Perak, Malaysia | Hradec Kralove, Czech

      Stigma by Muharikah | Book Review

      June 10, 2020


      I bought Stigma during a book fair if I am not mistaken and finished reading it at that time. Just because I recently bought the sequels of the novel which are Karma and Dilema, I decided to reread Stigma so that I don't have to get confused with the characters. :)

      Okay, what can I say about Stigma?

      Stigma by Muharikah | Book Review



      Title: Stigma
      Author: Muharikah
      Pages: 351
      Publisher: Iman Publication
      Publication Date: April 2018


      Maybe we can start with a rough synopsis?

      The novel portrays a life story with a medical background; Dr Iman Syahirah is the main character in the story, a medical specialist (a.k.a general physician) in an infectious disease ward, Dr Faris, a medical officer who work together in the same ward. They are in charge of patients with HIV / AIDS and the story plays around this topic. 

      Here come Dr Aleph, a cardiologist who ended up as Dr Iman's best friend. 

      One thing that makes me excited (yet scared) - all of them have the same internal challenge - attracted to same gender but struggling to live a normal, blessed life.

      Yeah, it is scary because it is uncommon for me to see people in medical fields who are LGBTQ and to be honest I am not sure how to react if I meet any. T_T There are some people that I know, but we are not that close... so that's it.




      ---------------------

      I don't want to comment much on the story line as it really depends on the preference of readers. Some may say the story presentation is a bit dull as it contains quite a lot of medical stuffs, but I don't have much problem with it as I have that background too. Yet, the author already explained every terms she used. 

      And maybe I am still a newbie with Malay novels, I find the book to be okay :)

      So, as usual, what I love about doing book reviews is more towards what I have learned from the book hihi... let's go! :)



      1. "Cuma Iman takut. Dalam dia menarik orang lain keluar dari kegelapan, mana tahu dia pula yang tenggelam di dalamnya."

      This is when Iman shared with her best friend, Zarith after Iman met Aleph in a conference I think. Aleph is actually a lady whose appearance is like a guy, a gentleman. At that time, Aleph was actually attracted to Iman and trying to hit on her.... hehe okay kat sini rasa semacam kejap.

      But what I like about both of them, they finally know about each others' past and struggles to change, even trying to support the process.

      Stigma by Muharikah | Book Review

      About the verses, to be honest, I don't much experience dealing with LGBTQ, but the verses sound so good, reminds me on how people afraid to get involved with people having bad issues because they are afraid if in case they got influenced to do the same.

      Stigma by Muharikah | Book Review

      Here, I am surprised to read that Faris furthered his studies in Jordan, while Iman in Egypt. Although they were in Islamic countries, they were still exposed to LGBTQ too. Maknanya, study negara Barat akan terdedah dengan budaya ni, rupanya di negara Arab sekalipun. Ahaa...


      2. "The struggle is real."

      This verse is quoted quite a lot through out the book.

      When Iman trying to counsel her patients about changing the lifestyle, I realised people who are LGBTQ somehow know their preferences are wrong but at the same time, they also feel there's nothing can be done because they are born that way.

      "Tapi, saya tak rasa saya ada pilihan pun, doktor! Dari kecil lagi saya suka kat lelaki. Saya dah cuba untuk suka perempuan! Saya memang tak boleh! Saya rasa geli!" - Johan

      "Percayalah Johan. Kita semua ada pilihan. Cuma kita selalu biarkan nafsu dan perasaan buat pilihan untuk kita. I know, the struggle is real. Tapi yakinlah, jika awak benar-benar mahu berubah, Allah akan bantu awak." - Iman

      From this conversation, I can imagine what if the advice given by Iman was actually given by someone else who is straight? The LGBTQ may even say that... "kau tak faham pun perasaan ni", in another word, we are saying out of empathy. Only if the patient know that the doctor herself was in the same shoes!

      Anyway, yeah. Memang challenging untuk ubah nafsu. The feeling is real. The love. The preferences.

      Stigma by Muharikah | Book Review


      "Bukan hak kita untuk judge orang, Faris. Setiap orang tu pasti ada pengalaman silam dia. Ada trigger yang menjadikan mereka begitu. Ada seorang pesakit ni jadi gay sebab kena liwat dengan abang-abang senior sekolah asrama. Bila you dengar cerita mereka, you will understand and appreciate their struggles. Dari situ, awak boleh bantu mereka untuk berubah dan kembali kepada Allah." - Iman.


      This makes me reflects a lot about my impression every time I met patients with known case of hepatitis, retroviral disease (RVD) etc. Some may even got the disease from husband / wife or even blood transfusion (though it is rare). We usually call them as 'biohazard patient', more towards our preparation to protect ourselves with PPE. 

      Maksudnya, bila nak ambik darah, kena pakai double gloves - walaupun kalau nak ditakdirkan tercucuk, tercucuk jugak. Getah lawan jarum, siapa menang? T_T


      3. "Hati kita ni, Allah yang punya. Serahkan hati kita kepada Allah."

      "Dah lama saya tak dengar orang nasihatkan saya macam ni doktor. Dah lama juga saya tak jaga solat saya. Asyik tinggal saja." - Johan

      " Jangan putus asa, Johan. Allah ada. Awak jaga solat, Allah akan jaga awak. Awak berdoa dan minta tolong pada Dia, Dia pasti akan bantu awak. Awak hanya perlu bersungguh-sungguh. Ingat ya, Johan? Hati kita ni, Allah yang punya. Serahkan hati kita kepada Allah." - Iman


      This conversation also reminds me how important of our prayers. I can relate with my work too. Memang tiap-tiap kali nak pergi kerja, doa banyak-banyak semoga Allah bantu. Alhamdulillah, even though I feel a bit sad because I don't have much opportunities to work with female senior doctors, I feel blessed that most of the male seniors that I've been working with are VERY HELPFUL. I believe Allah is helping me through them - their knowledge and experiences. 


      4. Umat Islam memang memerlukan ramai doktor pakar.

      This hits me a lot. Huhuhu. Maybe because I am still contemplating of furthering studies or simply stay in this position till Allah knows when.

      Stigma by Muharikah | Book Review

      "Dulu, profesor saya pernah nasihatkan, dia cakap: pertama, tak ramai orang Muslim yang berjaya sempai ke peringkat tertinggi dalam perubatan. Kedua, bila kita nak treat pesakit kita, rasa lebih nikmat apabila kita tahu cara terbaik untuk merawat. Bayangkan jika kita tak ada ilmu perubatan, sedangkan mereka perlukan pertolongan. Bagaimana kita nak bantu?" - Iman

      "Terakhir sekali dia kata, apabila dah jadi specialist, physically kita akan lebih banyak masa untuk luangkan dengan family kita. Cuma yang diperlukan adalah otak kita. Gaji pun bertambah, ada waktu hanyak perlu on call dari rumah sahaja." - Iman

      Huhuhu....

      Tapi nak sambung belajar balik tu... mashaAllah perasaan dia, serba salah betul. A lot of things need to be considered - money, place, family the most important. Based on my seniors sharing, ramai je yang bergolak rumahtangga bila ada yang sambung belajar. All need patience and understanding, right?


      5. Dosa

      "Dosa ini, pada awalnya memang kita rasa berat. Rasa gelap. Kita rasa sesal dan gelisah. Tapi, bila kita dah selalu buat, hati kita akan jadi gelap dari hari ke hari, sehingga kita tidak lagi merasai bahawa dosa itu satu dosa." - Ustazah Norhafizah

      "Hati kita sudah desensitize dengan maksiat. Apa yang berlaku bila kita dah tak sensitif? Dosa tu jadi perkara biasa. Kita tak sedar dosa tu satu kesalahan. Apabla ada orang tegur, kita melenting. Apabila solat, kita dah tak rasa manis beribadah. Apabila baca Quran, kita susah nak menangis." - Ustazah Norhafizah

      So true.



      Stigma by Muharikah | Book Review


      -----------

      Generally, the content is actually heavy but I glad that Muharikah managed to tackle it and produce the product with a light read :) There are too many things we can learned from this novel, insyAllah. 
      Good job, Muharikah :)

      I can't wait to share my reviews on the sequels too :D

      My rating: ★★★★☆

      SM, Perak, Malaysia
      200610

      Houseman Bingo (Part 2)

      June 9, 2020


      Let's continue with the next part. :)

      This bingo is actually for my own memories, housemanship has its ups and downs, so, I treasure all experiences I had encountered when I was a houseman :) Maybe this post can be helpful for any new house officers trying to read around about housemanship - though there are lots of other people posting everywhere, hehe :)


      Houseman Bingo


      10. Activate blue or / and red alert.

      In the hospital I had practised as a houseman, blue alert means there are some emergencies going on in the hospital involving outpatients, family members or visitors.

      Recently, there was a patient brought in to our ED after blue code activated. She was at the outpatient department, to be specific during the process on blood taking for her appointment date when suddenly develop fitting episode. With a known case of epilepsy, she was finally admitted for further management.

      Others can be as family member who is taking care of patient in ward suddenly found unconscious. It is not that the ward cannot do anything to him... of course they will especially for basic life support. But the emergency team will be called to attend the patient and bring him to the ED for stabilization :)

      While red alert can be found mostly in O&G department, involving pregnant women - eclampsia (sawan), post partum hemorrhage (pendarahan banyak lepas bersalin), should dystocia (bahu tersangkut masa bersalin), cord prolapse (umbilical cord di pintu rahim masa nak bersalin) - all of these cases are emergencies!


      11. Send patient for xray by self.

      This happened when I was in Orthopaedics. We were planning to get check x ray (means x ray that is done after operation) to see in formality if the operation is successful or not. The patient was put on some case (I can't recall the name) but it was a bit complicated to set it up. The radiographer need to remove the cast/sling first before shooting the x ray, but requested for Ortho team to be there to reset it back after the x ray.


      12. Explanation letter.

      Need to do this when in Ortho as well for some reason - actually I forgot details of this patient. 
      -_-'



      13. Send specimens to lab by self.

      It is a normal routine for housemen, despite we have PPK (pembantu perawatan kesihatan) but they could be doing other stuffs too, like sending patient for xray / to OT, taking food trays from kitchen etc. So, in daily life, sending specimens is our task too - especially in emergency cases in ward, like resuscitating patient.


      14. Sleepless oncalls

      To be honest, I don't fancy oncalls / night shifts. -_-' maybe that is one of the reasons I prefer myself to float in ED (other than I still can't decide which departments to go as I love all of them huhu). ED practices shift systems. 

      Oncall usually means, working for at least 24hours plus plus plus, for example going to work at 7am today and punched out at 1pm the next day. For some hospital, it can be up to 5pm the next day. I had no experiences with that shifts, as my previous oncall shift was different.

      In O&G - 7am-5pm, go home to come back at 10pm and finish oncall at 1pm the next day - though we can be stucked in the ward / labor room between that 5pm-10pm.

      In medical - 7am-12pm, break till 4pm, then continue working till 1pm the next day. The 4 hours break were totally UNPRACTICAL haha as the morning round will finish around 11am plus, and for sure it will be really hard to get all task lists done within 1 hour. Haha.... kalau bertangguh, tahan la telinga kena marah dengan family members sbb tak siapkan lagi surat-surat discharge semua. T_T


      15. Meconium bath in LR

      Meconium = najis pertama baby. Despite wearing plastic apron, our clothes / shoes can be soaked with the patients' meconium while we are helping the delivery. Meconium can be light / moderate / thick.

      Stain in meconium means the baby already pooed inside the womb. This can be a problem later if the baby aspirate the meconium as it can pass through the lungs and cause the baby to have difficulty in breathing upon delivery. This is not a simple case - it can even lead to death!

      JaypeeDigital | eBook Reader


      16. Feed and took selfie with newborn in ward.

      I really enjoy the feeding session in NICU (neonatal intensive care unit), you can see how eager some babies react to milk (be in expressed breast milk or formula milk). Usually if the babies need intensive care and monitoring, they will be admitted to NICU where they don't stay with mothers. So, the time for direct breast feeding will be limited and all mothers will be consented for formula milk.



      Different situation in post-natal ward or special care nursery (SCN), where the babies can be still under pediatrics team's observation but they are stable enough to be left with mothers. :)


      17. Belanja misi food.

      Usually after end of posting :) Haha.


      18. Mortality summary.

      Haaaa, I don't like this one. First, it means our patient had passed away. Next, they need good documentation especially in cases that family members would like to have a formal medical report to claim with insurance company etc.


      ----------------

      Wow, suddenly I missed my housemanship. Haha, but like others, of course I don't want to repeat the phase again. Housemen leave home before sunrise, return long after sunset. Almost daily hehe.

      Alhamdulillah. Thank you Allah for helping and guiding me through out the housemanship - with providing me good people around and experiences. :)

      SM, Perak, Malaysia
      200609

      Houseman Bingo (Part 1)

      Found this in my phone gallery. Before I delete pictures like these, I feel excited to share it on the blog first. I have 9999+ images more to delete, seems like I have deleted nothing. Hahaha.



      Houseman Bingo


      For this, I managed to achieve one Bingo. :D



      1. No off for 2 weeks.

      Yeah, it is possible for some department when you can accumulate two off days consecutively :) As a houseman, you are entitled to get one off day per week.

      In my case, it was during surgical posting. We have this 2 weeks rotation for clinic which cover office hours (Monday to Friday, 8am - 5pm). So, you can either have your off day on Saturday or Sunday for each week. Otherwise, you can request to the team leader to allow you to work the whole 2 weeks and claim your 2 days off later. 

      Housemanship has flexible schedule though. It was hard to plan for holidays, sometimes. 



      2. Ate hospital food.

      We called this - hospital diet. Trust me, almost 99% of the food are delicious! Usually the kitchen will serve different meals for staffs and patients. Even for patients, there are different food too - depends on each requirement, some may have high potassium diet, low potassium diet, low sugar diet, not to forget... we really care about patients' allergies too :)

      Houseman Bingo
      Tomyam ayam


      3. Felt like quiting.

      Hehe, I felt this way every time I failed to give my best, or unable to save patients, or unable to recall knowledge that I've learned.

      Medicine is a continuous learning, every day is a learning process and we encounters lots of new things every second. 

      Feeling like quiting is normal, just don't quit before you have really tried your best or have a strong back up plan. Find something to look for everyday. :)



      4. Did a vacuum dressing.

      There are different types of dressing to the wound. Dressing means technique to cover the wound - some simply with normal saline, some with special liquid, some with iodine. For vacuum dressing, we are basically put some negative pressure / put some suction to the wound, with the aim to remove all exudates (layman terms = air bisa?) and encourage growth of new healthy tissue :)

      Clinical evidences, personal experiences, recent applications
      Something like this - source https://www.wjgnet.com/2218-6190/full/v1/i3/13.htm


      5. Failed blood taking x5 on same patient.

      It is actually common for patient with difficult blood taking which usually we ended up with taking blood from the artery. I encountered this when I was in medical department, especially when I was doing my solo HO night shift. It was hard to ask for help as others are busy too with their medical wards. T_T



      6. Play with newborn in ward.

      I enjoyed this especially in O&G department, hehe I called newborns as cookies fresh from oven. :) Their smell is soooo nice, especially after we cleaned them up. After a baby is born, the doctor will need to do basic baby check, to make sure the baby is generally healthy. If the mother has some pregnancy problem, like gestational diabetes mellitus, history of infection, big baby - we eventually will call the paeds team to do the check instead. :)

      Houseman Bingo


      7. Kena 'buli' senior or MO.

      Hmmm, sometimes I don't realised this, until another colleague mentioned to me something like, "Eh, kenapa kau pulak buat benda ni, bukan patutnya XX punya task ke?" Haha.

      Bullied by MO, hmmm, not sure. 



      8. Get to know a supportive MO

      There are lots of them to be honest. Get to know them and you will have more opportunity to learn more. :) Every department, I have my favourite MOs whom I found easier to discuss and plan for management as they will ask me back about the reasons behind those management. :)

      "Kenapa aku buat macam ni untuk patient ni."

      If my answer is "not sure, nanti saya baca part ni." And he/she will give due date to present back to him/her with the answer. Sometimes, even after studying that specific topic, my answer can be wrong. But I love how they were still being patient and explain the reasons.

      These kinds of people, may Allah bless.  



      9. Punch out 4 hours after work.

      HAHA.... many times during medical department, especially during postnight shift. You are allowed to go home after 1pm (during that shift system), but, what to do if the morning rounds sometime finished around 11am, and you have lots of task to complete before leaving the ward. Usually what made me stuck there was when I failed to complete my tasks especially the one involving office hours - like sending / receiving fax to / from another tertiary hospital about patients' previous records, requesting urgent radiology appointment, calling another office / klinik kesihatan - where the lunch break usually from 1pm - 2pm plus. 

      While I still have other pending stuffs to do like settling patients' discharge notes, assisting MO with procedures, urgent blood taking etc. Hahaha. 
       

      ----------------------------------

      Enough with 9 for this post, gonna share the rest in the next one :)

      SM, Perak, Malaysia
      200609

      The Art of Letting God by Mizi Wahid | Book Review

      June 6, 2020

      I have my eyes on this book for months but keep on postponing because of the price -_-'. I know RM50 is not that much for a book, to be exact a hard covered book. But as I have spent hundredssss of ringgit during the previous Big Bad Wolf, I need to calm myself from buying new books until I read at least a quarter of books I bought from BBW hehe.

      So, here I am!
      I managed to grab it at a discounted price during Pesta Buku Iman and I can say I love it so much! The book arrived just before Ramadhan, so I have spent the whole Ramadhan reading it, slowly. I even brought it to the hospital and shared things I read with my colleagues, then we ended up sharing our own experiences. It was lovely, alhamdulillah.


      The Art of Letting God

      Title: The Art of Letting God
      Author: Mizi Wahid
      Pages: 147    
      Publisher: Iman Publications
      Publication Date: March 2019


      The Art of Letting God
      Back cover of The Art of Letting God.


      Anyway, while writing this, I realised I don't have much book reviews on non-fiction (?) Actually I've been known by my family as a person who lacks fiction imagination haha, so I tried my best to read lots of fiction books to improve it.




      Allow me to share snippets or beautiful verses from this book :)


      1. The greatest temptation many of us find most challenging to deal with in life - is the temptation to give up.

      This is very true, we have the temptation to quit whatever we are doing, for various reasons - financial problem, family problem, lost of focus, emotional attacks etc. But, the moment we managed to overcome this temptation, that's the beauty of success. It actually can be seen as one point in life, but to be honest, life is continuous journey so to overcome it needs life long courage and support.

      In this book, the author described more about Prophet Moses (p.b.u.h) who was not only asking Allah for ease in affairs but strength, wisdom, patience, ability and support :)

       

      2. Tawakkul is the word used to imply one's act of reliance on God or "trusting in His plan". It is also seen as "perfect trust in God, and complete reliance on Him alone.

      Reading this verse, reminds me on previous conversation with a friend of mine who is an atheist. Medical school was a hard time. To get through each tests and years, I learned a lot about tawakkal and really, success is not only about studying smart but the idea of having Allah to rely on after our hard works.

      "Tie your camel first and then put your trust in Allah."

      She mentioned to me how stressful she was and asked how do Malaysians can remain calm. Haha. Only if she could see hurricanes in our hearts :D

      "Maybe because most of us are Muslims? We usually leave it to God after we tried our best during the process of revising."
      "Oh, I don't believe in God, but I believe my success will be from my hard work, that's why I need to study more."

      In my heart... no wonder. Penat sebenarnya bila kita terlalu bergantung pada kemampuan sendiri sebab manusia memang bukan perfect, akan ada kesilapan dan kelemahan. 



      3. Believe that nothing just happens. Instead, everything happens for a good reason. And everything happens for you, not against you.

      Most of times, we tend to argue about others rizq and complained why such opportunities do not come to us. And we tend not to realised how much other rizq have Allah blessed us with. Some may have a good occupation and income, but he may not have children yet. Some may be blessed with children but having difficulties in work.

      The author also mentioned about the tools and ingredients to success that we may already have but we don't realised it - so, we ended up to keep wondering about our unanswered prayers. 

      The Art of Letting God

      "If all of you were to truly have faith in Allah s.w.t. He will certainly provide you with sustenance, just as He would give to a little bird, for when it leaves its nest in the morning with an empty stomach, but returns home in the evening full."



      4. Friends, reject the cup of poison. Instead, drink from the fountain of faith, the reservoir of resilience, and the sea of spiritual confidence.

      In the book, this part was described as we are exposed to lots of "poison" which would murder our thoughts and destroy our peace and happiness to its death.

      I believe most of us have our own experiences. 

      The Art of Letting God

      Rejections from other people.
      Bad words that push us down.

      Refuse that poisons, reject that unproductive comments, go beyond.



      5. "How do we know if we've forgiven somebody, and have completely moved on?"

      The author listed down few check lists to see where we are and how much further we need to go to finally achieved the term 'completely moved on'.
      • Are we still interested to know about them?
      • Do we feel our blood boiling when we hear their name being mentioned in a conversation?
      • Do we feel awkward when we bump into the person?
      • Are our emotions still at the mercy of our senses being triggered by old memories?
      • Do we feel unhappy when someone tells us about the person's happiness?
      • Are we secretly stalking them?

      I agree with the author with letting Gold be the one to "teach our enemies a lesson". We don't have to be one as Allah surely know the best lesson to give with the perfect timing.

      The Art of Letting God


      "Those who spend in prosperity and in adversity, who suppress anger, and forgive others, verily, Allah loves those who do good." (Quran 3:134)

      Let it go and let God :)

      "Experience genuine peace in your life when you learn how to love in moderation, fear within limits and hate within reason."


      The Art of Letting God


      6. Each new day, deserves a brand new beginning. Let go of yesterday's hurts, begin the day in the name of Allah. Just as He magnificently heals all of our physical wounds, trust in Him to supernaturally heal our emotional and spiritual wounds too.

      I love the part "Never back away from opportunities to help others who are struggling, by making a positive difference in their lives" despite having this kind of thought, "But I'm not good enough".

      Humans are never perfect.
      Humans do make mistakes.

      Even the first human Allah created - Prophet Adam, fell with persuasions of Iblis and eventually being casted out from Paradise, Prophet Adam repented for his sins and became the first Messenger of ALlah to humanity.

      I know we are not prophet, but from this story, we need to believe that humans make mistake and Allah is always there to forgive us more that we are to forgive ourselves.

      Beautiful :)



      The Art of Letting God


      My rating: ★★★★★

      SM, Perak, Malaysia
      200606

      Would You Ride Your Motorcycle Without A Helmet If It Was Legal?

      May 29, 2020




      I was scrolling my Quora and came across this question. It is an interesting question if we are trying to answer it from perspective of healthcare workers like me vs riders.

      To be honest, I don't have motorcycle license and have no skill to ride it as well. Haha. 

      And after working in the hospital, 
      I WILL THINK TWICE BEFORE RIDING ANY MOTORCYCLES. T___T


      https://www.quora.com/Why-do-people-not-wear-a-helmet-while-riding-a-motorcycle
      https://www.quora.com/Why-do-people-not-wear-a-helmet-while-riding-a-motorcycle



      -----------------------------------

      **WARNING - THIS POST CONTAINS WOUND IMAGES**


      Let me share with you a recent case I attended in the Emergency Department.

      It was the morning of last day of Ramadhan, maybe around 4am. The patient was a 16-year-old boy, if I am not mistaken. He was referred from a klinik kesihatan that was 40km away, with the impression of: To Rule Out Skull Fracture.

      Resources in Klinik Kesihatan can be limited, they can do chest xray, but not others. I've experienced a lot of referral to rule fractures from KK and to be honest, skills of doctors and medical assistants in KK are amazing. They are usually the primary team to stabilize patient in areas without hospital. 

      So, back to this case, he was brought in on a wheelchair, with lots of gauzes covering different parts of all four limbs. He could even walk from the wheelchair to the bed.


      Usually, when we attend trauma cases, we use ATLS as guidance.
      ATLS - advanced trauma life support.
      The PDF itself is almost 500 pages! -_-'

      Starting with A - airway + cervical
      • Patient able to speak in full sentences, no gurgling or stridor, no foreign bodies in the mouth/ nose, not on cervical collar, range of movement of neck was full.

      Proceed with B - breathing + ventilation
      • Here, we usually use the acronym IPPA - which means Inspection, Percussion, Palpation, Auscultation
      • I - breath spontaneous, not tachypneic, chest rise was equal bilaterally, no chest wound
      • P - resonant percussion bilaterally
      • P - no clavicle tenderness, no chest tenderness, chest spring negative, no subcutaneous emphysema / crepitus
      • A - lung was clear, equal air entry
      • Don't forget to check the oxygen saturation too (SpO2)

      Then, C - circulation
      • check other vital signs - blood pressure, pulse rate 
      • CCTVR - Color of skin, Capillary refill time (CRT), Temperature of extremities (is it warm/cold), pulse Volume, pulse Rate 
      • for this patient, it was all normal - pink, CRT <2s, warm peripheries, good pulse volume, pulse rate around 60-70.
      • then, we checked the abdomen - soft, non tender, not distended, no abdominal wound.

      After that, D - disability
      • GCS was full E4 V5 M6, pupils 3mm/3mm equal reactive

      Finally E - exposure / environment
      • Here, we inspected the whole body from top to bottom, from front to the back. 
      • This boy has abrasion wound everywhere - shoulder, elbow, hand, shin, foot. But there was no swelling, no limb deformity, no limb tenderness, no limited range of joint movement (means, he can bend all joints normally) - so we don't expect any fractures here.
      • There was no spinal tenderness / step deformity during log roll
      • But the head was covered with bandage and we could see some blood stain. When we open the bandage, fuhhhhh there was jagged wound, quite big one! the skull was exposed. And there was no skin flap to cover back the skull. 
      • We gave him antibiotics and painkiller too. 
      • FAST scan done, no free fluid.


      Something like this but smaller around 6cmx6cm size.
      https://www.slideshare.net/vipinvenugopalnair/free-ld-flap-for-scalp-reconstruction-dr-vipin-v-nair




      Okayy, I know there are LOTS OF MEDICAL TERMS here haha. It is okayyyy, you don't have to understand everything. :D

      To make it easy, generally we can say that this patient was stable clinically, vital signs was okay. Just, if there was no jagged wound on his scalp, he didn't even need to be referred to tertiary hospital.

      Biasalah orang accident mesti akan calar balar sana-sini. Takde patah, kira alhamdulillah sangat dah. Tapi untuk dia ni, kulit kepala dah terbukak, tengkorak terdedah camtu. Nak jahit kulit kepala pun tak boleh.


      We managed to request CT brain in view of the wound was big and skull was exposed - just to rule out any skull fracture or any possible bleeding in the brain (ICB - intracranial bleeding).

      Alhamdulillah, turned out CT brain was okay - no ICB, no skull fracture.

      So, what we did for his jagged wound - we referred him to Surgical Team so that they can refer the patient to Plastic Team. In big hospital, you can see lots of sub-specialty for Surgery - neurosurgery, plastic surgery, ear-nose-throat, hepatobiliary team etc. But, we don't have such sub-specialties here. There nearest one for that is HRPBI - Hospital Ipoh. 

      If the wound was a simple laceration like the one below, usually we can suture it ourselves..

      STOCK IMAGE, close-up of a laceration on the scalp repaired with ...
      https://www.medicalimages.com/stock-photo-image-image9257585.html




      I feel sad for his father, he looked very tired and when the surgical team informed him that the patient will be transferred to Ipoh, we could see his 'pasrah' face. I believe the importance of parenting, but kids nowadays can be beyond control.

      This is one kind of accident that actually can be avoided. 
      Why?

      The boy is underage, without licence, without helmet, went out riding motorcycle with his friends around 12am, speed at least 80km/hour and the mechanism of accident was as I expected - he said "kawan main motor himpit-himpit, saya tak boleh control motor tu yang terbabas"

      Rasa sedih bila jumpa kes macam ni. 

      And there were countless cases like this EVERY SINGLE DAY.


      So, if you guys or your family members are motorcycle riders, do remind each other kay. 
      Always wear helmet.

      200530
      SM, Perak, Malaysia
      Day 10 of May Photo Challenge - Self Care

      I Miss...

      May 15, 2020


      ... this view.



      I miss travelling actually, walking around the airport to catch flights.
      I miss sitting by the window and watch the beautiful scenery from the top.
      I miss the feeling to pass the security control and to have another stamp on my passport.

      :)

      I was actually planning to have a trip back to Czech after completing my housemanship hehe :D. Usually, after housemanship, we are allowed to use the remaining annual leaves and take a long holiday up to 27 days (if I am not mistaken). But my husband was still working at that time, so I decided to wait for him first to go later together. I went to the office to inform that I would be starting my floating (junior medical officer) soon. 

      Due to Covid19 outbreak, my friends who decided to take that long holidays were called to start working and our leaves were apparently have been frozen since March. 

      Ouch.

      And I think travelling abroad is going to be tricky after this pandemic, right?
      Maybe travelers need to provide supporting documents, health reports - new norms maybe?


      Day 9 of May Photo A Day - I Miss...
      SM, Perak, Malaysia
      200515

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