future

I think I need to start thinking about my future.

I need to know what I want to specialize in. I need to know (first) what I like. Which is not easy. Cause somehow, medicine isn't as simple as just being a doctor. You are either a heart doctor, mental doctor, kidney doctor, family doctor... (layman's language larrr)

Maybe, gastro would be nice. But there's a hell lot of gastro specialist in Msia. Cardio, resp, and geriatric is definitely a no-no. Neither are dermato, infectious disease (if there is any!), onco or haemato! Surgery? 50-50. So, I'm down to either gastroenterology or nephrology. Or just general medicine...ahahaha!

And I have to think about having my own family...hmmm.....cause nowadays, I cant stop smiling looking at other people kids! ARGH!!! Well...better than looking at other women's husband..eheheh!

Peace

hero

I saved my patient's life.

Around 1830 yesterday, macam biasa, I checked all the blood results. One of my patient's troponin came back as 0.6!!! (The first troponin was negative) DAMN! Cepat2 aku pegi jumpa patient tu, and asked him does he has any chest pain etc etc. Dia basically OK jek, except for dull, mild pain over the epigastrium area. He had USS Abd few hours before and it was fine. So, I did an ECG on him. Guess what?! Acute changes -> ST elevation 2mm in lead II, III and AvF. As well as TWI in lead III.

MI beb!!!!

So I spoke to the MROC (the nice and soft spoken Dr Khalid), and he asked me to start the patient on aspirin, clopidogrel, enoxaparin and metoprolol. And try to get a telemetry on that patient.

When he reviewed the ECG (2 hours later), he came to the ICU to see me, and with a big sigh he said, "Marisa, that ECG showed acute changes. Definitely MI. Will you repeat another ECG for me, because I may want to thrombolyse him". Okie doc!!

So, I did another ECG on the patient. Same ST elevation in inferior leads, no changes except I think the TWI has resolved. So, that patient (which is Dr Clarke's patient), transferred to ICU last night and was thrombolysed. Hooray!

Rasa cam hero penyelamat dunia seantero plak :)

carcinoma

Terasa malas nak keje.

Suprisingly, this week on take, we've lots of patients with newly diagnosed carcinoma. 62 years old lady, came in with obstructive jaundice with mass in portal/gall bladder fossa. Diagnose? Query pancreatic head ca. Need laparoscopy and biopsy. Coincidently, next bed to her, is another lady, already diagnosed of pancreatic ca and is currently on chemo. Good news though, as her repeat CT abd showed shrinkage of pancreatic mass and no sign if mets. Green light for resection.

Another patient, 72 years old lady, came in with pleuritic chest pain. CTPA showed pulmonary embolism and is currently treated for it. At the same time, she has mutliple vertebral fracture and on examination (missed by the SHO oncall) by my Reg, revealed a left breast lump, tethering to skin. Require referral to UCHG under Prof Kerin for breast ca assessment.

One gentleman, has tracheal deviation and hoarseness on examination. Highly suspicious of thyroid ca. CT thorax reported massive retrosternal goitre, slightly obstructing the oesophagus. Hmm...

Point I'm making is....THE IMPORTANCE OF GOOD CLINICAL EXAMINATION.

Peace.

Ciao

sakit

Doctors get sick too.

I was down with terrible flu on Wednesday. Must be due to exposure to a mixture of pneumonia and TB cough (query TB, nasib baik patient tu negative AFB x 3). And I was on call on Wednesday.

On Thursday, I got really bad. I dunno what my temperature was at that time, tapi boleh la nak rebus telur bawah ketiak. Eheh.

On Friday, after the ward round, I asked Colin, whether I can go home or not. He said, what time, and why do I wanna go home. I just said, I'm sick. Really2 sick. Cant think, cant walk, cant breath sume la. Sakit sangat. Dia pun cakap, "Marisa, kalo dah sakit tu, jangan malu2. Cakap jek. Aku kasik hang balik punye la" Yang pastinya, dia cakap dalam English daa.

So, aku balik awal Jumaat tu. 11.30 aku dah cabut. Weekend aku kene oncall. Seksa woo Sabtu tu. Tapi, selepas 4 botol yogurt 3 papan panadol, 1 kotak besar jus oren dan 2 hari kantoi puasa...hari ni (Ahad) aku mampu la nak oncall...

Eheks...

NB apa dah jadik dgn Dr Clarke. 3 patient post ERCP dia sakit teruk this week. Sorang dapat post-ERCP pancreatitis, sorang turns out ada liver abscess, yang sorang lagi..just plain low pain threshold..ahaha.
Anyway, since aku tak pernah tulis something berilmiah, meh la aku kasi tau apa risk factor for post-ERCP pancreatitis.
1. Patient-dependent: obesity, previous pancreatitis, female, young
2. Procedure-dependent: more than 5 attempts of cannulation, injection of contrast into pancreatic duct, extravasation of contrast into pancreatic duct, difficult anatomy

Peace.