Apr 6, 2018

Sensational Surgical Stories

Per rectal is the surgical fave like how VE (per vaginal) is for O&G lol

Can't believe I'm near the end of my Surgical posting. I remembered I was feeling restless working in the ward during the first three months. At the beginning, that feeling of having to get accustomed to new environments, new bunch of people, and new stressors at work is something I truly hated. Not all wards are unpleasant - there's one I really like working with because the staffs are a bit better than the other two, but I was really counting days to leave ward work and to start peri work.

For the record, any surgical-based posting is not something to my liking. It's not that I hate it - I just don't prefer it. There's something about surgical that really does not resonate well with me. In the first place, I hate being in the OT (operation theatres) because it's freaking cold and I had to lower myself when assisting the surgeons because I am quite a tall person. It hurts my back and I am not a fan of wearing scrubs and rubber boots. Secondly, I am really bad with anatomy so it goes against everything in Surgical to be poor at identifying which arteries or nerves supply which organs etc. 

But ultimately I am bad with anything and everything huhu. I just know how to do work - just a functional houseman but not really a lighted bulb person. I'm not even a hardworking doctor. I just do my job diligently without causing any issues to my bosses. The keyword here is: be a safe doctor. That's the minimum that you need to achieve.

There is a few cases throughout the four months in Surgical that have an impact on me. I never had the time to properly dissect each event and do a reflection on it, so this time I'm just gonna list them all out and briefly remind myself why each of them is important to remember them by.

1. Confused man yanking his catheter out

A male person with severe head injury after getting into motor vehicle accident - he was not fully conscious, in a lot of pain, and he sensed that a rubber tubing was inserted into his penis (it was a urinary catheter as he couldn't control his own urination) so in such a confused state, he proceeded to remove his hands from the restraints he was on in bed and savagely tried to pull the catheter out. 

Because a catheter is designed to have a balloon at its tip that can be pumped in the bladder once inserted (so that the tube won't come sliding out on its own), it can't be removed by pulling it out without deflating the balloon first. So that person tried yanking it out. The tube was stretched and stretched and when he couldn't get it out, he let go of it. Yep, it retracted back like any rubber does - straight into his penis and abdomen. He grimaced in pain and I couldn't do anything. Blood started to come out from his penis because of the self-inflicted injury and I was left with my mouth open, wordlessly gaping as I silently cursed in bewilderment.

I was at that time, holding his other hand and body from falling out of the bed. It happened so fast and that's the best I could do. It taught me that with people having severe injury to the head (and brain), they must have a lot of extra safety precautions. I have to anticipate the things that may go wrong and to be alert with the changes. It happened during the first week of entering Surgical so it really did nothing to improve Surgical's first impression to me.

2. Four foreigners being shishkebab-ed with parang

I was working in ward when my leader asked me to become a runner for a multiple MTP (massive transfusion protocol) cases in ED. Without missing a beat I agreed (anything to get away from the ward) and I started running to ED. Long story short, four foreigners were assaulted with parangs. All of them sustained bad penetrating injury with lots of blood loss, so MTP was activated to all of them. Runners (there's four of us) are tasked with the job of getting all the blood products from the blood bank as quickly as possible. In this case the transfusion is required direly to replace the blood loss. It was very tiring. I think I lost some kilos from running up and down the stairs many times that day.

I am making a mental note to never, never, ever set foot in Klang again once I'm finished with my housemanship. There is so many weird cases that I am certain won't be happening in more peaceful area.

3. Man choked on fishbone

A young man was choking on a fishbone during meals at a wedding. It was a big one based from the drawing he made. Apparently following that he took a page straight out the old midwives' tale - he pushed more rice down his throat in an attempt to relieve the choking. It didn't work, obviously. He vomited blood the next day and was admitted for an upper tract scope assessment (OGDS).

After the morning rounds in the ward we all started to do the morning tasks. For that patient, we had to get his consent to do the scope. As I was available at that time, sure, let me do it so I can tick him off the ward job list of the day. I was busy filling up the form at the cardiac table in front of his bed so that all the patient needed to do is to sign the front and the back page of the form when a student nurse interrupted me to inform that the patient is vomiting blood.

I already know the patient's case. So I said to her that it is expected to happen. It was a small amount, we are planning to do scope anyway, bla bla bla. I was a bit crossed for being interrupted. I just wanted to finish my work fast so I can move on with another patient after that. Then the patient vomited again. And again. AND AGAIN. He was holding the yellow plastic bag to contain the vomit but the blood he vomited was wayyyy to much. I was still holding the stupid pen and paper form in my hands, watching him as he bled all over the bed and onto the floor (and my pants and shoes too).

I quickly said to her, go get help. Now. I straight away called my colleagues as well and we attended the patient. He was in a dazed and not responding to our calls - a sign of shock due to blood loss. My internal bell is ringing with frantic alarms. The patient was pushed to acute cubicle, we ordered first stage blood for transfusion straightaway and patient was pushed for emergency scope. I was so caught up with wanting to finish my work I had neglected the thing that mattered most - the patient. Sufficed to say this is the biggest lesson I learn throughout this posting. After the incident I tried to stop any work I was doing when I need to attend to patients. I also avoided from eating fish for weeks afterwards. Seram mak.

4. Elderly lady with low blood pressure.

I kinda make it up when I met this elderly nenek who were admitted because of surgical site infection. Her thick abdominal skin was infected and was removed, leaving muscles exposed. One day when I was reviewing her in the morning, again one of the student nurses informed me that she had a low blood pressure. I asked her to repeat the measurement and the reading remained low.

This time I properly took my time and examined her thoroughly. She indeed had low blood pressure, and together with such a big wound across the belly, I suspected that she was in shock due to blood loss. Her gauze packing under the vacuum dressing appeared to be soaked, so I thought there must be some active bleeding happening. After ordering for a pint of run-fast crystallloid resuscitation, putting her on high flow mask oxygen, ECG and cardiac monitoring, I straightaway called my MO to inform him.

I felt good when thinking back of my plan at the time when I saw the patient. I was able to think calmly and did the right thing. My MO didn't correct any of my continuation of the plan - we both agreed to it and worked on doing them all. But after that he forbade me from touching any high-risk patient because he said if I started touching the patients sure more issues will come out of it afterwards HAHAH. The sad news was unfortunately weeks later I was informed that the patient passed away eventually. I was a bit saddened because she was such a softie and I tried my best to comfort her when she was in pain. Inalillah.

5. MO getting into a motor vehicle accident.

One of our MOs was involved in an accident and was admitted here. Long story cut short: this incident had prompted me to have a Takaful. I have a friend who is a Takaful agent and after a very short consideration, I took a Takaful with a few adjustments made that I think will benefit me the best. Takde kuasa aku nak kena admit kat hospital gomen, lagi-lagi kat tempat kerja aku ni. Kalau betul terdesak for operation, maybe yes, but afterwards nak mintak transfer balik ke private for better nursing care. Hey, that's my two cents anyway.


There's only a week or more left for me in Surgical. I just need to complete my logbook, present my slides on next Friday, planning on what to do during my four-day EOP leave before return to the vicious cycle of hellhole tagging in the worst department of all - Paediatrics! NIGHTMARE OKAY. I AM SO NOT READY. KILL MEH


  1. Hello doc. May I know which posting did you start off with when you first joined housemanship? Apparently we would be given the choice to decide which department we would wanna begin with?

    1. I started with O&G because at that time I thought that posting demands medium amount of workload and clinical skills, allowing me to catch up so I can become more functional. I dared not choose Medical at that time cuz I knew I'm slow with taking blood, inserting lines etc.