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你他*的白毛

电话闹钟响了起来
早上六点。
他*的,好烂的一个oncall。
就好好给我睡一下可以吗?

来电显示014xxx,没有看过的号码
很不客气的“哈咯!”
对方带着微微颤抖的声音
"is this Dr Kho?"
电话是从离Kapit最远的一个Clinic打来的
KK Nanga Tunoh Scheme。
我看过Kapit的地图
这个地方根本像是在火星那样远。

Nanga Tunoh Scheme, Kapit

如果有人从那么远call来
知道一定是不大对劲了
跳了起来,温和的应了一声
“yes, boleh saya bantu?"

 JM Evelyn.
一名community nurse,
 白帽,紫色条纹
她简略的响我报上一个孕妇的病例

Kami Sedia Membantu, very true indeed.

二十岁,第四胎
二十七周怀孕(六到七个月)
 凌晨一点开始下体出血
因为家住太远,晚上根本没有船可以到clinic去
所以一大早就到了clinic
就是早上六点。我的那通电话。

血压90/50mmHg, 心跳140
子宫颈开到了九公分
 baby的心跳大概140-150
先救妈妈,我下令两条大line
立刻进了1.5liter的盐水
心跳稳定了些些,血压也上了一点点

情况听起来像 placenta abruptio.
不懂华语叫什么
如果要从Nanga Tunoh来到Kapit医院
她们需要搭上4x4上伐树用的路
一个小时才会到最近的河流,
做半个小时的船到另一个clinic,Nanga Gaat
从那里,坐一个小时半的快艇
才会到Kapit Hospital

什么塞!两个小时!
 9cm,没有可能!
唯有在原地急救和做一切能做的事情

母女暂时还算稳定
现在早上8am,我还有两个内科病房和一个ICU要看

原地急救,要怎样把她们带出来呢?
MEDEVAC。 直升机。
费了一大班功夫,从Kapit院长到Kapit省议会院长
到砂州卫生部的老板,call到乱
终于直升机安排到了!
从古晋起飞,预计下午十二点到Tunoh
半路会来Kapit载一名医生,到原地急救
然后直接飞往Sibu医院。
现在才8am。

我于JM Evelyn至少半小时通一次电话
感谢至少celcom没有把砂劳越给忘了
其实我也真的不能做什么
但是我知道我不可以慌
你在医院慌,人家在那里要怎样噢!

Thank you celcom.
10am
再次大出血,血压再一次crash
开了10cm,小宝贝也跟着出来了
胎盘也出来了
什么都出来了
下令syntometrine + pit40
妈妈至少稳定一下了,至少是现在。

婴孩七个月大
不足一公斤
手脚无力,cyanosed。
JM Evelyn ambubag了一段时间
还是没什么起色
她告诉我“dada ada naik turun, tapi tidak gerak!"
一步步的我教她把拇指于食指夹再婴孩的脐带
然后在十五秒里,算一下心跳
“satu...dua...tiga...empat...lima........enam..."

婴孩心跳120bpm。
那安静的十五秒
我的心都快要停了下来。


至少妈妈现在还算稳定
孩子我不懂,心跳还好,但是不会呼吸!
什么都没有!要做什么!
把她放在强灯下,那塑料带包起来
至少不要让她冷到。继续ambubag。

11am
小宝贝离开了。
JM Evelyn 的声音几近崩溃。
无言。
好像眼泪有掉下来了。
我只记得把房门锁了起来。

JM Evelyn with Dr NCW. Hero of the day.

直升机终于到了。
同事兼老友ncw对妈妈做了应做的急救
把婴孩的遗体让家人领回
妈妈现在应该在Sibu了。
愿安好。


你以为在大炮吗?
你以为在看戏吗?
JM 是 Jururawat Masyarakat 的意思
也就是说她们的工作性质是不需要那么的临床(clinical)的
JM Evelyn 今天所做的一切
远远超乎了她所能驾驭的
自能说,行苦你了。

Aftermath.

你他*的白毛。
生命因为你而变成一文不值的东西。

Medical Evacuation


诗翔。
28/3/13
人生会有几个这样的经历。















posted by Shyang @ 11:51 PM, , links to this post




幼稚和天真的完美主义分子


幼稚和天真的完美主义分子
每天操着不要朝九晚五的生活
向往无忧无虑的刺激生活
高风险的态度和行为有时是好的
但是如果个人的基础是幼稚和天真的话
我只能祝你不要跌到太凶

你可以不负责任的责备你不属于的地方
但是一味的指责和给于幼稚的意见
只会另人厌倦
讲那么多却没有一件事情是做的轰动的
就请你不要再继续了吧

posted by Shyang @ 7:14 PM, , links to this post




My Grandpa


before this exam,
i really talked to my grandpa up there somewhere (somehow la!),
tell him please dun let his physician be my examiner,
i agree he is a wonderful guy, but please dun let me get him,
i will thrilled and confirm die!

finally, i still got him.
and i suppose my grandpa did know what is the best for me.

posted by Shyang @ 12:59 AM, , links to this post




又冷又怕


今天被将会是后星期做我考官的专科医生吓
吓到我话都不会讲
吓到我非常后悔做么要进医科来受苦
吓到有一种想法
就是如果现在忽然不幸就不知道怎么样死掉的话
可能会是一种解脱的那种感觉

 又冷又怕
不要在剩几天就要去考试的时候
才来吓我们啦!

posted by Shyang @ 9:04 PM, , links to this post




Boring Day

too bored today
is there any place u can get an escape package?
like they will come n pick u up at home n throw u somewhere
anyone?
grr..

posted by Shyang @ 5:47 PM, , links to this post




不切实际的鼓励和赞赏

如果说这个社会是一个学校的话
今天我上了一堂课

今天你表现了你的才华
很好真的很有潜力
大家给你很好的鼓励
很好的赞赏
我也觉得你真的很棒!
希望你继续努力!

抛砖引玉,
大家纷纷模范了你
很好!

被你抛砖引玉引出来的
如果是一块很好的料
当然也会得到全堂喝彩
只是表现平平
大家却虚伪的给于鼓励和赞赏
给我看来
这些虚伪只会给你带来更大的伤害
称的上是你的老友的却在最不适当的时候
给了你最虚伪的赞赏
请你不要在被蒙在鼓里而暗暗自爽
因为我是一个旁人
看了都为你心寒

称的上老友的
请你给他一个正面的建议吧
宁可虚伪的为他喝彩

适当和正确的鼓励和赞赏对每个人的帮助是很大的
过分和不切实际的鼓励和赞赏对人的伤害很大

与大家共勉之

posted by Shyang @ 9:17 PM, , links to this post




OK! WHATEVER! AS YOU LIKE!

today is my obs/gyn long case assessment day
posted to obs/gyn wards for 9 weeks, and i m happy that i got gyn for long case
dun really like (or hate!) obs!

very happy, when its my turn, Prof saw me n he actually brought me away to another case, which he think is better...so i like phewh~ good..i going to present to Prof, the senior obs/gyn consultant in SGH...someone who really appreciate ur knowledge n really good! so with all the good n high hope..i introduce myself to the patient nicely n start my 1 hour clerking.

my patient is a vr nice lady, 27 yrs old malaysian iban. G3P2, current in 23 weeks gestation.
was referred from KK Gita (Matang) cuz no fetal heart detected on daptone.
at SGH...scan was done n was told to have 'kandungan anggur' - a molar pregnancy.
ok good, time to shine! since i nvr expect to get this kind of case..but still good!

i think i clerk well with this case (associations, risk factors, past obs, etc) and had come out a vr good management plan for her..and yes...i even do a dipstix bedside..n protein was traced (?PE) so with all these in mind..i m ready to present this case to prof!!!!

SUDDENLY!!!!! I WAS BROUGHT TO THE OTHER LECTURER...THE WAT-THE-CRAP-SMKB!!!



and that time i really see SNOWSTORM!!!!!

i presented at least till management n follow up..but along the way i got irritated by so many atypical questions, which i would like to share with all of u!!! tamade!!!!

A is me; B is SMKB

1.
A: patient's blood group is AB, which is a risk factor for Molar preg
B: what!? then what is the paternal blood group? isnt that important!??
A: ...ok, sorry i didnt ask.....(so far i only come across the importance of maternal blood group, but also not proven yet!!)

2.
A: patient did not complaint of any abd mass or any acute pain, which i m worried of any theca-lutein cyst which tort and ruptured easily
B: ok..wadever, so do u noe how many % of patient will have theca-lutein cyst
A: in molar is around 10-30% (most literature quoted around 20%)
B: ur range is too wide, ok wadever u like
A: what!!???...

3.
A: uterus on palpation correspond to 20 weeks, not larger than date
B: so?? u should tell me the consistency!!!
A: (so so so so wad la! molar is a cause of uterus larger than date wad!!!) ok..it does not feel doughy!
B: ok, not dough, wadever u like

4.
A: so management is suction n curretage with oxytocin after procedure
B: what is the name of the thing they use to do SnC
A: er...its a curette with suction power..2 holes at the tips to prevent blockage
B: the name!
A: er......(thinking what special name tat thing have!!?)
B: SUCTION CURETTE!!!
A: mai high..that's not a name!!!

5.
B: ok, tell me advantage of suction compared to normal currettage
A: ok..to prevent embolisation during procedure, as the tissue is sucked out..not further curretted into the uterus
B: ok wadever u like
A: ....

6.
A: so after SnC, i will send the sample for HPE to confirm molar n to see any presence of invasion
B: tell me the characteristic HPE findings
A: ok, can see generalised/focal chorionic villi swelling + diffuse trophoblastic hyperplasia and +/- of fetal tissue
B: no, not specific enough!
A: ......
B: faster, i m waiting
A: ....sorry i duno
B: faster! i m waiting
A:......i really duno
B: hydroscopic degeneration of the cells.
A: ok. (wadever u back!)

A: during follow up i would advise for effective contraception, better to be barrier method, avoid IUCD and hormonal
B: why?
A: effective contraception, so when patient bleeds..pregnancy would not be an option; and since IUCD n hormonal can have breakthru bleeding..the presentation will affect my judgement on the progression of ds
B: ok, whatever u like!
A: ........

7.
B: lets say u following up patient and u c a vaginal mets
A: ok..so rare le..vaginal mets
B: tell me the exact site of mets in the vagina
A: er..........fornix?
B: NO
A: ....anterior n posterior vaginal wall??
B: ok which one!!!?
A: anterior?
B: NO!
A: posterior.
B: ok. then what should u treat?
A: since jus now i had started her on single chemo (methothrexate with folinic acid), now i would like to go for the EMACO regime
B: ok...good, EMACO, tell me the s/e of etopoxide
A: mana tahu la!!!!!

WADEVER U!
WADEVER U SMKB!
WASTED ALL MY EFFORTS FOR GYN/OBS!
U BETTER DUN FAIL ME!
F U!

posted by Shyang @ 2:30 PM, , links to this post




No More Rainforest!


Form 4: Pengawas Camp; cannot go
Form 5: Pre-SPM Exam; cannot go
Form 6: Pre-STPM Exam; cannot go
Year 1: Orientation; cannot go
Year 2: Orientation Committee; cannot go
Year 3: Sibu Posting; cannot go
Year 4: Bintangor Posting; cannot go
Year 5: FINALLY CAN GO!!!! ooops...H1N1; cannot go

great!
great!
great!

posted by Shyang @ 5:48 PM, , links to this post




不要为你自己的错误找一个借口

其实很多时候我都在思考一个问题
一般人都觉得读医的应该都是很聪明很勤劳的那种人
还记得第一年进医科
我看到了很多聪明的朋友
我也看到很多很努力的朋友
我因为先天资力不足,所以只能靠后天的努力
终于在过去的四年里成绩还算不错

刚记得大家刚认识时
每个人都很有冲劲
很自动自发,连走路的速度都很快
很多事情也不会去介意做得太多

四年过去了
我所了解的情况也不再看得到了

很高兴的,
有一些朋友还是带着一样的态度
自动自发,很努力的在学习
但是,这群人毕竟少之又少
所以当表现的勤劳一点的时候
反而会遭来闲话

"XXX还会在哪里?一定是在ward啦! hahahaah!"

其实我觉得自己懒就算了
人家勤劳就请你把嘴闭上
不要为你自己的错误找一个借口

为什么我写这些东西?
因为我不希望在不知不觉中被同化

与大家共勉之




诗翔
22/6/09

posted by Shyang @ 9:24 PM, , links to this post




O Hantu O Hantu!

鬼啊!鬼啊!

所怕的
所不想见的
所讨厌的
所不能接受的
称于鬼

鬼们
混在一起
商讨大事

损己利人,不做
损人利己,做
但是还要给自己理由

说是为了大家


鬼啊
鬼啊

posted by Shyang @ 9:49 PM, , links to this post