It's Hurt because it Matters

 

"You're not starting back?" He asked his friend.

I heard their conversation. They were just few steps away from me. 

"Have too. Not sure when. Did so much of damage in past few months. Too much of pain within ," he sighed.

I don't really understand what's the issue but he continued, "So often we try to make other people feel better by minimizing their pain. By telling them that it will get better;which will with time or  saying that there are worse things in the world."

"There are for sure," his friend uttered. 

"What people really need is for someone to tell them that it hurts because it mattered," he replied. 

I looked at them.

'How true I thought.' 

Sometime I felt, we can't go back and change the beginning. What happened meant to happen.The damage and dramas were there for a reason. But you can start where you are and change the ending. 

 

Kidney Failure and The Thirst

 

H20. Water.One of the factor that makes our planet liveable.

Fluidity, It's unique in it's own way.

"Aunty, are you aware that you shouldn't drink more than 500ml of water per day?" 

She looked at me with a grumpy face. 

"That much for 24 hours??" she asked morosely pointing at the small water bottle beside her bed. 

"15hours,if you sleep for 9 hours per day."

I realized that the fact doesn't make a difference. She was still a sullen person. 

"Before my kidney gone, everyone asked me to drink water properly. Now, everyone asking me not to drink. Such a cruel world,"she complained.

I just smiled and continue writing my review. 

The ward was chaotic that morning.Like a natural disaster's emergency health camp. 

Acute cubicle literally turned into ICU. Half of the patients were intubated. 

Subacute cubicle seems more like an acute cubicle. 

From Bed 37E's cardiac table,I can see the acute cubicle nurses were talking in hushed voices. 

In the midst of a tensed morning, what she just said was still echoing in my head. 

Water is your friend if you have a healthy heart and kidney. It became your enemy once it's dysfunctional. 

Irony of life. 

"Did anyone told you that when you're thirsty, you can put an ice cube inside your mouth, let it to melt and the thrist will subside ?" I asked the patient that was admitted for shortness of breathing for fluid overload. 

She gave a puzzled look.

"Noo."

An ice cube is roughly about 30ml but it overcome the thrist for a good period of time. 

Or we can get a water spray, fill up with drinking water, spray into our mouth whenever we're feeling thirsty;if we have to restrict our fluid intake. 

The tricks were simple but unfortunately, it never reach the people that need the most. 

Learnt the Correlation of Smoking and High Hemoglobin

 

Smoking can lead to an increase in red blood cells. 

To compensate the decreased oxygen delivering capacity, smokers maintain a higher hemoglobin level than non-smokers .

Sometimes, I used to wonder "Why this patient' s Hb is so high? "

Back then, I don't know the correlation between smoking Hb, hematocrit etc.

 The hematocrit is the proportion, by volume, of the blood that consists of red blood cells. It's normal value for a male less than 60 years old is less than 46% and 42% for someone more than 60 years old. For female of all age groups, it's less than 42%.

 If hematocrit increase, means your blood is getting thicker. If your blood is getting thicker, the flow will get sluggish and from there all kind of problem arise. 

Smoking deprives the bone marrow of oxygen, and it's tricked into thinking that it needs to boost its production of red blood cells, the carriers of oxygen.

The blood cells crowd the circulation and cause blood to flow sluggishly. That brings on a number of symptoms, like headache, dizziness, ear ringing and a rise in blood pressure. 

If you want to know more about your health status, send pictures of your blood investigation, xrays, lipid profile, renal function,etc to pranasteya@gmail.com and we will explain to you regarding your health status.

*More info about heart attack, diabetes, stroke, kidney failure, wound care etc.

Mistake as a Doctor :Listen to Others but Act According to Your Heart. .

 When I first started, I can't even take a patient's blood properly.

I can't insert a branula properly. Initially, most of the time I failed.

With time and experiences, I can sensed that I became better. Doesn't matter how difficult, by hook or by crook, I will insert the branula nor take the blood.

The only time I failed nowadays is when I listened to others opinion, ignores what my mind saying and get distracted with other's voices. 

Today there's was a hemato patient that requires branula. He is on chemo so the smallest size will do but other two houseman already poked him 5 times.

It's like breaking a person's trust five time which means I can never try more than once. Doesn't matter how difficult it is, when I really find for the veins, I always ended up with two options. Two sites that you know that it's guaranteed either one will work. Here's where your luck play its part. Multifactors can causes a failed insertion. When they called me for this kind of situation, I know it's only one time attempt.

Moment before insertion, I don't know if that nerd is a first poster or super senior, but he's just annoying. I don't know if he's smart or just a nerd that burden mo's for every small shit. If I'm an Mo, I wish i would never work with house officer like that.

"Hemato Mo said if can't get more than three times, inform Mo,"he said.

" Then why the fuck you both poked him 5 times, "I thought. 

I just kept quiet and opening the blue colour sterile branula. 

 Inserted and there's back flow, I removed the needle and tried to push it inside. I just can't stop the blood from flowing out through the branula despite how much pressure I gave, so i just wanted to insert quickly and secure it. 

"Did you release the tourniquet?" Nerd asked. 

'Just do it on your term or open it because he's seeing?' A confusion came in. 

I picked the second, tried to open the tourniquet with another hand, branula moved, and it's gona. I can't flush in the water through the branula and the patient felt pain ;means it's came out from vein and settled  in the dermis layer. 

I just wasted everything. 

For 3 minutes I sat at the corner and was thinking about it. 

'Why you didn't follow your heart?' 

'Why?' 

'You was good and you messed up because of other's opinion.' 

I learnt that medical is a team work. Almost all the jobs out there is a team work. You works better in a team but always, ALWAYS LISTEN TO YOUR HEART. 

You can take people's opinions but decision must be always your ;according to you heart. 

As a Doctor, Prioritize Yourself First

 

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"If you constantly compromise things in your life, how will you ever realize your full potential?" he asked.

He is one of the person that I really admire during my surgical posting.Surgical was like a family for me and I don't really know why I had that feeling. Soon to be a surgeon, he handle everything in a very calm manner.

I wondered how he could do that;always, never failed once. 

One day I asked him.

" Life will screw you in many ways,"that was his first response.

My first posting was partially surgical based as well. Suddenly, you have to enter OT. Training hard a day prior, can't eat during the day are a bad combo in an OT setting especially when you are handling an obese patient. Your muscles lacking the essential sleep and nutrition bombarded with the stress thinking when they will scold you, that's another deadly combo.

During my first  few weeks, I have been chased out from OT because my muscles eventually fatigued retracting a lady's thick fat abdomen with a BMI of 48.2;starving for a sip of water. 

Hence I stopped gym. 

Months later, I met him and he told me something precious. 

"Remember, before you take care of some one, you take care of yourself because you're always replaceable. Doesn't matter how good you work, there will be someone better and smarter than you. Always prioritize yourself. 

It's not selfish, it's just taking care of you. "

I didn't expect it from him. I thought he would say the same as others, patient comes first bla2.. 

" A well educated looking guy with an acknowledgement that he's having HIV will smile to you. Don't believe anyone, wear your gloves before you take his blood,"he said. 

Whenever I experienced it myself, I believed that, he said it from his experiences. 

Always take care of your self. Do what you love and what is good for you. 

How to Find Your Peace

 

"Make peace of your mind first," he said while looking at the waves.

"Happiness come in wave," he continued.

"Hmmm," I nodded.

"How?"

"We will never find peace of mind until we listen to our hearts," he said. 

"How?" my never ending how continued. 

"Simple," he looked at me.

"Stop fighting with your thoughts." 

Consequences of Skipping Medication

 

It was a chaotic morning for a Sunday.

Usually weekends will be less stressful, calmer than week days.

That day, it was different.

Patient came with GCS 3/15,intubated at ED for airway protection, sedated with midafentanyl cocktail.

Multiple IV lines, IVI adrenaline, IVI insulin sliding scale, sedation pump at the side, cardiac and bp monitoring machine on another side; the place was literally in a mess.

Beeping sound from every machine available there was disturbing. 

She's a 60 years old lady, with diabetes and hypertension. History from the daughter clearly showed that, she's not compliant to her medication. She used to skip her pills.

Self made decision that took a toll on her life, causing her to lie flat infront of me.

Blood pressure on arrival was 210/148mmhg.

CT brain shows acute pontine bleed secondary to hypertensive emergency..

If.. If she took her medication regularly, today, everything would be different.

Today wouldn't be her last day on earth.

One year of Housemanship

 

It's been a year since I started housemanship in Malaysia.

When I was in Bangladesh, I loved OT.

Used to work without realising it's already night.

Loved being in hospital without realizing that the the clock is ticking, the hours are going by.I just loved getting my gloves wet with bloods.

Today, it's a different scenario. 

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I don't know if it's the system here or the people ; with a terrible attitude. 

The title might seem glamorous, but it's not worth it. 

Don't make a wrong choice.

Regrets :Monster

"Are you doing it right?"

"Are you living your life?"

"Take a look at everything you're doing."

"Will you do it all over again?"

"Are you happy with it?"

"Sometimes all you need is 30 seconds."

"Just thirty seconds to remember the fact that you will never get the same breathe twice."

"Live it, don't look back."

"One day, you'll look back. Be proud of yourself. Don't regret it." 

Batu Caves, Malaysia :Conversation with an Uncle.

Little Message to my Nephew

We're 29 years old apart.

One day you might scroll, or check my blog post and might be reading this. 

Remember, life is a blessing for few, a curse for many. 

It's not a pessimistic tone but a hard reality. 

Someone, something going to hurt you, will make your life hard. 

Many to hurt you, few to encourage you. That's humans.

Sinful proud beings.

At the same times, someone out there, a complete stranger will reminds you that life is worth living. 

Keep them with you, ignore the rest. 

Environment will constantly insist comparison with others. 

There  will be someone better than you in many different aspects of life but no one can be you. That's your GIFT. 

Reading a CT Brain

"Why this patient is still here? We suppose to discharge him today right?" the surgeon asked.

"Neurosurgeon from HSB said the CT brain shows evidence that the bleeding is worsening, so they wanted to keep him for another 5 days and repeat another ct brain."

"Show me the latest ct film," my surgeon asked.

I always felt that even thought he is a surgeon in traumatic ward, his knowledge of reading radiological film is far more better than anyone in the hospital.

"Look at the film, can you tell me the volume of the bleeding in his brain?" he questioned.

I was in a mourning silence for a moment.

"Do you know how to calculate the volume?" he added another question. 

"I have an idea," I answered. 

"How many slices are the in the old film?" 

"6 in a row," I said. 

"The latest one?" 

"5," I said after observing the film which I didn't do previously. 

"If we magnify the image, do you think the size might visually appears big even though it's the same?" the surgeon asked. 

It make sense I thought and nodded. 

I continued, "I asked the neurosurgeon but he said, if you don't know how to read, go to the radiology department and ask them." 

"See, this is how they teach," the surgeon sighed to my ward Mo.

"So what you felt?" he continued. 

I looked at him for a moment.

"Like.. I'm... stupid," I whispered. 

He smiled. 

"See, how I see the film and how he saw it seems totally different right, even though it's the same film.Our perspection about ourselves is the kinda same. How you felt about you self might be wrong.Change it." 

In the mid of an Appendicectomy

"This isn't just a normal appendicitis. It felt like an appendicular mass,or maybe a perforated appendix. So better we go in by midline laparotomy, not Lanz incision,"the surgeon said.

Both of us looked at the surgeon with a blur look and nodded.

" His muscles are still very tight, can you giving a little bit more muscle relaxant ?"the surgeon ask  the anesth MO.

" Sure,"she said.

In the mid of ths surgery, the surgeon asked," Thiva, what you gona do after you complete your housemanship? "

" Don't know boss. Maybe will go into surgical or ortho, "my friend who is the second assistant answered.

" You? "surgeon looked at me.

" I want to be on Forbes magazine, "I answered without thinking for a second.

" That's too ambitious man. Then you can't  stuck here in medical field right? "

I smiled.

" One day I'm going to read your article then. All the best man,"the surgeon said with an encouraging tone.

" I doubt it doctor. There's only seven months left for me to be 30.Certain dream will remain as a dream, forever. "

He looked at me and smile.

" In seven months, a lot of things can happen. Certain dreams came particularly to us for a reason. It meant for us. Believe it. If you can see it in ur mind, if you have the courage enough to speak it, it will definitely happen. "

Starting Back

"Seeing you after so long. What happened?"

He made a gentle tap over my right shoulder.

I smiled without saying anything.

"Drifted, maybe, as usual,"I kept it short.

" I know that feeling, "he sighed and continued," When you go away for a long time, you return as a different person. You never come all the way back. "

I don't really understand why he was saying that but it's a sentence with a deep meaning.

It's not about losing weight and muscles. In any situations, if you went far, it's hard to return back like before. Sometimes it's helpful, sometimes it's regretful. 

The only way to make a worthy journey is to finish what you started.

My First Patient In Trauma Ward

I still remember the day when I first met him.

His story started 10 years ago with a small motorbike accident.

When I saw his 10 years old history 

with multiple surgeries to fix his intestinal bleeding, my first thought was,' I'm done'.

New ward, three surgeons, I'm definitely won't be able to remember every shit and they gona screw me for this. 

"Don't worry, I'm here for quite a long time. They knew my case well. They won't ask much." 

I stopped flipping his report and looked at him. 

"Did he heard my mind voice?" I questioned myself with a surprised look. 

He smiled. 

"That's what everyone felt when they saw me for the first time." 

He answered my voiceless question again. 

From that day onwards, he was not just a patient but a friend as well. 

Each time during dressing, I can literally touch his intestines because it was such a big open wound with his peristalsis visible to my naked eyes. 

Weeks later.

" Bro, what is the first thing you wanted to do once you're well and out from here?" I asked him. 

"Get a job and repair my room tiles," he answered with a sense of discomfort. 

His vacuum dressing was partially soaked. 

"I already informed my wound team MO. Today he will come and change the dressing,okay?"I tried to make him feel better. 

" And I wanted to buy a new phone for my sister, "he uttered slowly. 

I can sensed that he really wished to live a normal life like us. 

" God didn't bring you this far to leave you. Everything will be fine soon , "I shared the quote that my consultant shared in her WhatsApp status that morning. 

I was believing that the quote was true for sometime. 

Today he's no more. 

But he made me realized something.

Each soul crosses our path for a reason. Either for their growth or to make us grow.