Mar 8, 2017

Work Diary

[0700 hour]
Jolting myself out of bed in a frenzy. Yesterday I accidentally slept at 8 pm on the floor and woke up at 12 midnight, feeling woozy but hungry. In a dazed I ordered some McD chickens online and could only go back to sleep at 2 am. With no time to spare I had a quick shower (more like a splash, really. I don't think my body had even dried properly before I rush to the hospital), gulped some water and out of the room. Subuh prayer? Ke laut.

[0715 hour]
I remember the nurse in the MFU (Maternal Fetal Unit) of the O&G clinic asked me to come again and help Mr R today. No such luck. As soon as I stepped into the Ward 1A, the nurse called me and asked me to review this one patient I had met briefly yesterday.

She is a 40 years old lady, Para 5 (meaning she just delivered her 5th child) who delivered her baby some time yesterday around 4 pm. I was working AM shift this week, meaning my shift starts from 7 am till 5 pm. In some, rare good days, I can finish my work on the dot and can go back at 5 pm. On bad days such as yesterday and today? Not so punctual. 

I received a call yesterday from the Microbiology lab informing that the lady's viral screening is reactive for Hepatitis C. At first I thought oh okay maybe the patient hasn't delivered her baby yet or that she is in her first trimester (because I haven't seen this patient yet) but no, she is a postnatal patient.

Bewildered, I soon noticed that she has never went for antenatal booking or any antenatal check up at all throughout her entire pregnancy. That means, she is an unbooked, unscreened mother. Those two words alone can cause a headache to any doctor, made worse if she is already delivered, became worse still when her blood is positive for antibody HCV, because we don't know anything about her and her pregnancy at all or whether the baby is also infected or not.

Why antenatal check up is important? Because a lot of things can go wrong during pregnancy. There's high blood pressure with protein in your urine that can trigger seizures called pre-eclampsia, diabetes during pregnancy that can cause baby to grow big and developing low fetal blood glucose neonatally, miscarriages that come with bleeding and pain and passing out blood clots and pieces of the undeveloped foetus. The baby could be upside down or even horizontal, the baby could have deformities, the baby could be already dead but the mother didn't notice it.

In short, antenatal care is important. We have good antenatal care system in Malaysia, you know. Just ask your mother or any pregnant friend that you know to show you their "pink" antenatal book. Every health aspects of the pregnant woman is being assessed, beginning with scan dates to confirm the gestation of the baby, the woman's blood group and viral screen for HIV, Hep B, Hep C, her weight, height, etc, blood glucose monitoring, blood pressure monitoring, anaemia check-up, baby's kick activity chart, and many more.

Heck, if I have to describe everything that is in that pink book, I won't finish it by the time I become an MO. Just go and have a look at it yourself. I once met a patient who had her antenatal care in freaking Australia and she only have documents (no antenatal book like us) with her that she compiled in a folder. It was disorganized and we had to rummaged through them all and even then there is a few key information missing. Granted, seeing as she is not an Australian she only went for a private check up but hey, in our lovely Malaysia yang pemurah, all warganegara and also bukan warganegara who are pregnant can do their booking in KK (Kinik Kesihatan) and get the antenatal book. After this please la don't be so quick to condemn Malaysia teruk la itu la ini la ni benda bagus depan mata ni korang takpernah nak guna elok-elok.

[0720 hour]
The staff nurse had informed me that the patient is complaining of abdominal pain. She went to the toilet a few hours before and noticed that her pad was soaked with blood and blood clots. She didn't report it to the nurse. She only mentioned it when she had the pain.

I was cursing in my head. Blood clots and heavy bleeding pun takkan nak diam je? Tu kan benda abnormal it's not natural after delivery to get bleeding that much. Dah ada 5 orang anak kot takkan tak reti-reti lagi. DISCLAIMER: THIS IS ALL IN MY HEAD. I AM A PROFESSIONAL AT WORK. I TALK TO MY PATIENTS WITH SMILES AND SOFT TONE OF VOICE. Then I hurriedly informed an MO while getting ready to prepare speculum and a torchlight to figure out what the heck is causing the bleeding.

[0730 hour]
I took some blood from the patient and sent it to the lab. 

[0745 hour]
The MO asked me to insert the branula for the patient. I failed. But the needle is still there and the MO took over. She godek-godek the jalan and it went in. Wait. I am talking about a different patient here. By this time there was a number of patients I attended simultaneously. And by the word 'attend' I mean running here and there doing errands ordered by the MOs and the staff nurses alike.

[0745 hour]
Got the result of the blood. Haemoglobin is 8.0 which is a 4.3 drop from yesterday before delivery. The MO asked me to change the GSH to GXM and get 2 pint of packed cells for the patient to get blood transfusion. I filled up the request form and hurriedly went to the Blood bank.

[0750 hour]
The guy in blood bank said the blood can be collected in half an hour's time. I went back to the ward.

[0900 hour]
Finished clerking the subacute cubicles after being interrupted multiple times to do here and that. Saw that MO is fishing out a huge chunk of retroplacental clot the size of a songkok from the patient yang bleeding tadi tu. Oh em gee where the heck the clots came from?

[1030 hour]
Saw a new case coming in and no one else to clerk this patient. So I went to clerk, because that's my job. Oh, early labour. Simple enough. But she is supposed to be check for vaginal examination half an hour ago, which means I'm already late. Then the HOD (Head of Department) came to the rounds. That means I have to drop everything I'm doing and follow the round. Shite.

[1130 hour]
Just finished the round. I had to ask a colleague to do it instead.

[1300 hour]
I lost track of time. Did prostin review template and awaiting for the MOs to asssess the Bishop score for the patients ongoing prostin.

[1600 hour]
Still haven't eaten anything today. The only meal I had is that sinful McDs from last night. Oh, got some free time! Went to perform Zuhur prayer.

[1620 hour]
A patient that is supposed to be electively admitted this afternoon just came.
JUST GREAT!! Why waste your time when you can waste mine??! There are three discharge cases to be done. IOL list is still not done. I kept looking at the watch and sigh in defeat.

[1715 hour]
The PM shift housemen came to work. Whew. But I can't go back yet my work haven't finished. Then there's a shout for an emergency Caesarean case. I tried to ignore the case because night housemen are there but... sigh I had to help. So I helped called the Paeds housemen and inform them about the case.

[1800 hour]
Another new case that arrived before 5 pm but went unnoticed until now. Great. I grabbed the BHT and start clerking the patient. Nasib baik case senang ceh ceh

[1900 hour]
Performed solat Asar. I know I know I'm such a horrible man oh God forgive me for praying so late. Went to confirm that everything is settled. Okay, looks good.

[1917 hour]
Punched out the card. Now thinking about the Western restaurant that I found a few days ago. Looking forward to stuff my face with much food.

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