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