Attachment Day3 24Aug2011

Attachment Day3 24Aug2011

Ward 2A

Okay, today I went early as usual, joining the morning po and follow the morning round. And there’s this Dr. I just kenal. Dr Lum Lee Chin. I’ve seen her yesterday but only for a while so today, I just kenal her since HAHA, she said to me, ‘’Sorry I don’t know you.’’ And time tu lah I tell her who am I. :P

Okay, so for today…I can’t remember much but hey, I enjoyed myself getting to know items in medical room;bilik kelengkapan perubatan and also treatment room;bilik rawatan. Hm.. I;m not sure to tell you items there cause it’s too much and not important now. But still, I’ll share some where I think you guys need to know or might be of interest. So, we have, disposable glove and sterile glove, vials and ampoules, pipelle, speculum; disposable and metal. Yesterday, Dr. Khiu tell me several things of the wards and show me where sharps are disposed in; there’s a bin for the sharps to be disposed of. There are 3 bins; 1 sharps, 1 domestic bin and 1 for any clinical waste like tissue fluid, blood, smear, etc etc.

Oh, and I also curi2 time looking around and also after asking Dr. Aisyah, there’s ward 1A and 1B; Ob, labor room, screening room, ward 2A; Gynae and Onco, and clinic which also including EPAU.

Bercakap ttg Dr. Aisyah, I went down for 2 times because looking for her. And at the first time looking for her, I learnt that there’re 3 to 4 staffs with the same name; Aisyah. There’s 2 for specialist, 1 for the staff nurse and the other one xsure. MO kot. Kot lah. So, after the first time went down to ward 1A, 1B; where I met other specialist name Dr Aisyah too and get to the clinic, I met her at the clinic after my 2^nd attempted. So, met her, talk abt my day, learnt a thing or two from her past exp mainly her attachment previously and tips and advices for me while doing attachment, I went up after thanked her.

Later, after puas sembang kejap ngn Dr. Aisyah, I went up and get to the counter as usual and get down and read BHT which is on que for discharge summary and also any case admitted I take interest in. At the same time, I also look out for chances to see Dr.s doing U/S in the bilik rawatan. Well, it’s my activity since yesterday too. And so today I got another chance and this time also, Dr Aziemah again set the speculum on for transvaginal U/S. Well, seems like most HO here asked her to do it because they dunno. At one time, I follow in, Dr Khiu minta tolong get the spirit alcohol for him, I dunno where and haha, Dr Aziemah marah, ‘’Bukan kat sini.’’, she scolded me haha. I don’t mind, really. What I mind is if I am of trouble to her and annoyed her being there tu je. And if yes, I’m sure she’ll tell me. (: So, I got marah by her, I mean, she’s annoyed je lah kot, well, as I said before, MO quite tempered here haha. Banyak keje kot.~ Jadi leader lg.~ Husnuzon.~ :D So, Dr. Khiu help me with the location and then ask me to fill the sample bottle cause they’re taking cervical smear for Paps test. Then she asked for tissue and I kelam kabut amek haha. But then, the 2^nd and 3^rd time she ‘s inserting the speculum and do the TV scan, she suddenly asked me if I wanna see cervix. :O It’s a little surprising but then I tengoklah. She’s kind indeed. I am sure of it haha. Except that I think it’s quite pressuring lah being a  MO. Dunno why but seen them with temper make me conclude it that way but hey, they’re actually nice. Only at a times do they get soak in the temper and also, there’re still MO yg x garang sgt pun. Nak tao sape? Wait lah for my other Days coming. :D And I get the chance twice, she let me see it and says, ‘’Haa~, napak kan, lain kan.’’ (:

And she also can laugh lah and senyum2 too among other HOs. She even asked them to learn doing the TV U/S, asyik dok mitak tlg dia je.~ Bila nak blaja. Hehhe. I heard that. :P

After that, I went to the counter and get a BHT of this one pt and started to copy everything on it and btw, she’s discharging today. And my BHT? Dr. sebok nak pakai. =.=’’ tulah time 2^nd time I went and get Dr. Aisysah. :D By the time I went back here, I get the whole time copying the BHT. Ibu asked me to do that if I have nothing to do. And it’s a good thing lah. You’ll learn the pattern and get some idea of how Dr. clerk the pt, the am/pm review, and much terms and shorthand you don’t know of.

I’ll share some here..not everything lah sbb xlarat nak type hoi.~ :P  s/b; seen by, p/w; present with, SVD; spontaneous vaginal delivery, Cx; clinically, HPE; histopathology excision, POA; product of conception, c/o; complain of, NAD; nicotinamide adenine dinucleotide..no lah~…Nothing Abnormal Detected. :P , mn; midnight, cm; coming morning, MOT; maternity operation theatre, GOT; general OT *I dunno the diff bet GOT and MOT =.=’’*, BSP; blood sugar profile, UFEME; urine full examination microscopy examination. And hey, good things also go thru the BHT is that you get to see/know how they plan for management. (:

Okay, these are my sharing for you guys. You can skip if you want to. I think there’s additional traits we should acquire. It’s not obligate must some of the you’ll need of and some are of good benefit if you have. These are; fast clear talker, fast walker *inspired by Dr. Khiu :P*, efficient/cekap, good memory, good services, professional, smile, relax and no panic, good skills, speed writer, speed reader, good listener, good at congak cause sometime simple calc are of needed, being an Islamic role model *inspired by Dr Zainßwho? You’ll know later.*, soft skills, social skills and time management skills. Share with the world if you can. (: And a good thing is if you can speak Multilanguage sbb in GH, esp in Mys, we are of multiracial country and also better if you can learn of their culture a little cause it does play a role esp when you’re taking history and clerking a pt. (: And also, based on my exp, we also have Siamese come to GH and you….cant talk to them because they don’t understand you. The only way is to learn, even Dr pun ask the HO to tampal paper tulis; yes, no, sakit etc2 and I think depends on dept. since I am in OnG.

After the pm round, I, sat next to Dr. Khiu and ask him his b/ground etc2. So, we talk while he’s doing the discharge summary. And here, he also ask our systems and said that he’s learning gne old system since in Crimeastate *if xsilap* they use old system instead of us; integrated. Dak2 IMUs pun gne same system as us, I mean we used same as them. =.=’’

So, he then started to ask me random things abt studies like pop quiz lah. Then he asked abt this Leptospirosis. In this event, I’ve learnt something which I would like to share with you guys, and also one of the reason I love to tag along to him. When I can’t answer things *yeah, cam bangan, aku da study kuat2, aku bole lupe mende ak blaja sem ni ngn sem lepas???!!! =.=’’ * he ask me this L. Interroghans; what is interrhogans, the meaning and then I can’t answer so he said that in Latin, it means question mark. Form there I got the idea that we learnt the morphology is spiral with hook end , right? So, the morphology come from the name itself and he started also with others like staph and strept. Yes, and he did tell me, ‘’Did you curious how your parents give you your name? And you asked them, right?’’ And so he said to me that ‘’when he actually blaja, he always curious of things and question3 himself this and that and go find the answer. That way, you’ll keep yourself interested in studies and also x perlu menghafal like what they say, ‘membabi buta.’ ‘’haha. That word hit me, I mean makes me fall so much in admiration to him. You guys igt senna2 ke org mlayu nak ckp cam tu? Hue~ I like lah the way he inspired me like he always does.

So, driven by himself also, he asked me abt the system ctrling our body and I get 2; CNS and peripheral nervous system but you know what he said, ‘’there’s three and you are good cause you can answer two but to be a different doctor, you should know the 3^rd.’’ and the answer is? APUD. HAHA. We learnt that in endocrinology block in histo right? I almost forgot it. Even in the GIT block also. =.=’’

And I really can’t stop smiling lah sbb dia nak nasihat me who I a malay? He;s not racial, I tell you. Everyone I met so far are not racial. (: So, when we finished talking and he;s still with the computer, I tell him to ask me any question, I’ll try my best to answer and if not, he’ll be giving me homework for that haha. And what did he says to me? Come to me if you’re seeking for the answer. :P

And shortly, there’s MRO; multi resistant organism. One of them? M.TB, and not tuberculosis; that’s a disease caused by it. Haha, kantoi lagi my answer. :P*DR. Khiu asked also*

Speculum= is a medical tool for investigating body cavities, with a form dependent on the body cavity for which it is designed. Like an endoscope, a speculum allows entry into a body cavity; endoscopes, however, tend to have optics while a speculum is intended for direct vision.

Sharps= any needle/sharp instrument like syringe, needles and branula.

EPAU=early pregnancy assessment unit

U/S=ultra sound *salu terigt ultra scan. =.=’’*

Pap smear test= papanicolaou test for cervical cancer

TV=transvaginal

GH= general hospital

MRO= multi resistant organism

(:

to my future husband. (:

Angin bayu membawa diriku
Sepintas lalu ku terkenangkan mu
Memori silam meresap malam?
Kenangan bersama tersimpan selamanya?
Walaupun kau pergi jauh dari diri ini
Cintaku masih bersemadi di hati
Keyakinan kita kan kembali
Menghidupkan semula janji bara cinta?

Kita bersama mengejar mimpi
Terpisah sementara ku pasti
Suatu hari nanti cinta kita bersemi
Kembali menerangi mekar di taman hati
Walaupun jauh pandangan mata
Ku yakin kau kan tetap setia
Begitulah ku jua keikhlasan di jiwa
Dan cintaku hanyalah untukmu

Saban hari diriku menunggu
Khabar berita darimu di sana
Gerimis senja kembali reda
Kerinduan di jiwa kau jadi penawar
Rinduku padamu tak dapat ku terkata
Setiap saat waktu bagai terlalu lama
Bila kita kembali bersama
Hiduplah semula janji bara cinta

Kita bersama mengejar mimpi
Terpisah sementara ku pasti
Suatu hari nanti cinta kita bersemi
Kembali menerangi mekar di taman hati
Walaupun jauh pandangan mata
Ku yakin kau kan tetap setia
Begitulah ku jua keikhlasan di jiwa
Dan cintaku hanyalah untukmu

Kita bersama mengejar mimpi
Terpisah sementara ku pasti
Suatu hari nanti cinta kita bersemi
Kembali menerangi mekar di taman hati
Walaupun jauh pandangan mata
Ku yakin kau kan tetap setia
Begitulah ku jua keikhlasan di jiwa
Dan cintaku hanyalah untukmu

p/s: i'll be waiting for him lalala~ <3

Attachment Day2 23Aug2011

Attachment Day2 23Aug2011

Ward2A; Gynae/Onco

Oh, did I tell you before, I work*work?!* office hour; 7.30-5pm. But lately seems like I settled around 3-4pm. :P

Okay, the theme today is green and I don’t know why but I’m green too today. =.=’’ I mean, the wards here is in green and by chance too, today I’m in green baju kurung. =.=’’ Too much coincidence lah. Haih.~

This is my first day in this ward and where I should be today, as instructed by Nurse Ting *not sure if she’s sister or nurse so I go by anything I prefer lah to her. Hehe. *

So, awkwardly as usual, today I go around by myself and since I get early here around 7.30, I don’t know where to go and there, at the nurse’ counter, I can see a couple of male doctors whom I assumed to be HOs are sitting around and chat a little. As I walk by and turned around back, I started to introduce myself to them and it seems like they are of a good help. They are Chinese and Indian doctors each and the Chinese HO after my self-introduction, suggested to me that I should go in the bilik pendidikan; tutorial room? and wait there for their morning passing over and introduce myself to them; doctors and nurses, sisters.

So I went there, in front of the room and wonder what a bother I am if they’re having meeting. At the same time, there’s this two nurses who were new and  were going *mane satu aku punye tenses nih, past ke present ke future tense? =.=’’* to report duty for first time posting and so asking me to come in together  so I went in first and looking for empty sit to sit in. the nurses follow me and we sat next to each other. Later on we started to introduce ourselves after the meeting; morning P.O after Dr. Krishna aware of our presence and he seems to notice that I am an elective posting student haha. Well, later on I found out that he’s the HOD and that’s why lah he knew. =.=’’ I think he knew abt it since before but yesterday, I didn’t have any idea of this P.O and so I don’t come lah. Maybe he do thought that I cuti yesterday. Who knows? =.=’’

So, at the same time, Egypt do caught attention of specialist and everyone here hehe. :P

Then, after the meeting’s over, I went out and follow the morning round. As yesterday, I’m sort of didn’t understand things but just trying my best to listen and put my interest into it.

After the round’s over, I went around and try to hang out around the HOs at the counter and introducing myself. And my first encounter is Dr Aziemah. Haha. She’s a beauty, since I’m attracted to her by her charmed during the round; she’s sort of a leader type lady hehe. I bet she’s MO and yes, she is; what a spoiler haha. So, after introducing myself, and asking whether is it okay if I follow her*this is a type of crucial question if you’re doing attachment though, some doctors whoever they are, doesn’t like the idea though* and her answer? NO. Haha. She said she’s not in the mood and that I should follow other doctors. Well, it’s quite understood that you might feel offence abt the answer but for me, it’s great! And she did tell me politely though she’s not in the mood. I’d say she’s professional. :D Plus, my conclusion here is, most MO lah, are way more garang than the specialists. :P Maybe because so far in here, the way I see specialists punya garang seems like not too garang for me, in which way I can imagine based on what ibu told me.

So, I get up and grabbed another HO and she’s Dr. Hanisah. She’s inserting branulla while I stand next to her. At the time, I can’t even answer her question of what the thing is*branulla*. She also asked in what patients we can hardly detect their veins. I..don’t know. =.=’’ So, of what I remember she said are; cancer*whom she’s inserting the branula to*, renal failure pt; acute if I’m not mistaken, go back check eh and can’t remember what else. And so, she tells me that I should know every instruments, items, materials, as such in the ward because specialists do sometimes ask of such and even the use of different syringe and branulla. Yeah, I got scolded lol. And she also said that some HOs don’t like the idea of having someone tagging around. Well, I’m not sure if she meant it for her to me hehe. Then, I start to go to the blood trolley and interacting with stuff around there by myself. After seeing things, I went to other HO, Dr. Aini. She’s a nice person and let me follow around. After following her, I sit at the counter and have a time knowing Dr. Shahir. While asking terms I am not familiar with in the BHT, another HO came and I introduce myself and ask his name; Dr. Khiu. At first I’m not sure of his name because it sounds CUTE, :P so I curi2 tengok his name tag and there; Khiu Fu Lung. A name I won’t forget for my life. Why? You’ll see later.

And so, I get accustomed to him really fast haha. Well, I introduce myself and we talk little lot in between time after he finished his work around the counter. I also get a chance to know Dr. Sethu and Dr. Shahir. They are all really nice and help me gets comfortable real fast. And so, as they don’t mind, I keep on tagging to any of them when they went to any bed.

Usually I tag along Dr. Aini, Dr. Sethu and Dr. Khiu. As tagging around and not allowed to conduct anything *tp Dr. Aisyah ckp boleh if kite dah pandai2, observe sume, boleh assist.. =.=’’* so, I only observe as much as I can and ask things. As for now, I’ve seen different HOs inserting branula. If you watch and learn carefully, different HO did it the similar way but differently. I mean, you can see mane yang lg cekap and mane yg not. Here, I have seen two whom I really like they way insert it. Very kemas and smooth~ jer. Tapikan, you can’t expect to do it easy on onco pt. Sbb onco has difficulty in finding their periphery line. Why? I…will ask prof later. =.=’’

And also, it’s important to have your ID on. Okay, my first day yesterday, no ID since I tatao plak yg mmg dorg bg ID. Then today I think*ni dah hbs attach br nak tulis, mmg haram lah nk igt sume =.=’’* when I follow Dr. Khiu to get blood for FBC and GSH, he ask me where’s my ID and I said, ‘’takde, br je nak buat td lepas met admin.’’, and you know what he said? Nvm you can put on your school name tag… aha, I never thot of that. =.=’’ But still, I don’t have lah skola punye name tag, ID mrsm pun tatao mana pegi. =.=’’ But this is not my answer to him lah. I just kept quiet only. =.=’’

Oh yes, since today they draw several pts blood for FBC and GSH, I get the chance to isi form for this two. Haha. Dr. Khiu only teach me how, and he’s fast you know. Really. He’s doing everything at fast rate. I admire him. <3 Later, when I tag along Dr. Aini, she teach me also and then let me fill in the form and after tengok the form she sign it and put it aside for the nurse to take over. Well, if it is not stat, they just let the nurses settle it and wait for the result but if stat, it’s otherwise. They will get it downstairs by themselves and of course, there’s stat mention in the form. I felt rugilah cause several time when they go for stat FBC, I didn’t follow. Rugikan? D:

Usually the time I can get to know HOs are at the counter; where they do discharge summary; I prefer to call it DC  summary :P Here, as they have told me before, different hospitals have different system and so, for HTJS, they need to make a hardcopy printed DC summary because? The BHT are of handwriting instead of blueprint. And yes, different hospital has different management system.

Oh yes, since I wear white coat, some nurses thought that I am a tagging doctor/doctor tagging. Haha. And later I learnt of it a little lot after asking a HO few days later.

Oh, there’s this quote from Dr. Khiu when I follow him clerking, taking FBC and taking consent from the pt to undergo a surgery. And hey, I also get the chance to see how the HO inform the consent to the pt. :D Oh yes, the quote here, ‘’We learn by copy others, then by time, our own way.’’ :D

I’ve spent my whole time today in this ward and didn’t go to LR today. So much to learn here. (: Then, later after lunch break, *erm, puasa kan~ :P* and solah Dhuhr, I went back to the ward for the PM round.

During round and also throughout my  course here doing attachment, I observe that, well, I you watch House as such, they are using pager right? Well, I’ve asked abah last time abt pager since he had one before *and plus, he’s engineer* abt it and he said, well, yg I remember lah, it’s not relevant to use it now sbb phone lg better. Plus, they have operator working around for the line etc etc. xigt ape lg abh cakap but seems like leceh lah actually using it, phone lg better lah. And so, back to my question yg xhbs tulis td, they don’t use any pagers here. Instead, phone is crucial here. If urgent they will call. If not really or it’s a note, they’ll be texting or etc. so, I think you should concern lah abt the battery and also your credit. (:

And now back to the round, Dr. Aini ask me to join them together in their CME after Dr. Sethu received a reminder text abt the CME today. I’ve asked Dr. Shahir abt it before since I’d read entry attachment Baem abt it. *eh baem, you’re taking a lot of credits here eh, cam tiap2 entry your name is around, nati blanje aku eh. :P*

So, from his answer, it’s a good thing if I join the CME. Also, it is scheduled on Tuesday and Thursday around 4pm. *the time which in next 2weeks, I balik rumah :P*

Oh, did I mention before? After pm round, all HOs settled down. Mane yang draw blood, draw blood, so, everyone do their tasks  while some sit at the counter and starting to make discharge summary of the patients. Banyak pt discharge for today.

Oh and yes, they do the round in English.~ And so, after going through some of the BHT *my current fav activity though much need to u/stand*, I waited patiently for the CME today. Quite excited abt it with the feeling of butterfly in my stomach. :D

So, I waited around sambil ushar2 Dr. Aini but later….she’s gone!! D: Well, I just sit down and relaxed while looking at Dr. Khiu sebok ke sana sini after he’s just finished his discharge summary. And then he’s gone…but then I dunno why I see him came back and signalled me to come with him. He said, ‘’let’s go to CME.’’ :D I am so happy haha. Rase cam date plak. XD No lah.~ Haha. So, following him, dekat luar ward, we have to take the stairs because CME is on the ground floor while we are 2 floors above. So, I think he took the shortest cut lah. But at the same time, I have to lari2 plak sket cause my wedges is quite tinggi and also he’s FAST!! Totally fast that I have to run a little. Well, tinggi and kaki panjang + he’s speed mmg kono larilah eden. And as walking, he did ask lah what language we use there in Egypt and then sedar yg I’m a little left behind, he advised me, ‘’Jadi doctor kene jalan laju.’’ Hehe, yeah, I gone red lah a little but hey, he doesn’t know abt my wedges prob and also, I need to speed up more since that’s the fast I can get with my heels on.

But yes, I totally love, like and impressed by him cause he’s telling the truth. I can see the difference in him than other HOs that he walks real fast even though he’s tall and have long legs *very IDEAL!!! XD*. He’s trying he’s best in doing much things. That’s what I see. I can see how he puts in his heart into it. :D And you know what, during my day today with him, he asked me a lot  abt basic science regarding our last three yrs. What I mean is simple questions lah. Sort of spot question, something like that. Yes, I can’t answer much *oh, how I always forgot things I learnt. =.=’’* but I still just sit and listen to his answer. I like him so much regarding he;s habit and attitude.

Oklah, back to the CME, we went downstairs to the clinic and into a small room-like area where they take blood there, and sit down, and I take my seat next to him. Ok, the case today is ovarian cancer which I remember a little rather than a lot. I can see some of it as a revision of our last lecture and also, some are of new things I learn like RMI; risk malignancy index for ovarian cancer. And today and yesterday, I heard a lot of TAHBSO which I dunno till my last week of attachment. =.=’’

Later after the CME, which is like our PBL a little lah, the Dr in charge of them *I thot specialist first but I think she’s like senior doctor or MO or something like that…ntah, I think only* ask question at the end of CME to each of them. She’s referring sometimes in between the CME to her pdf during sometime in the course, I think to stressed some idea, and then back to the HOs slides. So, she end the CME by asking each of us question and me? I didn’t answer anything haha. Nak tao story? Come to me and I’ll story mory to you. :P

So, after the CME, Dr. Khiu ajak me to go upstairs to ward. There’s a HO ckp cam, ‘’nak naik dah? Ape lagi~ baliklah.~’’ haha. It’s like typical things we would usually one to do but I really praised Dr. Khiu for he doesn’t look it that way; he’s attitude which I dream to take into account to be a good..better doctor.

So, on our way upstairs he ask me a lot a bt the CME. Whether I know abt ovarian CA, what is the cause of it, why we have different types of CA in ovarian CA compare to other CA like gastric CA or etc and so on. For the last question, of what I remembered of is, the cause is not because  it is of 3 layer or the ova is fast growing cell or because of totipotential *haha, kantoi my answer :P* but of what igt, it’s because it has highly mitotic figure and it has all three layer of origin in the body and that’s why we have varieties in ovarian CA. haha, that’s what I igt and you know what he said?, ‘’We don’t have to think tinggi2 but go back to basic, where it is actually simple and the place where the pathophysiology underlie. Well, he learns *even the IMUs* pathophysiology but we..learn it like pathology and physiology. I learnt that they are similar but not the same *when I started to google around.*

And did I even tell you before? I met a Dr., specialist I think at first, after the morning round. He’s just came in and bincang with Dr. Krishna kot, ke Dr. Nazura I x igt. I dunno why but I think he’s quite familiar to me. Tapi tulah, I just wait and listen to them and then later, he ask me who am I, maybe because of my white coat or cause I don’t have my ID on. So, after introducing myself, he said that he’s been in Alex. Yeah, we did have little talk around and then he left. I dunno why but I feel comfortable talking to him. He seems really peramah. The rugi part is that I forgot to ask his name. =.=’’

So, back to Dr. Khiu, he’s..that lah…asking and telling me a lot. So, back upstairs I went to the counter and later he’s hilang, ntah mane pegi, amek FBC result kot. *till end of my attachment, I dunno where they did the test, where’s the lab. =.=’’*

Since it’s getting late, I hurried downstairs after packing up my bag.

Oh, there’s this miscarriage I learnt when? I don’t remember but what I can remember there’s a several type; miss miscarriage, inevitable miscarriage, complete miscarriage and threaten miscarriage.

Well, that’s for Day2; the beginning of interesting day of my attachment though I’m alone. And why is that? IMUs students are sitting for exam and I am all~ alone. It’s boring at first but I adapt a little fast and also since the HOs are also of help. And that’s also the reason why I can go anywhere I want.HAHA. (:

Morning P.O; morning passing over where doctors share yesterday cases which they are interested in and usually special case  and emergency but I’m not sure of this info since this is what I heard roughly from a HO and also based on my experience. And also the time where they have announcement and also the place where HO must always be to continue on study; bak kate HOD Dr. Krishna. Oh, FYI, he’s a guyß you might mistaken the name as a woman. Also, this also times where dr.s can do sharing of some cases and also being advised by.

HOD= head of Department

BHT= Bed head Ticket, it’s like report and summary of pt lah. Every thing starting from the OPC till the surgical report, X-ray, referral letters to the discharge summary

Discharge summary=I rather called it DC summary. Are pt discharge summary where Dr. summarised the cased of the pt and Dx and the plan management until the discharge. So they summarise lah.

FBC= full blood count. Blood investigation, lab test.

GSH=group, screen and hold;

•  Group the patient
• Screen for Antibodies (Ab) in the serum (AHG test)-anti human globulin test
• No need to reserve crossmatched blood if AHG is negative
• If no Ab are present (AHG negative), if its necessary, transfuse group specific packed RBC of the same ABO & RhD blood group as the patient
• If Ab are present (AHG positive) in the patient full crossmatch must be done to find compatible blood.

GXH= group cross match. Cross-matching blood, in transfusion medicine, refers to the complex testing that is performed prior to a blood transfusion, to determine if the donor's blood is compatible with the blood of an intended recipient, or to identify matches for organ transplants. Cross-matching is usually performed only after other, less complex tests have not excluded compatibility. Blood compatibility has many aspects, and is determined not only by the blood types (O, A, B, AB), but also by blood factors, (Rh, Kell, etc.).

Stat=immediately bak kate baem. :D

Doctor tagging= a doctor who is doing tagging i.e, in a dept a dr. is posting in, he will have a tagging period *depends on the dept itself and also the hospital, in this case, this OnG dept is around 14 days* where the HO learns everything abt the dept as such, where the wards, rooms, clinics, OT, what they should do in each, the rounds, materials sit in, senang citer everything lah.

PM=post meridian? :P petang lah~ =.=’’

CME= continuous medical education bak kate baem. Good things. Based on my exp?*experience ß game influence HAHA* a little like PBL. :D

RMI=risk malignancy index. I only know it is for ovarian CA. not sure if it is also use for other CA. it’s like a score where there’s a range or limit whether it’s okay or not, need surgery or not etc etc.

TAHBSO=total abdominal hysterectomy with bilateral salphingo oophorectomy. BSO doesn’t always follow TAH. A surgical procedure of removing ut. And f.tube if followed by BSO.

CA=cancer

Attachment Day1 22Aug2011

 Attachment Day1 22Aug2011

Ward1A Ob/Antenatal & LR

Note: So, since I have gone thru baem punya blog..i’ll be doing almost the same things as him here lah. But might be different also since my way, rite? Okay, we might as well get index/glossary down way to the end of entry. And anyway, since I am concluding before, this entry onwards may seems to be overlap to you guys since I have completed my attachment so it might be that in Day1 you might thought that I know a little lot abt a person or two. :P Also, if it happens that you don’t understand much of terms of xplnt I give, you might as well did a little research on it. And share. :D And sorry lah if I'm very particular while writing this. Skip as much as you want if you want.

Day 1

Not as good as we usually think of. Yeah,right. Well, lets be positive around here. :D

Okay, with adrenaline rush, I went to the admin since I haven’t take the certified letter from the hospitals yet. And so, after seeing my beloved Pn. Mariam, I went to the clinic to report my duty, as instructed. *duty? =,=’’*

After seeing Nurse Ting and leave my details to her, I was asked to see specialist Dr. Siti Aisyah bt. Daud. *I think people around should know abt any person I met here, well, who knows, you might work with them later right?

So, I was asked to go upstairs and wait in ward 1A. After entering, I went in awkwardly and went to the nurses’ counter and see random person around; practically the nurses and HOs, to asked abt my specialist whom I am assigned to. As inform by a HO, she is not around and will come in by 8am. So, I wait patiently and cuak-ly there for her.

And hey, it’s pink in here and I dunno why but I’m having my pink baju kurung today too. =.=’’

Later as I heard from the nurse, she is here and so I followed here when she’s actually starting her morning round with the HOs. So, I introduce myself and as I am not expose to the clinical year yet plus ObGyn, she said that I might not benefit from my attachment here due to this. And so, she said that I might follow any HOs and observe them and might as well asked anything since I am lost with no knowledge in this field. And she said so because there’s this Egypt student too, a girl whom I can’t recognized till today. =.=’’ If anyone happen to know her or she read this, I hope you at least can contact me tru email or fb or something. :D

So, as she said like that I started to get more awkward, feels like I’m being scolded in front of HOs haha. Well, I just followed w/o my coat on while I’m thinking of it. Then later, Ward Sister asked me to get my coat on so that people notice me as a doctor? Since I am not allowed; anyone are not allowed to walk randomly in the ward/hospital. So I went to put my bag also *sound by the ward sister =.=’’* in the room where HOs put theirs and also solah in.

Then, after make sure of myself of my appearance, I went out and followed the doctors’ morning round. There I learn of several HOs, and MO. =.=’’

This is when I learnt abt the quote, ‘’Bad habits die hard.’’ Yeah. They did die hard. And so it comes from  the specialist and directed to the one of the HOs. My point here is not to harass HOs but rather learnt from the situation. When you don’t know something, you tend to ask your colleague but the better way is to ask the seniors or especially, the teachers or anyone whom specialise like the specialist or something. Even from the nurses and sisters. Because we actually tend to habits things we learnt from friends and such.

So, after the morning round with all the jargons, I awkwardly stand there alone and start to follow one of the HOs. *tips #xx; follow those whom are better is the best* and then I started to choose to tag along other HOs and introduce myself. As for my first attachment, I don’t really know how to start off so she started by informing abt the pt and her neonate whom is suspected to have neonatal jaundice.

And there she goes with all the conditions I can’t remember but as for the sign of jaundice, it is clinically apparent except that, I can’t remember anything much. And yes, she did mention some of the cause of the neonatal jaundice she I can remember of, the breast milk itself, the traditional herbs taken by the mother and also sepsis. Here, we must take into account the culture of each patient esp in Malaysia since we are multiracial country.

So, after a while, Dr Kaur said that Dr. Aisyah wants to see me in the clinic and so I went there and met her.  As for our meeting, she says that I can go anywhere I want as long as I report myself to the person in charge of wards or labor room. And she also recommend me to read essentials in Ob since I am clueless to shit. =.=’’

No don’t worry. I am not a shit to her, it’s me who put that in. =.=’’ and guess what, she did recommend Ten Teachers and Essential*any book* as I asked her to recommend a reading. So you guys later can get a hand on such when we start our ObGyn block. :D

So, I went to the library *I don’t know of the library in hospitals until Baem mention one in his entry*. Then, I get my hands on some books and starts to read..and getting sleepy. =.=’’ so after abt 2hrs *demit!* reading a little and scan thru all the pages in the book, I went down and randomly follow any HOs. Then I asked abt the breaks which only 1 hr at 1-2pm. So after that I started to hang around the student nurses and be frienf them. Some I can remember of are Amira Azmira and can’t remember more. Most of them are mira. All Miras, lalala~. :P

So, they have just been here and will be for some other weeks and then start off posting in other wards and depts. And they did recommend me to go to the labor room which I don’t know where. Later after asking them where and talks a little, I went to the labor room. Oh yeah, before that, there’s only one Malay HO I found here whom is Dr. Khairul Rashid yg cute haha. Soooo~ manly. But seems like a shy person lalala.~ Seems only lah since I haven’t talk with him at all thru out the attachment except that, I have seen him several times. I wonder if he’s married already. XD

So, being in the labor room for the first time also seems awkward. There I try to see the labor room sister and after report duty, I was asked to change in the staff room and get the blue clothe thingy. I dunno what you call that. =.=’’ anyone knows can inform me. :D So, after change I went in, and anyway, in this dept is the first time I heard of midwife and read the terms in the book last time which I don’t understand. =.=’’

So, there, since most are in the blue form*uniform* so I thought all are doctors but turns out some are also staff nurses and maybe midwife? I don’t know whom are the midwife. =.=’’ So, I met one of the nurses whom are very friendly and I sell my Egypt story HAHAHA to her and she said she’s a nurse, so she informs me abt, ‘’There’s a doctor there, Dr. Tayyib.~’’ and as I see him sitting there looks sort of not in a good mood to talk, I went down the whole attachment not talking to him. =.=’’ Feeling guilty and rugi lah, later you will know why. =.=’’

So, talking and waiting, plus looking around, I waited patiently for any delivery which I expected to be normal lah since Dr. Aisyah said it’s better for me to start off with normal delivery. And I haven’t read that part yet. =.=’’ And so, I start off wondering, wandering, touching looking and seeing stuff around. The best part doing attachment here is, I am allowed to touch look and observe things and stuff, except patients haha.

So, after penat2 tunggu, no deliveries and I was also called by Dr. Linda but I recognized her face, she asked me what I know but later tell me things since I know nothing. I shud know abt normal deliveries. Abt the os opening around 4cm would be admitted here and wait for the delivery. There’s also certain terms for Obs I learn of. PROM and PPRM. These are of common I heard of here.

Okay, of what I have read and also told by the Dr.s, this dept is a specialise dept so in case of ObGyn especially, the history taking is a little different since we are concern of the menstrual history, gynae history and of social history much more here and after the chief complain, we will start to rule out all the DDx and concentrate from a wide scope to a certain point which is more focal into the pt chief complain.

After lunch break, I went to the LR back and changed. By the time I finished, I missed the first delivery. L I happened to see the doctors/nurses doing suction to the newborn only and see how doctor sutured the episiotomy done before.

Later, a HO teach me how to read the CTG, well, roughly because she said I need to go back and read more to u/stand. It’s more or less like ECG. There is four items to comment on. For more, go search eh. J

As for CVA, I learn from baem it’s CV stroke and from the book, also known as CV accident. J Oh, did I mention before, clerking template for ObGyn are different from other specialties?

Okay, the last case I saw was in LR. I got to witnessed my first delivery; TWINS! Yeah2, well, I can see how big the ut/abdomen is, and so let’s talk abt twins.

She seems to not have a problem..or she actually memang senyap. It seems very merrier after Dr. xigt check her os full*ready for delivery,I am not sure how full it is but actually by 4cm, we should ready for any spontaneous delivery* because everyone rush in and out kelam kabut get all the materials needed for the delivery. So, after the first newborn come out and doctors and all staffs jerit ‘’teran2’’ banyak kali*very meriah and supporting, you see* they let her rest before next teran while monitoring her FHR of 2^nd twin. And then, she continue her next push with supports from everyone around. After the delivery*each*, I realized that they show the mother the neonate’s lower body part particularly the sex area; genital area and ask, ‘’anak ape puan?/baby girl or boy?’’ and so after telling and asking this to my mom*the nearest pt I can ask everything HAHA*, I learnt tht they do so so that babies xhilang or xngaku baby or any case tht might involve the babies.

So, we got twin girls here. Anak Ramadhan since they come out by time Syawal is around the corner, anak raya also lah. HAHA.

And yes, fellow doctors and staffs warn us students*me, the only medical students and all other nursing students around* to backed away for the 2^nd twin to come because you might get juiced by the 2^nd placental rupture and yes, Dr. Tayyib get splashed a little *he’s conducting the deliveries*. So, after the delivery, he massage the ut/abd and at the same time slowly pulling the placental and the cord out. Next, he sutured the koyak part. I think it’s tore apart because I didn’t see them doing episiotomy to this one.

And yes, as we learn in alex, they draw blood from the neonates feet to test for T3/T4 ß hypo/hyperthyroidism but here in HTJS, they draw the blood from the placental cord. Interesting isn’t it? J

So, I also get the chance to see the placental freshly from the oven..no, ut/vagina…SORRY~ L It’s fresh, and I saw that they bukak sane bukak sini, nak check if it’s DCDA or MCDA and guess what..i dunno which, since I don’t literally and technically understand what I see and what can DCDA and MCDA show. =.=’’

So, this is the closing of my first day. Bad closingbye.

Neonatal jaundice= wiki lah. :P

Midwife= a term used in reference to both women and men, although the majority of midwives are female. Midwifery is a health care profession in which providers offer care to childbearing women during pregnancy, labour and birth, and during the postpartum period. They also care for the newborn and assist the mother with breastfeeding.

Pt= patient

DDx= Differential diagnosis

Tx/Rx= treatment, Rx are more likely of drugs.

LR= Labor Room. *my shorthand=mySH*

Ut=uterus

Abd=Abdullah..xlah, abdomen :P *mySH*

Episiotomy= also known as perineotomy, is a surgically planned incision on the perineum and the posterior vaginal wall during second stage of labour.

CTG=cardiotopography; In medicine (obstetrics), cardiotocography (CTG) is a technical means of recording (-graphy) the fetal heartbeat (cardio-) and the uterine contractions (-toco-) during pregnancy, typically in the third trimester.

PROM=prelabour rupture of membrane

PPROM=preterm prelabour rupture of membrane

CVA= cerebrovascular accident

Spontaneous delivery=A spontaneous vaginal delivery (SVD) occurs when a pregnant female goes into labor without the use of drugs or techniques to induce labor, and delivers her baby in the normal manner, without forceps, vacuum extraction, or a cesarean section.

HTJS=Hosp Tuanku Jaafar Seremban

Chorionicity=A chorionicity scan is used to distinguish between twins that share a placenta and those who have separate ones, so that twins at a higher risk of complications can be monitored more closely.

DCDA/MCDA=dichorionic diamniotic/monochorionic diamniotic. Esok we’ll learn more. Susah are google search. =.=’’