The long distance runner

"The loneliness of the long distance runner"

The cold steel of an early morning engulfed the lonely figure on the bed. His wearied stature and wrinkled scrub define the very meaning of fatigueness. Just under an hour ago he had to pronounce a man's demise despite vigorous resuscitation attempt in the ER.

The crisp clean white sheet underneath him was no longer the comfort bearer of his disturbed slumber. The middle age man uncurled the 'fetal position' while making final analysis on the 2 phone calls he just received.

The first call which awaken him was from an orthopod doc. She need to cut open an elderly man's left arm to relief a pressure rising within it. A serious condition called 'compartment syndrome' which may develop following limb trauma. This unfortunate man might lose his arm if they wait for the 8am shift to take over.

His mind hurried over the steps and equipments required to...

... RIINNGGGG!

The phone rang again.

The second call was from OBGY, a young mother unable to deliver her first baby vaginally. She has already ruptured her membrane for quite some time and now she was running a little high on temperature - a hint of infection. The bad news was a CTG that monitored her contraction and the fetal heart beat showed signs of fetal distress. Worse still it was a type II deceleration fetal distress.

Both need urgent actions. It was time to summon the cavalry. In dire emergency, the 2nd anaesthetist on-call who is in charge of ICU had to be called in order to open 2 emergency OR.

His colleague happily chose the 'Compartment syndrome', which left the man with the task of giving spinal block to the 19 year-old mother.

25 minutes later a healthy baby boy weighed 4.25 kg was born.

At the end of all that, as he lay down on his bed he realised that within a frame of 2 hours he had witnessed the two ends of a human lifespan spectrum.

"The end of it for one man and the beginning of one for the other".

Wassup doc?

"Our doctors are currently busy attending other patients.Your life is important to us, please hold the line. You will be intubated shortly. Thank you."

Now isn't that something?

Last week I had an appointment with a guy who was 25 mins late and then called me up to ask whether i'm still there waiting for him because he was still stucked some place 40 minutes away. The horrible thing was I even called him up twice earlier in the day to confirm the meeting.

I believe that one should try be punctual or at least make an attempt to tell the other party if one is going to be late. It can't be that hard especially with 86.8% of working adult have a watch on the left wrist and a cellphone in the right hand (unless you're a lefty of coz; btw i made up the figure, so what sue me !)

PS: 84 working-hours per week ..
and many sleepless nights.. have a break bro

.....

I woke up at 4 this morning breaking in cold sweat.

"You know you're fucked up the moment you are afraid to choose the obvious. There will usually be once or twice in your life, where you will come to major cross-roads. You have been there before and you knew what to do well before you reach that point. The answer is staring down at you with unflinching eyes".

This is not a drill.

In real life, the truth may not prevail.

Oh! I'm doomed.

Manual Dexterity

Ringggggg.. rinnnnggggg

"... another caesarean?"

"No man, I wish. We gotta do a MRP, it stucked for 40 mins now"

"... blood loss?"

" about 100cc... but her vital signs still holding on... BP 110/70, PR 100/m"

".. hmm maybe not for long... call the maternity OT, and tell them we're sending her down now"

I hang up the phone,and asked Mr G-Shock.

1.30am. Blimey! Still early, I havva feeling it's gonna be another looong night.

A placenta stucked inside the uterus isn't a pretty picture, no I'm not talking literally here.

These extra long sterile gloves help a lot

when you're in knee-deep (ops! elbow) in work.

A retained placenta could prevent the uterus from contracting, hence the mother could end up with a MAJOR blood loss... yes it can be fatal. So, the placenta need to be delievered within 30 mins after the baby is delivered.

If that fails then the gynae folks will have to perform MRP (manual removal of placenta). Yup manually with one's own hand. The right hand is inserted into the womb's cavity via the cervix and negotiate the separation of placenta from the uterine wall.

Of course the patient will be anaesthetised, and is done under central block AKA spinal block with a modified saddle approach in attempt to concentrate the drug's affect at the 'part covered' when you sit on a saddle. ("Eureka! let's call it saddle block then" - supposedly brilliant white man (1876 - 1930).

"Removing the placenta gently... "

The procedure went smooth and uneventful.

One happy ending to the mother and her baby.

Not for us though coz we had 2 caesareans afterwards... wink2.

The End

The day will come when my body will lie upon a white sheet neatly tucked under four corners of a mattress located in a hospital busily occupied with the living and the dying. At a certain moment a doctor will determine that my brain has ceased to function and that, for all intents and purposes, my life has stopped.

When that happens, do not attempt to instill artificial life into my body by the use of a machine. And don't call this my deathbed. Let it be called the Bed of Life, and let my body be taken from it to help others lead fuller lives.

Give my sight to the man who has never seen a sunrise, a baby's face or love in the eyes of a woman.

Give my heart to a person whose own heart
has caused nothing but endless days of pain.

Give my blood to the teen-ager who was pulled from the wreckage of his car, so that he might live to see his grandchildren play.
Give my kidneys to one who depends on a machine
to exist from week to week.

Take my bones, every muscle, every fiber and nerve in my body
and find a way to make a crippled child walk.

Explore every corner of my brain.
Take my cells, if necessary, and let them grow so that, someday,
a speechless boy will shout at the crack of a bat
and a deaf girl will hear the sound of rain against her window.

Burn what is left of me and scatter the ashes
to the winds to help the flowers grow.

If you must bury something, let it be my faults,
my weaknesses and all prejudice against my fellow man.

Give my sins to the devil.
Give my soul to God.

If, by chance, you wish to remember me, do it with a kind deed or word to someone who needs you.

If you do all I asked, I will live forever.

- Robert N. Test (1924 - 2002)

Anaesthetist vs surgeon

07:45

"All the drugs syringed up yet? You never know which one of these elective cases might pulling your leg around" the boss sounded extra cheerful today. Ahah! He musta got himself lucky last nite.

Well lemme see... the 4 epitome of life:

1. atropine -- in case the heart rate goes down


2. ephedrine -- if the BP drops


3. thiopentone -- in case you need to gas them down


4. scoline -- to paralyze the body, if needing rapid sequence induction

07:55

1. gas machine aka GA (general anaesthetic) machine checked --> no leakage


2. intubation trolley all prepared


3. M.A.L.E.S (err just happen so): mask, airway, laryngoscopes, ETT, suction - checked

08:00 Patient is on the operating table. Waiting for surgeon to show up.

08:15 Still waiting for the surgeon

08:30 Idle mode switched on :(

Finally, I can't take it anymore, this is worse than waiting for RAPID KL bus
Me: "Nurse could you check up on dat surgeon... Dr Seymore Butt, whether he's on his way? Thanx"

Nurse: "Well.. he still stucked with his ward round, he's sending down his registrar Dr Buttkiss instead to do the first case"

Me: "Well he better quick! Or he'll be seeing his butt on my shoes instead!"

Wel there you go... great tales of heroic surgeons and their ever-loyal sidekick anaesthetists are so over-rated in Hollywood these days. Their tricky relationship is somewhat similar to a married couple.

The fact is one needs the other to fulfill the meaningful purpose of one's own existence in the operating room.

"...for thy shall neither cut open an awake patient, nor gas him for fun"
--- dead pond scrolls, Jurusalem 586BC

Yet there are times when the two do not get along well. In the eyes of a patient, usually it's the surgeon who stands out. No wonder in the private sector, anaes gotta claim only 30% of surgeon's fees.

+++ EPILOGUE:
11pm
Seymore Butt (phone call): "Allo dude! We got a very bad MVA (motor vehicle accident), 16 year old, Mat Rempit had an argument with a tree and lost. GCS 6/15; small subarachnoid bleed with no midline shift, intubated in ER, diagnostic perioneal lavage was positive ?Intra-ab injury, probably spleen rupture, vital signs stable we're pushing him straight into trauma OT!"

Me to OT team: "Ok guys lets have it all.. I want the whole enchilada! Central line, arterial line, 6 pint pack cell O-ve standing by.. and make sure Dr Butt's ass comes in with the boy! ....and in the meantime could someone make coffee??"

**4 hours later In ICU**

Seymour Butt: "Heh the boy might make it .. He may live to remp-it another day"

Me: "Well the heart lives my friend, we'll just hafta wait and see whether the brain survives, as the great Morpheus once said.. one cannot lives without the other".

We looked at each other in unison and in that brief moment the spirit of camaraderie runs thicker than our blood.

+++

Tagged?! Oh no!

"I used to be a front-page model in Play-cat magazine"

I got tagged by Dr M!

Being a new kid on d blog, this tagging is sorta new concept to me. Gee now I have to tell 6 weird things about me huh.

1. My nickname at highschool was 'straight'. I didn't know that i was a geek back then... hmm?

2. I'm a right handed person, but i'm a lefty when it comes to writing.

3. My first trip to Penang, Langkawi & Cameron Highland was last year.

4. I quit smoking in 2nd year med after seeing a lung-cancer specimen in pathology museum.

5. Although I loveee mocha, I always got bloated after drinking it.

6. As i grow older i become more terrified of getting a needle injection.."weii smallerr needlee 24 gauge tadak ka"

***Uhh dats it ya.. too much of confession isn't a good thing :P