ETD3

Last night 2nd to 3rd nov, got oncall with awesome drs. Dr fatimah, aiman majdi, zulkhairi and hanum. My collegue include me, faizuddin and afiq azri.

Evening drs are dr mila, dr gan amd few other. Not remember sho. Hahaha.

So last night i have to clerk about 7 pts. D/w dr gan, that pt stranded till morning. Pity her dx cap with type 1 resp failure and uti. D/w dr mila inferior MI with RV infarct post metalase not perfused killip 1, able to masuk ward.

Then continue dgn night MO 2 trauma cases. 1 case d/w dr fatimah, resolved cc with multiple abrasion wound-discharged. Another case d/w dr aiman CC with retrograde amnesia +laceration wound of upper lip- refer dental and surgery, admit surgery.

1 case acute dyspepsia with dgenerative spine disease, d/w dr aiman-discharge. Another case PUD d/w dr aiman, admit obs ward. 1 case acute pharyngitis, initial HR 130+ post 1 pint ivd, 90+-discharged.

Actually rasa mcm ada 1 lg. Tp lupa case apa. D/w dr aiman. Anyway. Really enjoy last night shift. Misi2 pun osemmm jugak.

Being in ED able to witness drama of life. Last night there is 1 pt c/b dr gan. I think she got gila isim. Heard her shout mcm2. Sometimes curse. Sometime hadis nabi. Somethime just shouting. Pity her. Still young. May Allah give her cure.

Then i witness happiness from pt. Got NVP, booking not done yet. Do TAS, noted 2 fetal poles with their heartbeat. Admit to gynae ward for observation.

My pt having post stroke spasticity ul and ll, came with abd pain. Done ogds in 2016 with finding of hiatus hernia with gastritis. Wifey worried her husband got ca. H/o visit to district hospital almost weekly. Me like 🙄
What ever laa. Nnt specialist counsel them in the ward. Hahaha. Jahat dop aku.

Mindful gym course

Today i attended mindful gym course. Malas sebenarnya nak menulis. But its very beneficial. Maka aku gagahkan jua utk menulis. Lol.

Definition of stress
Tension arise from changes, challanges and danger.

Usually our body will respond with:
-fight (physical, word, thought)
-flight
-freeze

Dr dewi showed us a very interesting video how a boy frozen after doing some mess and was recorded by his mother.

Mindfullness definition: remembering to pay attention to present moment with kindness, beginners mind and wisdom.

Our mind can be trained to be mindful using few tool in order to confront stress situation.

Mindful tools
1. Mindful stretching to deviate stress and feel physical tension and relaxation
-squeeze lemon
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-push up ceiling
-tortoise
-tell aaaah
-tell eeeeh
-tell oooh
-toes grip handkerchief
-toes to shin
-toes touch the wall

2. Mindful breathing
Feels the breathing, the best is abdominal breathing. In from nose, out from mouth

3. HTC (hearing, touch, see)
Pause a moment. Take deep breath. Closed eye. Focus on what you hear. Touch or tap yoir shoulder, hand. See around. Look at beauty in something you tak perasan before.

4. PDF
Prioritize your work
Delegate urgent thing
Focus on what you are doing
Multitasking should be avoided

5. Mindful communication
Be a good listener. Use miyaow?
Mmmm... i see.... yes... aahhh.... ooooo... wow... ?ask back

6. Mindful STOP
Stop busyness temporarily
Take deep breathing
Observe 3 things/HTC
Proceed work with smile

7. Mindful gratitude
- be grateful even for simple little thing
- write gratitude note

ETDstories

In Ed ni, i saw a lot of cases. Interesting one. Disgusting. Annoying. Frustrating. And so on laa.

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Yesterday i was oncall in green zone. There was 1 man, quite young 50+ NKMI, bp on higher side, GM 18 ketone 0.7 other vs stable, ECG stable. At 2ry triage, they labelled him having epigastric pain + vomiting. I called pt. He was coming with wheelchair, looked very lethargy, unable to sit up properly and closed his eye. 

M: pak cik mari ni sakit perut ko?

P: dok sakit perut, pak cik pening. Dgn muntah *asnwer with lethargic voice and still close his eyes. 

M: cer pok cik tengok sini smeta nk tanya soalan

P: *try his best to open eye. Tok leh pening lajok ni *close back his eyes

Gave him stemetil, reassess back after 1/2H. Condition not improved. Do thorough neurology examination, impaired few cerebellar sign. So uptriaged pt to YZ. Request CT brain urgent. Granted. Dr aiman pun pelik how this pt was triaged to GZ. Later on i asked my friend, yes that pt has right cerebellar infarct.

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Another case from GZ yesterday, interesting one also. 67 yo malay lady, has DM n HPT. Triaged as fall. 

Me: ghano mari mokcik

Mc: letih. Pahtu td mok kebas semua sekeliling mulut n lidah. Tak leh nk kecek. Mok cik sero keno stroke.

Me: ada peluh2

Mc: ado ado

Me: td gini ko? Napok po segar. Muka x senget. Kecek lancar. Td ada senget ko muko?

Mc: habis dh air sekotok ngan roti. Rasa segar pulop

Relative: tu la td dok gini. Dokleh kecek. Tp x dok senget

Me🤦‍♀️

They worried too much. Padahal sempat je pergi KK dahulu. Assess sana if indicated they will refer here. Anyhow mak cik so chumell.
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27/28 oct 2019
Last night, i was on night shift at GZ with dr zulkhairi. Nasib baik he is cool and daebak. Case came like waterflow initially strong current and towards the end flow become slower. But it non stop. From 8pm-7.30am i was like zombie dah.

And at 5 dr hanif called from RZ. Asking which pt still pending. He willingly discharged pt from system. What an OCD kinda person he is. Hahaha. Pantang see many pt in the system. I answered his phone call. He said my voice is too sleepy and i was like. Yeahh mmg i sleepy punn 😪

Before going home he was like izzah you looked terribly sleepy. And i was like. No i'm not now dr. Mocking me said i saw too many cases. I was so speechless seeing his happy face. Sbb biasanya dia bukan jenis tegur orang especially aku laa. And still i cant make up with kak fatin. But idc. Hahaha!

Last night i saw variety cases. Paeds mostly, gynae-this i one i will share later, surgery and suprisingly 3 psy cases and non emergency case like dyspepsia/constipation colic.

Haa yang gynae tu kes NVP, PUQE 12-moderate. Then i refer this case to gynae oncall, dr tarmizi
M: dr, saya izzah from GZ. Nk refer 1 case
BM: mg nk refer gapo zah?
M: NVP moderate- PUQE 12 laa. Tp x buka buku lg laa
BM: mg confirm gano dia pregnant?
M: sy buat UPT +ve. Pastu dia dh scan...
BM: mg x scan ko zah. Gano aku ajar mg ni? Kae jgn percaya finding org. Pastu gano mg tau tu intrauterine. Kan PUL ke?
M: nmpk iugs masa dia scan kt private
BM: heh mg ni kan. Aku oyak dh jgn percaya finding org lain. Scan dulu. Oyak smula

Then i bring pt to YZ for TAS 😭
Fortunately can see FH, show it to mother.
Me very happy. Tq Bos Miji. Aku mmg malas nk scan sebenarnya. Sbb sokmo kabur2 jah nampak. But last night alhamdulillah, god ease everything. Thank you ya Allah!

Next will be with other person dah laa oncall. Please help me God.

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Nnt if i rajin tulis lg, i will add on here. Hahaha

Kasih abadi

Hari demi hari
Mencari makna diri
Hati yang tersakiti
Bagamana mahu diubati
Salam buat nabi
Diulang berkali-kali
Hati yang tersakiti
Terasa telah diubati

Magisnya cerita nabi
Kepahitan baginda lalui
Caci serta keji
Demi sinar Ilahi
Tabah baginda tempuhi
Demi ummat yang dikasihi

MyETD2

Heyyo.

Few days ago, i'm having night shift togegher with pia, idin, alif akmal and fadzil Z. I came to hospital as usual. Taking passover from evening people. My friend from ortho said, people in YZ tonight are insan2 terpilih. Me like ???. Why. She said wait till night MO come. I already knew MO incharge that night are dr hanif, dr red, pok jak and dr arif. Dr hanif came early. His shift should be at 10 but at 9.30 pm he already came and clerked NC 🤧 (but he dont want us to d/w him saying his shift not start yet.hahaha)

Then i msg la back my friend what did she meant by insan terpilih tu. And here her reply

I don't think dr hanif choose me. It just coincident je i think. This is my second time night shift with him in YZ. I think if he choose me, it will be in RZ laa. Baru best. Hahaha.

And last time in YZ he taught me about hanif maneuver. Hahaha. There was young lady, having 'severe headache' and i thought GCS 3 dah budak ni. Coz not respond to pain stimulation at all. Dr hanif told me, this kind of pt you should clerk at 2 or 3 am. He told me 'i will not attend her of her relatives are nearby'. So i asked her relative to go out. Tadaa he did hanif maneuver and told me either use this technique or give her lasix banyak2. She will wake up either one. I could say this pt traumatized with that technique by her action- dont want to be left alone. Lol. Hahaha.

This night shift, i can see his true colour. And its shock me 😲 

I dont want to mention it here. But seriously i have to be competent if i want to bring my islamic figure as i dont want to be the reason people downgrade my islamic figure due to my incompetency.

Well thats all for this entry. Need to go to work. Chio.