 xlarat. Penat la masuk OT sbb kna berdiri lame2. dush.

Masa on-call review kt A&E ptg tadi, ade pergi kt seorg makcik ni. Dia dlm bilik Resus. Dh namenye dlm bilik resuscitation, mestila makcik ini kurang stabil. Ape yg ak dgr dr MO yg present case ni, this old Malay lady presented with shortness of breath n gasping for air. She was then turned unconscious. ECG was done and it was asystole! resuscitation done, im not sure how many cycles of CPR, atrophine and epinephrine given but during the Specialist review, she was unconscius, and the pulse rate was 48bpm, blood pressure 46/25mmHg!! bradycardic, hypotensive while on norepinephrine infusion. Dr Rozita said, it's better to stop the drugs because even the patient survives, she will ended up with HIE (hypoxic ischemic encephalopathy). So, theres no point to prolong her life as it will increase her suffering, increase her burden. Then i donno wat happen after that but when i come again to A&E, she wasnt there and the bed was replaced by another makcik. May be she was already passed away, or may be she was sent to ICU, i dont know. [tetibe ak teringat quote Dr R from CCU, HKL; we try to save patient, as much as we can. but if patient still unrespond to treatment given then let the NATURE to take it course..dont prolong the suffer]

Hari ni jgk, dlm pukul 3 ptg, ada 1 kematian di wad. Septicemia. (septicemia secondary to ???). I dont know about this patient because he was admitted last night, unconscious. Masa ngah teaching ngn Prof Roslan, tetibe tgk keranda masuk. Dah agak dah, mesti pakcik ni. Dan, sebetulnya dia. Al-Fatihah.

Kedua2 kejadian ni mengingatkan aku ttg kejadian semasa aku posting Emergency Medicine. Juga berlaku di A&E. Bagi yg x tahu A&E tu ape, ia adelah accident n emergency unit. hehe. erh, ianya bermula apabila seorg Indian man, in his 70s, dtg sbb rase suah bernafas. Ade jgk chest discomfort. Masa tu dlm pukul 9.30mlm. Ak nk buat branula kt uncle ni. Aku try buat, tp x menjadi sbb cucuk je, terus bump! ak ingat lg uncle tanya, 'why it takes so long', dia refer kpd masa ak nk pasang branula. Oh aku fail di situ! erkkk.. Then dia agak OK. Buat ECG, mmg ade hypertrophy and ischemic changes. Sebagai info, uncle ni diabetics, dh buat CABG (coronary artery bypass graft) surgery 10 years ago but defaulted follow up for 1 year. After given his medications, he was OK. Dia smpat lg tanya BP dia brapa, ok ke x. bersembang2 gitu. Then, ak tgk lg patient lain. Dalam pukul 11 lebih, ade patient baru masuk, dia kna buat ECG. Di A&E, ECG machine ade 1 je. So, utk patient baru ni, Ummu nk buat, then aku teman Ummu g amek machine ECG, tapi tetibe ade staff nurse cakap dia nk guna dulu. Urgent katanya. Kitorg ikut jela staff nurse ni. Tgk2 uncle Indian td. Dia sdg breathless! nmpak sgt dia gasping for air, dan bunyi macam bnyk sgt secretion dlm mulut dia. Bunyi mcm kita kumur lpas gosok gigi tu. Lpas buat ECG, nurse terus pergi. Dia xcakap g mane. Ak ngn Ummu bingung xtaw nk buat ape. Kitorg berkejar g cari dokter, pastu nmpak nurse tadi pggil dokter. Sekejap je, xsmpai seminit. So ak ngn Ummu g semula kt patient tu. Ummu ckp, 'eh knape dada dia xbergerak?'.. Ak pn tgkla, dan berkata 'eh uncle ni xbernafas ke?'. Serentak dgn itu, doktor pn smpai. Terus kitorang tolak patient masuk Resus room. Masa tu uncle dah xbergerak. Not responsive langsung. Resuscitation started, lead by Dr A. First time ak buat CPR kt patient betul. Rase bersemangat sgt. Tp penat jgkla sbb kna compress chest tu laju2 dan kuat (dgn prinsip push fast, hard, let the lung recoil). Lpas stengah jam resus, uncle masih xresponsive. So Dr buat scan, Dr cakap jantung dia tu Pulseless cardiac motion (PCM). Maksudnye jantung bergerak, tp xde nadi. So then, he was pronounced death at about nearly 1.00am. Sbb masa tgh resus tu, aku smpat tgk jam, lebey kurang kul 12 lebey. Then panggil la family members dia. Meraung anaknya. Yelah, pemergian bapa yg disayangi. Lpas tu, kitorg students berbincang2 la pasal uncle ni. Rupa2nya, sebelum staff nurse nk buat urgent ECG tu, patient ni ckp dia sakit kaki, krem katanya. So nurse nk bagi ubat tahan sakit. Masa tu la dia prasan uncle gasping for air.....

Selepas tu, aku mula berfikir2. Mungkinkah sms dia cramp kaki tu, nyawa dia mmg sudah di tarik?? Adakah semasa aku tgk dia susah gile bernafas tu, dgn banyak secretion di dlm mulut tu, nyawa dia sudah berada di tengkuk??.. sbb sekejap lpas tu, dada dia dh xbergerak.....Subhanallah. Jika betullah ape yg aku fikir maknanya aku telah melihat Sakaratulmaut.. Ya Allah.. Nmpak sungguh perit. .

Kesimpulannya..kita xboleh nk jangka bila waktu kita ak pergi meninggalkan dunia ni..mungkin sekejap lg ak akan collapse dan pergi. Aku tak tahu. Kita pn xtahu. Anda pn xtahu. Dgn amalan yg seciput ni, dahla seciput, belum tentu Dia terima lg, bersediakah ak nk berjumpa dgnNya? Tepuk dada, tanya iman.

Aku selalu berazam utk menjadi budak baik. Sbb ak rase diri ni mmg tidak cukup baik. Sentiasa mahu berubah, namun tiada istiqamah dlm berbuat sesuatu. Bukan tidak mahu tapi susah utk mengekalkannya. Ermm, aku sgt berharap dipertemukan dgn si dia yg mampu membimbingku ke jln yg sebetulnya. Lelaki baik utk perempuan yg baik. Itu je. Dan ak pn kna la ade inisiatif sendiri jgk. Ok, berubah slow2 ye Hidayah.

Dengan itu, sekian sahaja malam muhasabah diri. Semoga dpt memanfaatkan sesiapa shj yg membacanya.

Sekian, slamat mlm smua.. (i mean, pagi la.. huhu)

Wassalam.