Monday, April 7, 2014

The Tough Battle





Hey kiddo, wake up! Stay with me. Dont close your eyes

Opening the eyes, looking at her surrounding. “My neck is hurt, my whole body is hurt.”

Palpating the neck region. “Does it hurt here?”

“Yes it hurt over there”

“Get the C Collar please,” All right what’s the situation here?

A young paramedic replies, “high velocity motor vehicle accident invloving a car and four wheel drive about half an hour ago. Victim 14 years old girl, brought by passerby. Five victims in side the car. Father and little daughter passed away at instance. Mother still stuck in the car, awaiting for transportation by ambulance.”

“How’s the vital nurse?”

“Holding up. BP is 140/80, PR 101, SPO2 100% under room air”

“Al right, let’s do a primary survey. Well, everything seems to be fine here. Nothing much in secondary survey as well. FAST scan also negative. Alright, get the trauma panel and downgrade her to the yellow zone.”

“Hey little kiddo. Stay in there ok, we will have a look at your family!”


*****

Quickly move to another patient with Fast Atrial fibrillation. Well, it looks like you no longer have the light headedness and shortness of breath. The propanolol and hydration seems working. And the cardiac monitor shows that the abnormal rhythm has reverted back to sinus. Just a paroxysmal AF. He can be downgraded to yellow zone as well. Probably need Holter later.

Another patient enter the resuscitation room. Three bells rang and everybody gathers again. The doctor, the nurses, paramedics and supporting staff.

“This is the mother. Front passenger of car.” She’s conscious but look very weak. Whispering slowly. Her sounds muffle and supress by the sound of the monitor alarm.

“Get the C spine, and lets start with primary survey. Airways is intact as well as the breathing.”

“Doctor, the BP is only 50/30 and pulse rate is 120.”

“There’s big scalp laceration. The left hand is deformed, the left thigh, the proximal and distal leg is deformed, there’s an open wound at the left thigh. And the right leg is also deformed.”

“Ok guys, let’s get three large bore IV line. Get the trauma panel, run the crystalloid. Give 1 gram of tranxenamic acid, 50 Microgram of fentanyl, 10 mg of maxolon, 50 mg of ranitidine and cover her with cefuroxime and flagyl.”

Damn! The line is just too difficult. Ten minutes of trying and finally manage to get the line. 500 cc of saline infused. BP still not picking up. Another pint infused and blood pressure still the same. Another IV access obtained!

“Run the Gelofundin and Voluven.”

Soft sound whisper? Voluven? I thought we are banning it usage now due to risk of renal failure?

“ In septic shock, yes evidence says it’s harmful! Increase the mortality rate as well as renal shutdown. But in trauma, evidence is still lacking. No conclusion made yet.”


****


Doctor! We have upgraded the 6 years old child. She’s a back passenger of the car. GCS on arrival only 11/15.

Damn, she’s fitting. Generalized tonic clonic seizure.! It aborts spontaneously but then starts to vomit.

Taking out the glove,” secure all the bleeding and get the blood product fast! Run at least 2 pints of packed cells.”

Prepare for intubation set. Get the midazolam, fentanyl and scoline ready! Pre oxygenation, induction agent and muscle relaxant in. tubing done. Infuse the sedation and prepare for CT SCAN.


*****


Then another two bodies arrive. Severely head injuries and possible thoracis injuries as well. Nothing can be done.

And suddenly the daughter in yellow zone cries loudly. Calling out her father, mother and siblings. 

“Who’s the stupid fellow who tell her about their family?”

“Be patience doctor, she deserve to know the truth.”

“She’s just 14. Give her time for God sake!”

And there’s a screaming from the outside. This time, it’s from the patient triaged as green.  The one with a very minor injury. The one with fever for only one day, or forget to take their medication in specialist clinic, or having a nail prick. People with mild tension headache who dont even bother to try over the counter pain killer first. And now they are making fuss for not being attended after one hour.

Will they ever realized that they should go and seek family doctor and not to come to emergency department at the first place?

Emergency is the place for a major trauma. A patient whom life is on the fast lane. They will die without an intervention. They could be your family or even yourself. Can you have the heart to let them be served first?


*****


The radiology image of the mother is ready. Surgical and orthopedic also finish their review. Blood on going and BP stable at 100/60. Lung contusion, open fracture of left mid femur, bilateral pubic rami comminuted fracture, left tibia/fibula proximal and distal fracture, right distal tibia/fibula fracture and foot fracture, scalp laceration wound. And urethral injury possible having internal iliac vessel injury. Pelvic binder applied. Prognosis guarded!

And the child having small intracerebral bleed, good survival chance.


*****


A message received a day after from a colleague.

“Sorry to inform, we loss the mother. She coded and  unable to revive her. And the worst part, the 14 years old daughter was placed just in front of her bad. And she witnesses the death of her mother.”

But the little kiddo with intracerebral bleed is making  a good recovery. We will soon extubate him.


*****


This is part of drama that a doctor needs to encounter day by day. A heart breaking story. Doctors are human, medicines are men made, we can fought, but we cant confidently say that we will win the battle.

In this battlefield, we doctor, also fought but not without gun..we don't have battleship but we have an ultrasound, CT Scans.  We dont have M16 but we have needles, syringes, suturing set,all those dressing..We dont have bullet but we shot them with IV drips,blood product and medications..after tough battle, we may save some of them.but sometime, Allah loves them more. We can only tries but Allah will decides. But you as public may help us too. Help us by not mis abusing the emergency facilities. Let us focus in treating the seriously ill patient. If you have minor illness, please visit your family physician or outpatient department. You may need to wait for hours, but you are doing justice to those with critical illness.

Wednesday, April 2, 2014

Cinta Pada Senyumannya


Aku relakan dia pergi,
Andai lidahku berdusta,
Tidak jujur dalam berbicara,
sekadar hiasan di pinggir bibir,
kelihatan manis tetapi hempedu.


Tidak aku tidak berjenaka,
jauh sekali aku tersasul,
dari apa yang dikata hatiku,
inilah rasa yang sebenarnya,
sudah berkali aku ungkapkan.


Seperti mana bicara hati,
Itulah yang terpahat pada bicara,
Sungguh aku terpesona,
Pada ukiran senyumannya,
Yang berbekas pada jiwaku.


Dekat tapi jauh,
larianku tidak sampai,
untuk menyentuh hatinya,
apatah lagi memegang jiwanya,
mungkin cukup setakat senyuman.


jacknaim,
Lahad Datu
1/4/14, 11.50 PM

Sunday, March 16, 2014

Angin Kehidupan (Catatan March 2014)





Hidup ini bagaikan angin. Ada masanya, ia membuai lembut dan mendatangkan nyaman. Namun ada ketikanya, ia berpuing laju hingga mampu menerbangkan jiwa yang sedang dalam kelalaian. Tidak ada satu manusia yang bisa menumbuhkan satu ramalan yang tepat tentang apa-apa yang akan berlaku disekeliling kita.


Banyak perkara yang tidak dapat kita duga akan berlaku. Contohnya, kehilangan misteri pesawat MH370, Boeing 777 pada tanggal 8 Mac 2014 mengejutkan seantero dunia. Hingga ke hari ini tiada siapa yang benar-benar pasti akan nasib yang menimpa anak-anak kapal dan para penumpang.


Begitu juga berita ngeri kematian enam orang anak muda dan beberapa yang lain masih dalam keadaan kritikal ekoran mengambil dadah jenis methampethamine secara berlebihan sewaktu berlangsungnya hari kedua konsert Future Music Festival Asia 2014. Tiada siapa menjangka bahawa dalam rakyat berkabung akan nasib yang menimpa pesawat MH370, berlangsung pula parti liar di stadium kebangsaan negara.


Minggu ini juga merupakan minggu yang cukup memenatkan buat saya. Tiga hari berturut-turut diving marathon bersama divers dari Lahad Datu dan juga senior dari HUSM benar-benar mencabar minda dan kekuatan badan. Lima dive pada hari pertama (3 Day dives dan 2 Night Dives) di Lahad Datu, Dua Day Dive pada hari kedua (Sepatutnya empat dive tetapi dibatalkan atas urusan teknikal) juga di Lahad Datu dan seterusnya tiga dives di Pulau Mabul pada hari ketiga memberikan kepuasan yang amat sangat. Ternyata, alam laut ini masih dipenuhi dengan misteri. Hanya dengan selaman sedalam 22-24 meter itu juga sudah mengandungi pelbagai jenis haiwan dan tumbuhan, maka siapa yang dapat memberi jawapan akan habitat laut sedalam 10900 meter seperti di Jurang Mariana.


Selesai diving, diikuti pula dengan Kursus Snakebite & Envenomation Management 2014, di Semporna Sabah. Ini merupakan projek ketiga saya setelah bergelar Medical Officer di Jabatan Kecemasan dan Trauma Hospital Lahad Datu. Alhamdulillah, ia bukanlah 100 peratus sempurna dan ternyata banyak lompang-lompang serta ketirisan yang berlaku. Tapi saya yakin, kursus yang dihadiri oleh 72 peserta dan 20 orang sekreteriat dari seluruh sabah dan juga peserta dari semenanjung dan Sarawak ini pasti mempunyai impak yang tersendiri. Semoga peserta mendapat ilmu untuk merawat penyakit tropical yang sering dilupakan ini apatah lagi para fasilitator terdiri dari penceramah-penceramah hebat dari Malaysian Society on Toxinology (MST) dan Remote Envenomation & Consultation Services (RECS) seperti Dr Khaldun, Dr Shukrudden dan juga Dr Zainal Abidin.


Kemuncak SEM SABAH 2014 adalah lawatan social ke tiga buah pulau iaitu Boheydulang, Mantabuan dan Selakan. Program ini sengaja diadakan kerana kursus ini dijalankan dengan konsep santai dan juga mesra alam. Buat masa kini, kesemua pulau-pulau tersebut masih terpelihara. Namun, sudah ada tangan-tangan rakus yang cuba untuk membina resort-resort mewah. Dan saya menjangkakan, dalam masa 20 tahun nanti, keindahan yang ada pada hari ini pasti akan hilang.


Hari-hari yang memenatkan itu sudah berlalu. Seluruh badan masih terasa bisa dan ia amat menyakitkan. Masih banyak lagi kerja-kerja yang harus dilakukan selepas ini. Paling utama, rancangan untuk mendaki Gunung Kinabalu pada pertengahan Bulan April ini. Kesibukan tugas serta badan yang penat menyebabkan saya sudah ponteng latihan di Gym selama tiga minggu.  Dengan masa berbaki yang hanya sebulan ini, mampukah saya menyediakan ketahanan mental dan fizikal untuk menyahut cabaran ini.


Ya! Tinggal beberapa perkara lagi yang saya cita-citakan untuk dilaksanakan di Sabah. Selepas ini, dimana hala tujuan saya? Hati ini masih dipenuhi rasa sayang untuk meninggalkan Negeri dibawah bayu ini. Ia seakan sudah sebati dengan jiwa. Dua Tahun dan lapan bulan saya merantau. Masa berlalu dengan amat cepat sekali.


Ke mana destinasi selepas ini?

Saturday, February 15, 2014

Tales That Keeps Me Moving Forward


Day by day, I starts to understand why more and more colleagues quitting this noble profession I used to condemn but now, I myself starts looking deeper and harder, will I stay strong with oath to carry on this profession till the last of my breath?


Those who left, they are enjoying each passing day with their love one. Earning good money with less work and stress.


Sometime, you are wondering about your value. Are you really that noble, or just a useless brat? You spend five years in medical school, torturing your mind and body to earn the medical degree. This difficult year will not always yield good harvest in working life.


You are being scolded by everybody. Your superior, angry colleagues, relative and even patient who never go to any formal school and yet, they seems noble than you. You are being scolded as if you are just plain rubbish.


Well, I experience it too. Being in a situation where an angry relative threatened to smash you into pieces. A so called rich and arrogant bastard recording your work, taking blood investigation from their un cooperative child by using their expensive smart phone.


Working like a cheap labor and you don’t get the payment that you are being promised to. And THEY request you to do free jobs outside your working hour while you already burnt out and sleeping is the only thing that you want to do. Treating patient is noble. But how noble it is to work like hell, until you vomit out everything that you eat earlier on. Even though you are sick, you are still not taking the medical certification leave while your patient simply threatened you for MC even though just for a simple runny nose. On your special day, you are still dedicating your life for work. What about payment? When you start asking, then people will say that you are materialistic, you do not have the heart to cure the sick, and you are taking advantages on sick people by making money out of it.


Not to mentioned, the feeling of guilt whenever a patient died. You will keep asking yourself, are you the one who causing them to die? The moment when you have to undergo mortality review or even some relative may lodge police reports against you. You are Murderer!  And the guilt keep eating you from the inside and it makes you cry every single night that you have.


It is painful whenever you need to think, how hard you are struggling to save a patient life. You are playing with medicine, bloods, machine and everything you can have but at the end of the day, you watch a straight line on cardiac monitor and you can see their final breath.


The guilt deep inside your heart when you can’t treat the patient as what you have being taught due to financial constraint or nationality status is so painful. While you are taking oath to salvage every soul that you can regardless of the races, religion, economy status, things do not happen in reality. The worst part, when you have to see the patient died because they cannot afford the treatment.


There will be a moment when you see the patient suffers but you just can’t help them because you are less intellect. Not knowing what is wrong with the patient. You just feel that you are useless.


And when you are trying to help, there will always be a smart ass who tries to make fun on your career. While you are trying hard to be a professional in your profession, they will still accuse you of trying to take advantage on patient. Doctors are filled with lustful desire that they are hungry of women boobs and pussy. No matter how hard you are trying, there will always people who use religion to condemn you.


Not to forget, when you are trying hard to council patient regarding their illness, the importance of taking medication and etc, there will be group of people who sell their magical product that can treat thousands of illnesses. No matter how rubbish they are, they will always appears as hero and you are the enemy.


Sometime, a patient just need a place to die and they already accepted their fate. But you can’t even assist them to undergone the suffering. And you can’t convince your colleague to accept the case because of the precious limited bed available for a patient that has good chances of survival.
                                                                                                               

Reality is painful. It is what you have to swallow every day. I will be lying if I never have any thought about quitting my job. Yes, I want to have a luxurious life for I’m tired of being someone with less money. And I’m tired of being scolded as if you are someone with no education. Well, I cry too despite of the fact being man and hate tears.


I want to quit, but then the images of my previous patient kept coming in my mind. Yes, I will never forget them.


How can you forget a child running in the ward and hugs you after he recovered from a laparotomy due to a very bad intra-abdominal infection.


And a patient who comes in with a very bad kidney failure and when he recovered, he even kisses your hand despite the fact that you are much younger than him.


A patient with multiple abscesses and multiple organ failure requiring renal support, lung support and heart support till everybody was just giving up. Tracheostomy was created because he can’t even breathe properly. And on one fine day, after so long time, He starts to sit on wheelchair and then able to talk, smile and eat happily. And you come across with him at hospital corridor after few months being discharged. Smiling happily and thanking you.


You will never forget the smile from a patient who comes in with difficulty in breathing and about to die and you realize that it is a tension pneumothorax. A simple procedure draws out the air and he can smile and talk.


Or patients with heart attack with life on the fast lane, ready to depart to the other world but with God help, you manage to dissolve the clot and they have the second chance.


Or the tale about a grandmother who live in a remote island that need to wait for three days before she manage to bring her sick day five of life grandson. And the septic baby survives and you can see the tear drop from the pitiful old lady.


And the smile of mother when they listen to their baby cries after delivery even though you keep on being accused of taking advantages on them.


Yes, I will not going to forget my elderly patient with a very severe flesh eating skin infection and everybody already nearly give up. But then, with GOD help, you just decide that you want to give another extra effort and she finally walking back home, smiling and forcing you to accept foods as a token of appreciation.


And yes, I have hundreds more tale that I will not going to forget. Tales that manage to ease my heart and make me strong.                                  At the time I’m in agony, it is them that keep me strong. I’m wondering what my life would be if I quit my profession. Will I still be able to see the happiness glowing in the patient’s face?


This is a shitty life. It will not going to give you richness. You will not going to have a forever nice sleep decorated with beautiful dream. And you will lose a lot of precious time. But this is a gift for you. Something that you carry from the first day you are announced as a doctor. A title that you will carry till your last breath on earth. You just can pray that you will keep strong in this profession. Praying that you will not going to have neither a mental breakdown nor the physical burn out.

Allah Matlamatku, Rasulullah ikutanku, Al Quran pedoman hidup, Syahid impianku.

REVOLUSI MAHASISWA MEMBENTUK PEMIKIRAN MERDEKA

"Janganlah kamu bersikap lemah, dan janganlah pula kamu bersedih hati, padahal kamulah orang-orang yg paling tinggi darjatnya, jika kamu org-orang yang beriman."[ Surah Al-Imran ayat 139]

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