Midnight sightings

The thing with being in a tertiary hospital which is supposedly the largest maternity unit in the country in terms of deliveries (perhaps also Asia), is that you get to see things which come out of the blue.

1. Saw one case of holoprosencephaly, where the specialist on call had to perform a cephalocentesis because the baby had hydrocephalus on scanning. Baby was delivered but didn't survive.

2. Patient presented with fever, chills and rigors.. Query dengue fever, patient deteriorated and got admitted to ICU. Urinary pregnancy test positive, so a transvaginal ultrasound done found a stillbirth fetus lying at the os, which was later removed.

3. Since the midwife students went home at 9pm, by hook or by crook I needed to get a normal delivery done, so by the time finished rounds, already midnight. Helped to conduct one, but towards the end the baby became bradycardic, requiring MO's help.. got a signature anyway, left at almost 2am.. need sleep, tomorrow going into OT to witness hysteroscopy. Oh wait, MY EBCP ASSIGNMENT!!!!!

More labour room blues

From my experience and observation so far, Chinese patients have the lowest level of pain tolerance during labour. Don't ask me why, I duno. Today got stuck again in another scenario where I reassured a patient in preterm labour and gave her some N2O for pain relief, patient just grabbed me by the arm refusing to let me go (for 1 hour), asking me to stay with her. I think this happened to the extent that doctors and staff nurses who entered the room was wondering whether I am the patient's relative. She requested for me to deliver her baby, but it was not to materialise, coz a senior staff nurse (one who appears to stride with authority in the labour room, that even housemen and other nurses look up to her) ticked me off, "What are you doing to my patient?!". Instead, she asked me to quickly open the delivery pack as she delivered the baby.

For a moment, I was quite upset lar.. wasted one afternoon. But then, it turned out that the patient was so grateful to me, that out of nowhere she requested for my phone number. I was like, "Its my pleasure and job to help you, just a simple thank you will do lar..why you want my number? No need lar.." She repeatedly kept pestering me in Mandarin, "I am really relieved and thankful to you for staying by my side through it all. Other doctors don't really bother about me, they just drop by for a while and left. But I really really insist you write your number down for me leh, I must show my appreciation and gratitude for what you did.."

Problem was I gave in to her, so I duno whether any medico-legal or ethical issue involved or not lor.. any advice?

December 2008 - It was revealed to me that there is something which I need to learn to overcome sooner or later..

May 2009 - That something has been rearing its ugly head for the past few weeks.. Need to learn to take steps to lay down and breakthrough in this area. My shepherd shared that he could only do so much to encourage and help, what eventually happens depends on what I decide to do with it.

Another night on-call

Tuesday. 12 May 2009. My 3rd day on-call.

Morning
1. Let's start off with what the morning has to offer. Sat in with a specialist during gynaecology clinic. Was looking for a patient to clerk, when one Chinese lady approached me, as if she somehow knew that I was looking for patients to clerk, and those I chose probably can have their waiting time shortened. So I clerked her, she presented with primary subfertility for 4 years post-marriage, and she was in a hurry to 'go to work', and didnt want to end up coming back for another appointment 2 months later. When I presented her to my specialist, got abit of a earful, coz there were other patients with conditions deserving more attention than people like her who refuse to wait.

Then when the specialist eventually looked at her investigation results, it was found that she was not ovulating due to low progesterone levels. One of the MOs who came in was asked this question and got grilled badly coz he could not figure out the problem staring at him through the investigation results, coz he did not attend to the clinic often enough. I think he hated me from then on, when he scolded me for accidentally taking his patient's card.

2. 2nd week in O&G, tired, but coping lar I suppose with the workload, tutors seem to be hinting that my knowledge, history taking and case presentation seems to indicate as if it's my 1st day in O&G. And I need to somehow squeeze time to study and finish my assignments and logbook!!

Evening
3. Not many cases. Most of those in the labour ward were experiencing poor progress of labour since morning, and eventually scheduled for C-section. So couldn't really perform normal deliveries. I did sat in with one of the patients who was supposed to undergo trial of scar, but eventually it was decided that she will undergo C-section. Nevertheless, all the medical and midwifery students missed a normal delivery while we were away momentarily following the specialist on rounds. It happened so quick that it was not on the whiteboard list of admissions.

4. There was a teenage preterm pregnancy. Police report cant really be made coz the perpetrator was 17 years old.

5. Sat in the room trying to study while accompanying that patient of mine. She wanted somebody by her side so that she could grab hold of somebody's hand or scrubs, for reassurance and support whenever she feels pain. Had a chat about family, whether I am Malaysian Chinese (to her, I somehow looked Indian Muslim) etc. Prayed that I will somehow manage to do normal delivery for her, but most importantly; the mother and baby's safety lar.. seems like it was not my day when she got confirmed for LSCS surgery at midnight, to be performed at 4am. So I initially thought of going home for the night, since I was super tired from classes since 7.30 am, and I have to wake up early again the next day. As I went to say goodnight and all the best to my patient for her surgery, suddenly I realised there was a new case in the next room.. So rushed in and asked for permission to conduct, and there! I got my normal delivery!! Finally can go home to rest after assisting her episiotomy..

Next day as I walked through the obstetrics ward for ward rounds, I heard somebody snapping her fingers shouting out "Doktor! Doktor!" Turning to my right, there was my patient from last night, smiling and waving to me, asking me to come over to see her baby.. Cute little baby boy, asleep from a long night.. Successful operation, mother and baby safe :-)

A love song on Mother's Day

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Sentuh Hatiku
by Maria Shandi

Betapa kumencintai
Segala yang t'lah terjadi
Tak pernah sendiri jalani hidup ini
Selalu menyertai

Betapa kumenyadari
Di dalam hidupku ini
Kau slalu memberi rancangan yang terbaik
Oleh karena kasih

Chorus
Bapa, sentuh hatiku
Ubah hidupku menjadi yang baru
Bagai emas yang murni
Kau membentuk bejana hatiku

Bapa, ajarku mengerti
Sebuah kasih yang selalu memberi
Bagai air mengalir
Yang tiada pernah berhenti

2nd night on-call

Friday, 8 May 2009
6.30 pm - Started my on-call by standing by a Chinese during her delivery. She was remarried with a 2nd husband. 4th pregnancy (history of 3 miscarriages). I think she was so scared and in pain that her grip nearly broke off my ring and little fingers. Had to reassure her and give inhaled anaesthesia / sedative.. When she finally delivered, aside from suturing the episiotomy, the MO and nurses left the room.. she hung on to my hand tightly, begging me not to leave, coz she was afraid, and lonely coz nobody came to visit her. So accompanied her a further 15 minutes or so lar, reassuring her that everything is fine, had a bit of chat about me being a student, not being able to speak Chinese convincingly (that's why during delivery the staff nurse of mixed Malay-Chinese descent commented that my choice of Mandarin words sounded funny) etc. Then her husband came looking for her when she has been transferred to the Pusat Bersalin, had to show the husband where it is..

10.00 pm - For a moment I thought could get my 1st OT signed off with a Caesarian section.. after a long exhaustive wait for 45 minutes.. the baby came out via normal vaginal delivery on the OT table.. *swt* even the MO to perform the surgery was shaking his head.

Saturday, 9 May 2009
12.45 am - Vietnamese lady married to a Malaysian Chinese husband. Husband was asked to come in to translate the doctor's instructions for the wife when straining / pushing. Instead the husband got so excited, that from the way he encouraged his wife to push, it would seem like I'm watching the scene of a die-hard Japanese football fan's reaction in front of the TV when his team is about to score a goal.

1.20 am - I conducted 2 deliveries.. both ended up as instrumental ones with vacuum coz if we wait any longer, the outcome for the baby is not so good (Argh, I needed to do my normal deliveries!!), but oh well, got one vaginal exam signed off as well.

1st on board

Yes, I delivered my 1st baby today!!! Co-shared with a midwifery student (thankful the staff nurse allowed me to coz usually when midwifery students are there during the day, they get preference over us).. He weighs 3.55 kgs with an Apgar score of 9. Delivery time: 10.30 am in the Labour room. 4 more to go..

p/s: And in my enthusiasm to cross over to help the staff nurse perform an episiotomy upon invitation, I accidentally hit my head on the overhead lamp (twice), in full view of the patient.. *swt* Ouch.. but nevertheless, she wished me all the best :-)

Musings in times of busy-ness

A few repeat incidents occured today..

1. In the gynaecology ward, I was flipping through the case notes of the patient I'm following up on, and the nurse asked me how come the file was so thick.. to my surprise, I realised I was reading the wrong case notes. So I reacted sheepishly as I returned the case notes to the patient in the next bed. The middle aged lady in the bed beside my patient's bed told her, "The doctor looking after you very 'cute' leh.. (hen ke ai) eh are you Malaysian Chinese ar? You got the Japanese look leh etc etc" I was like *swt*

2. I asked the specialist to sign my ward round attendance. She commented, "Ur name is Gary ar? Eh, macam itu Spongebob punya siput kan? Nama pun sama."

That aside,
3. I remembered a Vietnamese friend of mine in YA CG last year.. long time didnt talk to her already.. last Sunday I had the opportunity to catch up with her for a while, since it has been quite some time.. I remembered when I first met her then, was very encouraged to see that although she was a foreigner among Chinese, with language difficulties and despite her boss making it difficult for her to attend CG and camps, she still has the heart to try her best to come. I thank God for her testimony which she shared about her life being changed from being a very pessimistic person away from home, to one who found hope in the midst of a family away from her biological family. She is actively serving in Sunday school and recently she shared that she had been retrenched, and might be sent back to Vietnam soon by her employers. But it is encouraging to see her still hanging in there optimistically, and in return she did comment that I changed a lot since my days in YA. I guess in due time, we all need to grow :-)

10th Southern region and international church camp

A Sustainable Church

Jesus is building His church to be His end-time instrument that will establish His kingdom on Earth. Though difficulties or attacks may occur, the church will survive until God's plan is fulfilled. God wants to use His people to carry out His vision. God's will is for all churches to be sustainable for the Master's use. He will do His best to sustain each local church, but each should do its part as well.

We do not want to build a church that lasts only for a short time, but one that will last until Jesus returns. How can we be sure that our church is sustainable? Come and join brothers and sisters from Southern region, East Malaysia, Indonesia, India and Taiwan, as we find out more!

Date: 4-7 June 2009
Venue: Peacehaven, Genting