hernia

Trying to demonstrate hernia in clinic.

"Boleh kau menangis kuat2?"

Kid shook his head.

"Should I break your heart and make you cry? No I shouldn't."

i cant explain, once a sweetheart always a sweetheart i guess

The other day my surgeon said something regarding xray comments that made me want to consult my favourite Radiology trainee. 

I contemplated few weeks before I finally asked him that question today before I started my oncall round. It was a simple salam greeting followed by my question. No dilly dally. 

He replied soon after. I thanked him. 

And then he said "Anyway lama tak dengar khabar".

I remember pausing at his words. Why would he say that after he turned down my confession? I guess he really meant it when he said he wanted us to remain friends as we were. Should I return his good will? 

I did. We chatted about our friend, his work, my work. And then few updates on his mom. That's it. I didn't really put that effort to prolong the personal conversation. 

Feeling really is a living thing. You need to work on it to sustain it. If you ask me now do I still feel what I felt, I'd say it waned down since I didn't work on it. I am less sentimental. You were wise to ask me reasons why I liked you. 

But would I say yes if, perhaps an overshoot and will never happen, if you suddenly revisit and return my feelings? I would ask for a reason and hear you out. 

Don't overthink. All is well. I hope you'll always well and motivated. I hope you'll always be happy, healthy and at peace. After all was said and done, still a piece of sweet memory in my heart. 

Getting rejected was a roller coaster of a good thing. I think. Or not. I don't know.

I want today's oncall to faster end. I want to go sit by a riverbank and look for buaya tomorrow. 

my chinese horoscope for 2021 said im at danger of an accident later this year

I had a dream last night.

I was sitting in the left back side of a purple MyVi. My friends were driving and at the front. We were getting up a slope on a muddy road and slipping. The driver hit on the gas and the car swirled up, making the horrific tire noise of non gripping. The car surged uphill and flipped onto itself.

We were upside down, stuck in the car. I had a penetrating injury to my left hypochondriac but I was still alert. I put pressure on my wound and when I took my hand off I could see blood gushing. I went into another car asking the driver to get me to a hospital.

The dream cut to my post op day. I'm not sure POD what but I was healing, standing already. The Surgical team and Anaes team were explaining what happened to me as I flipped the op note. I had multiple bowel perforations that was repaired. Syukri and one MO did surgery on me. I remember being amazed that he did an exploratory laparotomy and bowel repairs on me unsupervised. I hope I don't leak. 

I woke up and later texted him, thanking him for not stoma-ing me. He said are you sure you had no stoma? Or was it ileoanal anastomosis.

Turns out he's oncall today. I told him perhaps he's going to get an MVA with multiple bowel perf. He said he had 2 MVAs in ED already, intubated. 

jodoh dengan paeds

One time I was chilling with the Paeds girls and they started asking me about dad. 

"Ayah kau baik ke Atiqah? Ke dia garang?" 

"Tengok la Atiqah baik je mesti la ayah dia baik!" 

I was grinning. "Ayah aku baik. Dia yang teaching HO." 

And they asked if there was any time I called my dad because I was dissatisfied with Paediatrician management. 

Yeah I did in Lahad Datu. Twice actually. 

They referred me TRO biliary atresia but they didn't do the prolonged jaundice workup because "my specialist said it's a clear cut surgical cause" and I almost called the specialist up to ask did she biopsied the child already to confirm it's a surgical cause, but I called my dad instead and ranted. He agreed that we have to rule out all medical causes as well. 

Anyway I saw the kid. Bilirubin range yeah sort of like BA, but got transaminitis and the stool was effing pigmented. They didn't do ultrasound yet. Clear cut Surgical cause apa? 

I actually opened up the Paed Protocol in front of the MO to show the list of causes of conjugated hyperbilirubinemia. "Surgical cause 3 je, ni lagi 10 korang punya. Takkan la korang nak suruh kitorang terus buat invasive procedure padahal non invasively diagnosed condition belum rule out pun." 

And that one time they referred me an HSP kid with abdominal pain TRO intussusception. But they didn't start on steroid. 

I remembered Dr. Nik Nas taught me "HSP kalau sakit perut, it is intus unless proven otherwise. Start steroid." So I asked them why didn't they start steroid. The MO told me if I wanted to start steroid, I may start. I blinked. Is that my decision? Aren't you guys better at managing HSP than a Surgical MO. I opened up the Paed Protocol and sure it was written there first plan under the heading of severe abdominal pain for HSP was to start oral prednisolone. I called my dad to confirm and he confirmed. 

So I wrote there "for USG abdomen. Suggest to start prednisolone."

The referring specialist saw my plan and did start on prednisolone after my review. 

The girls then asked me why didn't I become a Paediatrician when my dad's a neonatologist.

"Because I was still in medical school when he said I'm not calm enough to become a Paediatrician."

The yelling started. "KAU INGAT PAEDIATRICIAN NI SEMUA TENANG?"

They then listed all the names of their Paediatrician and told the stories how kalut they were when patient deteriorated in front of them.

"Pulse volume! Pulse volume!"

"Dr. Heng je yang cool. Patient fitting depan dia, dia tengok tenang je. 'Diazepam.'"

Hahaha. One would think Surgical are more ganas than Medical based, but you should see how these people do BMAT. Literally drilling into concrete. 

prokofiev is playing in my head

Got a boy with Prader Willi in clinic attended by his mom and sister. Anthony shaked my hand, talked and greeted me in Chinese.

"Oh no, I'm sorry I don't speak your language. I can only speak Malay." was exactly what I said while I rubbed my hand with alcohol. And then I clerked the case.

At the end of the consult, I waved them goodbye and Anthony kept saying "xie xie" to me. 

"Baik lah aku balik study Chinese. Bagaimana mahu sebut sama-sama?"

His sister answered me but I didn't catch that with him non stop "xie xie". I just replied him with a "sama-sama". 

missed ARM is always a shame

My recent oncall Tuaran called me at almost 11pm to refer "an imperforate anus."

"Okay."

"Day 1 plus 19 hours of life boy-"

"Oh no." I muttered softly. 

"... started on cup feeding at 2pm..."

"Oh no." Again, just softly, not interrupting her presentation. 

"... abdomen is distended..."

"Oh no no no no no." 

At that point I was just singing in my head. 

how to stop thinking, help, tell me how

Post cbd insertion

Frank blood

Whatever you think

Need tro bladder injury

Do usg

Slow infiltrate sterile water

And see

Small can go non operative

Abx

Drain urine

---

RT for surgery always nasogastric

So it wont dislodge during intubation or baby chewing 

---

Allow pseudomembrane to form

Don't kacau it much

---

Sudden abdomen distension

AXR not so good penetration

Might be pneumoperitoneum 

---

There's a webinar tomorrow night

On how to suppress traumatic memories

I wanna attend

But I'm effing oncall

Help