Meaningful quotes

I watched a movie entitled recently. Find out that some phrases are meaningful.. It says that.. 'everything you see exist, i can see other ppl,i can see into other ppl's eyes. i can see my hands, but i cannot see myself, so do i really exist? Why i am me and not somebody else'

It applies to our life. We can only know how ppl look likes, the face, the smile, the hair and the attitudes... We can see what ppl do for life.. But we cannot see ourself. SO do we really exist? We could not see mirror every moment every time to reassure purselves that we really exist. The only thing we know is we can control our body, mind and soul.. So, occasionally we will forget who we are cos we only see who other ppl are... not ourselves. We dont remember what we do time to time but others will. They couldnt see themselves but they can look at u, observing what u do and comment on u at certain circumstances.

Another sayings quoted from the movie are as as such '' If we mix mash potatoes and sauce ,we cant separate it later,it lasts forever. The smokes that came out from the ciggarrate wont go back in, when the time tick tocks and time passes, we cant go back. So, its hard to choose. You have to make choices and of course the right ones. As long as you don choose , everything remain possible.''

I like the last sentence whereby if we are in a big jungle without a compass, trying to make choices of which directions to go and where it might lead to.. You will also think about the consequences and whether u are making the right choice. You will used up a lot of energy considering this and that .. Not only wasting your time and also burning off your calories in no time. Living in a complicated life awith many choices to make.. sometimes you really want to make it simple. As such that we live with a principle of ' come what may'. With these, your brain wont be so congested and confused and your nervous system connections wont get burned due to overvoltage .. As long as you dont choose and let it come by itself, everything remains possible. Hope it will be applicable in jobs where if you don create a demarcations between love and hate... you will have more rooms of improvements and more enthusiasm in anything you do... cos you don even think twice when doing it.
Just do it...

The truth about government hospitals

Ever since i stepped into medical life as being a medical students, i had received or heard lots of complaints regarding the bad attitude and services of the doctors in government hospitals. At that time, i only heard from one side which were the complaints from the patients or those in concern.Seriously, before i started my job, I kept my finger cross so that i wont repeat their mistakes after i become a doctor.

However, starting from the day i become a hseman, i start to realise there are 2 sides of the stories. As i am in the doctor's shoe, i realise that everything is not under my control. As i was in charged in the clinic, i started seeing patients. However, i was not a qualified doctor yet. So, a lot of consultations from the medical officer were needed. And to look at a clear view of the scenario, actually in the clinic, there were 8 hseman in charge and 2-3 medical officers with 1-2 specialist. So, hseman job is to make sure the patient's history clear enough and to find out his or her current condition besides identifiying the pathology in the patients. To reconfirm it, we need to consult the medical officers for 2nd opinion and definite decisions. Base on their experiences, they will make the right call. And with limited MO's and specialist and tonnes of patient waiting outside, what we need to do to prevent patient from waiting long are to act fast, manage fast and then to attend the patient ASAP to prevent patient from waiting too long.

However , the complaints that i heard were listed as below.....

1. the doctors are busy writing and lack of explaining.

2. the doctors see patient for less than 5 minutes with lack of concern

and the list goes on...

However, if they can think it in our shoes, in a government hospital with lots of patients in queue, its impossible to keep the patient stagnant inside the clinic till late in the evening. We need to be fair to everybody.Patients also need to work. They cant take leave for whole day just for a clinic visit.There are lots of things we need to consider. We need to act fast and the process of double consultations plus for a precise management already taken some time. So, its impossible to entertain patient for so long and besides filling up their follow up cards for a clearer view with precise diagnosis during next visit and also for medicolegal purposes. So, the so called lack of concern comes in.. The true hard facts are that the Medical officers and the housemans are actually handling ward cases and also clinic cases at the same time. Sometimes, we need to keep ourselves in hunger until the clinics finish and at times, there are also ward cases that need to be settled that make us starve until the evening. If anybody could understand this... there will be mutual undertandings between everyone and no more complaining and frictions will happen.

I am not defending for the doctors .. but standing as the medical personalle view.. i could only say that its not that we are lack of empathy or care, its out of our control whereby there are lots of patient ( approx. 150 patient per day ) in ratio of the doctors amount. So, there will be some messy conditions happen. Hopefully by these clear cut of explainations, ppl will start to view things at different angle as there are reasons behind each issues.

The fishing concept...

Life is like fishing... What you catch is what you get.. Everyday,fishermen go out to the sea.. They fish for living.. But they could not predict what they will get. They wont hope for something impossible like catching little sharky, 'memo' or water dragon for the day.

So is life.. We cant ask for things that we could not possibly get..What is yours will be yours. What is not yours , just let it go. We cant force it to come when things dont belong to us. Its like holding a grasp of sand. If we hold it too tight, we will lose more. Asking for more creates more frustrations and anger.. But the issue here is why cant we ask for more? Can we? Is it wrong of wanting something too desperately and couldnt let it go .... Its life we are talking about. Its our inner self that craves for things that we dont have and we want to have it no matter what it takes.

Why i put out this issue is that i heard from a friend of mine that a friend of his wants to be a doctor. He really struggle hard in order to get good results in SPM and STPM. And alas, he get straight A's for his A level. The hope is getting higher and the dreams are about to come true. He wants to get a local uni or get scholarships so that he can achieve the sky high ambition. However, it ended up in dissapointment. As usual, life cant be smooth sail all along.. There are obstacles that we need to face. However, he wont give up .. There are sacrifices behind the desperado he is having. To get at least 300K to go oversease to fulfil his destiny is not a small amount. For financial wise, family sacrifices are needed for sure .

Its a scenario that not only a few of us facing in regard of ways that we manipulate things in order to get stuffs that we want in life. Is it worth a sacrifice? Cant we just follow the trails as being set for us and move on like what other ppl do. Must we strive that hard, to go thru dozens of hardships to get a feeling of satisfactions. Getting up from fall is a painful procedure especially it is done repeatedly. In the middle of nowhere, sometimes u will feel scare, feel lonely and having million attempts to give up. To pass thru the dark side in order to get to the brighter side, it requires a lot of sacrifices and strength. It is not merely a simple stepping stones. Thats the sacrifices that need to be made in order to get what you really wanted in life. At some moments of time, you wil even ask yourself.. Is it worth trying? Am i in the right track?

And the problem is ... is becoming a doctor so good? haha.. i really couldnt answer this question though i am sitting here in front of my laptop , labeling myself as a doctor .To me, its just a job..its not an easy money.. every cents earn according to your own effort. Working 36 hrs during oncalls.. And having backaches, headaches, heartaches and u name it.. any aches will do..

Hmmm.. with all the sacrifices made by ppl these days.. it keeps me wondering.. Is ambition a big thing until a person can sell their properties..transitioning from rich to rack just to grab the opportunity to turn into a white collar saint instead of a simple person who seize the day by holding the concept of ' come what may'..

No idea... another food for thoughts..

Post-call Sharings....

Huhh.. currently post calls after working for 2 days... Having ''indigestions'' in the sense that there is so much thing to highlight here..

Lets talk about the upsetting part first. A part of me compiled a lot of sadness.. Those who had been accumulated from the day i started working till now.. Its the sufferings that a normal working ppl might be having. The scolding part and the blaming part play a big role for my sadness. This morning, i was accidentally given a job.. (as i passed by that area) whereby it was thrown to me without any further order or instructions.Then i was figuring out how to handle it..And i barely know what or how to do it. So, i jus do according to the simple order and ended up with disaster. I wasnt being informed that i have to do bla bla bla stuff... And i was ended up being scolded like a piece of shit.. Wat a nuisance.....

I think its a small matter only but i kept feeling upset for almost the whole day. After some deep thoughts..only then i figure out there are many things that occur the whole day.. A little of sarcasm, a little of criticism and in combination of a little scoldings. Then it builds up gradually until it reaches a mountain high of pain and sadness.. ANd with that, it has already crosses my threshold and i nearly blown up. I know that deep inside, i deserved to be happy .. Why? cos i do nothing wrong. And i was just trying to make things right.

But no matter what i do, there are mistakes occur...Why? Due to dissatisfactions. Cos i cant satisfy everybody. I am trying to be careful of everything that i do.. And try to be conscious about patient's feeling and emotions besides filtering things that need to be filtered before voicing out anything. The defence part that i used eventually wear off at the end of 2 days( or even longer).

Though i did do some tricks (like cheating the patient who continuously 24hrs need my help for something which cause such a nuisance...) There is one patient who ordered me to give him drugs that can reduce swelling in his legs.He asked for about ten times in a day while obviously his leg was not swollen at all.. He wouldnt stop nagging at me. And at last, what i can think about is PLACEBO.. I gave him water injections and told him that it was very effective in reducing swelling.. The next morning.. he told everybidy that i gave him a miracle drugs and the swelling resolved much. Hmm.. Do i worth a praise? eventually not...

I am holding a princip of ' service with a smile' but it works in only certain ways but having reverese reactions on the other way. Why i say so? cos ppl thinks that i am not easy to get angry and easier to be bullied. Can be a qualified punching bag without considering that i am actually a painful sack after all the punches.. I have my own ego and anger. Its just that i know anger dont work in either way. But to swallow it in silence is a painful and stressful task to fulfil. If anger works, the world will be having more and more wars.Endless chaos and crisis... What for..
So i need to advise myself to be patience... patient..

Ok.. untolerable.. Need a sleep to forget everything. Tomorrow will be another beautiful day ...

Your life, your call

When i was starting my housemanship days, i barely know anything. I can't even decide for any tiny miny things , for example how to manage high glucose level, hypertension or worst enough, how to manage a patient when the BP crashed. I have no idea how to deal with any of it. Whenever the staff nurses asked me , i will be so confused, i started cracking my head searching for answers. Idiotly, i would say,'' wait arr... i ask other ppl first. Later i will get back to you.'' Thats what i did for weeks. My mind nearly exploded with questions, questions and unsolvable questions... I will keep hoping for anybody to pass by so that i can beg them for answers. At that moment, i had only one principal, TRUST. So, i just need to trust everybody in order to get things in aligned and so that my job will no be stagnated for miles.I cant put my job in jeopardy cos i was still new at it and its not my fault of not knowing anything. However i dint realize the fact that there are 2 types of ppl in this community, somebody who wanted to help you and also somebody who intended to fail you.

There are some attempts that ppl tried to make use of your trust to betray you. They set u up without u even notice. The moment you noticed it, you are already facing the consequence of blind trust. A question popped up... why ppl do so? why ppl can be so ignorance and so arrogant? Food for thoughts..

Hard to blame them.. We need to survive in the society. There are rivals, there are comepetitions.. We need to get things well organised and at the same time gain trust from the bosses and become the best among the rest. This is jus a method of survival. Its your rice bowls that you are protecting. No harm done..

As for the victims per say, i need to be more precautious of any decision i made. Because of the trust, i was scolded by my bosses many time though i did nothing wrong. I jus asked and follow whatever ppl told me. I was just trying to make things right. But i have to bear the brunt on all my actions. From that time onwards, i am more aware of what i am dealing with. As time goes by, i gain more experience and skills from what i had been thru and what i had learned. Eventually, its my call ... I have to decide what is the best for the patient and to minimise the consequences if possible. Trust has already faded.. Confidence comes in..

Yah.. we can trust ppl but we need to be selective at times. You wont know who is actually the angel and who is the devil who is backstabbing you from behind. Its not that we are being too judgemental. No one s perfect. We know that.. But in every human being, we are well prepared with all sorts of defences. We have a shield in front of us. We dont live in fairy tales. When it comes to real life, everyone stands out. But at the same times, they will try to protect themselves in any circumstences.Avoid from being hurt, avoid of being the victim in the endless war..

So, to stand out,first u have to stand straight. Trust is a big issue and the consequences can cost you a life. Think about it....For me,i still have a long way to go..There are still tonnes of things i havent learn. I need cumulative experiences to get things right on track. Its my life, it will be my call. Keep the finger cross...

Plausible Deniability

The truth is people are born, grow old, get sick and eventually die. Its a life cycle.. Its the fact that we must admit. Standing at the entrance of the hospital, i see many ppl come and go. People that walks in with wheel chairs ,crutches, casts with the head or limbs bandaged or even with bruises all over the body.They are here to be treated and mostly are due to trauma or sickness.. In their faces, i can see mixed emotions ~ irritated, sickly and frustrated. Somehow, there are people who are happy go lucky type and just laugh it off with their sickness. The truth is no one wants to be in the hospital if nothing goes wrong.

Walking along the way to the ward, there are thosef ppl who are more sickly that need to be admitted for further management. In the ward, you can see more intense emotions in them. As in orthopaedic, ppl come in with trauma.. with the limbs got fracture or lacerations. Everyone of them come in with pain which varies in term of intensity as each ppl has different threshold of pain. The utmost part of it is the anger, the frustrations and the denial whereby they dont want to be admitted. They are here due to accidents,industrial injury, trivial injury or even domestic injuries at home.. Accidents happen. Its life.. we cannot control these from happening but it does happen out of our will. Unfortunately, all of us have our superego inside. We denies it.and it ends up in anger and frustrations. So, the pain threshold gettting lower and lower. The pain will get more intense for sure.

I see many ppl came in with tears.. However, as a first liner, we could not let them cool down and let the family members take care of it before we try to attend them. We need to ask them what happen and what miseries they had gone thru in no time. Hell i know that asking things like allergy , personal history will make ppl more irritated.What to do, thats the routine part of it.. Its so not good when we are asking these things when they are held up in tears.

In trauma cases especially open fracture, we need to do irrigation on the wound. It is the most cruel part where we are using copious amount of salines to flush off the dirts and contaminations of the wound. The patients will be yelling and screaming in pain and begging us to stop torturing them. Its not up to them to decide it as we are doing the right thing at the right time. We try to manipulate it as gentle as we could not help it but the pain is there. I had experience it all the time but the most frustrated part is when i am doing it in the middle of the night. They will scream until it echoed to the whole ward. The toughest part that i need to go thru is they will hate me for life as i am inducing more pain for good. I am the devil !!

Some ppl cant accept the fact that it is just an accident. No one wants it. With a fracture on, they just don want to accept that they need to be operated to get cured. Though the person are in their fifties or sixties , they will undergo transitions of becoming a kid who couldnt decide maturely. What they want is to go back and no one will ever touch them again..

I undertstand this point as if i am in their shoes, i will do that too (touch wood). But the funniest part i ever seen is that the whole family has the same thinking. Opt for conservative treatment~ massage or chiropractic therapy for a fracture?? oh my god. All the persuasions and explainations play no roles in changing their mind. They jus want to be discharged home at their own risk. What a plausible deniability .... How is it possible for a person to go back home with the limbs deformed and unable to move with additions of pain and swelling.. Sweat (-_-)'''

Its hard to understand human.. and its hard to change ppl's mind. I guess all we can do is to decide the best for them besides giving them alternatives.

Complex netwrk between grass and roots

Choices and Decisions

YES or NO.. TRUE or FALSE.. RIGHT or WRONG.... these statements bother us most of the time.. which is which.. who to believe... which one to follow... what is the best choice....


Most of the time, we do things base on our instincts. Every times we decide on something, it is a balance between id, ego and superego. In layman term per say, there will be mixture of your common sense, wisdom, personality and emotional intelligence. However, everyone has different thinking and opinion. So, they decide differently although they are dealing with the same issue. To correlate it in my daily life, i have many collegues, many ppl under me and above me. There is a network connection between those working under the same roof. And the fact is everyone has their own frequency and channels in the sense of thinking and preference. This creates a complex human behaviour.

To be frank, ego put a larger percentage when it comes to making decision. The ego is a component of personality especially when dealing with reality.And talking about personality, it builds up from your background moulding you into a human with unique characteristic. Hence, what is in the outside will be the reflections from the inside. Your inner self or personality will be acting like a preset mind which will makes u act/ behave according to what you learn. So, our so called ' fight and flight' responses are different in the sense of how we react when dealing with hardships, obstacles or problems. And this preset mind has ego moulding inside . That make things complicated.

To cut the crap, i will apply it to my current bleeding issues which blunted my decision making ability. As i mentioned, everyone has their own thoughts. So, trouble happens when you have many bosses in queue.. this one order A, that one order B, and the other ones order you to do C.. So, at the end of the day, confusion happens. What should be done? A , B or C ? or A+B+C? or dont do anything at all.. which is which.. Can we do half and dont do the other half?? If i dint do the other half, i will be blamed for not following the orders. Standing in the heats, you will lost your decisive ability as those things are related to human life and undeniably are serious matters. Acting according to our instincts might be wrong at times. And the point is there is no room for mistakes. So, i am carrying a big stones behind my back which is to do everything ordered and confirm i will work until i wear and tear. But if i miss something relevant by doing things selectively, i dont really trust my instincts.
Blunted.......

I cant blame anybody as we all are complex human beings. And according to my bosses experiences and skills with all the hardships that they had been through, they can decide things which they think will be the best for the particular patient. As quoted from our rule of thumb ~ DO NO HARM. But leaving the middle man bleeding without active management is kinda cruel i guess ... Which one is the most accurate ones? who has the right to decide everything..

One more bleeding issues arise from here. Is there any right or wrong in life? How to define right and how to define wrong... which is true and which is false... Guess there wont be any answer for that forever. Safe your breath from asking those questions. There are points to and points against in each statement. It depends on how you analyse and how you see it. If you think its wrong, no one can say its right. Cos these are your assumptions and your own ego. Sometimes, its good to stay in a grey area and stand on the fence. In that way, everything will go smoothly. You wont differentiate hatred or love, basic or complicated, should or shouldnt and do or donts.
But, the problem is staying in a grey zone dont make you a human. It is like a chicken on the fence, that will fall down to either sides when the wind or tornado comes in.

My conclusion is there is no conclusion.. This is just another uninteresting blog written by me after 36 hrs working.. tired, exhausted and GREY...
gonna be black soon as i am gonna sleep edy.. zzZZZZ...

unsoundable complaints

When we were asked about the problems we had been facing during housemanship... i think there will be an endless list. And when the next question throwed to u which is.. did seniors do anything bad to u or bully you or taking you for grunted.. the floor turn into silence. Why?? lots of questions will appear in the mind... And before voicing out anything, we need to think, filter and extra filter so that we wont hurt anybody besides getting what we want. However, its kinda hard as these complaints are not general to everyone, but specifically to certain ppl. We cannot make it as a prototype saying that this senior sucks, so everybody who is a so called 'senior' will be grouped in a category or being put in a bucket..

An issue arise when u really wana voice it out but you know u cant. Why?? cos with a mature thinking and good emotional intellligence, u know this matter wont be solved by other ppl but yourself. If u dont make it as an issue, it wont be an issue after all... But if the patience has already offf limits, u have the eagerness and hesitancy to splurt everything out at one time. Nvertheless, your subconscious mind told you not to do so as it wont bring any benefit but to create more chaos to the society or to the other unrelevant ppl.

What is the best way to solve a problem..
1. when you are being bullied blindly as those ppl who is elderly than u jus wan to take advantages on those so called ' stupid' jr by giving wrong information or more towards ignorance.. Is ignorance a bliss in this settings?? of course not..
2. when you know that its not your fault and you are being backstabbed by someone who is a known case of lazy worms, jus to show off during ward rounds to impress bosses. when you are jus doing your job, they will hate you like hell and describe u as a mirror that reflects away their brightness. HOW ON EARTH can they get such an idea while you are doing nothing wrong..

Sometimes, you can just keep quiet after those hard cores and endlesss jobs with 36 hrs staying awake ended up being scolded or criticised that u r blocking the brightness in them (although during daylights). Its a voiceless message that i am trying to convey but a pointless ones.

So, there's no point discussing pointless topic. To end it up... i shall only say to myself. Keep quiet and do your job. thats the best answer after all

My 1st intervention ~Vacumm assisted dressing

This morning, i finally has a chance to do my very own vaccumm assisted dressing.. As i had learned it weeks earlier, so i might had some ideas how to deal with it.

For this procedure, i am asked to use some cheap stuffs to build a vaccumm assisted dressing with wall suction. And previously, i saw other patients using high tech stuff with an equipment cost about at least few thousands ringgit not including the accesoories...
So now, i am going to use a more economical stuff as we have inadequate machines in the ward.

So, the tressure hunts begin. Equipments needed are basically sponge, gauze, ryles tube, suture, suction tube and a big bottle . Initially i found an RM1 sponge that has been autoclav ~ super sterile.. i grab 2 sponge and put into my trolley. Then its time to find the suction tube.. Searching up and down for the tubes... tiring but interesting. Gauze , suture and ryles tube are easier to find as it is a common stuff used in ward. And lastly, i asked for a big bottle from the staff nurse. After everything done..its time to get myself sterile.

Before starting to do anything, i need to make sure the wall suction is powerful enough to suck the pus and keep the wound in a vacumm state. Luckily i found one but it was being used for a comma patient as he needs regular suction for his tracheostomy. Then, with a bad intention, i stole his suction and exchange a less powerful suction for him (still can be used~ i am still not that bad i think- p/s : i tested it already before i change. it is functional).

After attaching the pot filling with chlorhexidine and suction in situ, i cleaned and drapped the patient under sterile technique. Actually, he has a big cavity wound with big pouches filled with foul smelling psu which is an indication for us to do vacumm assisted dressing. So, i irrigated his wound with povidone iodine mixed with normal saline. Then, after drapping him up,i start to cut small holes along the ryles tube to create more holes so that more suctioning can be done. After that, the ryles tube is wrap with gauze and sutured with dafilon 3/0. And then, the ryles tube is inserted into the pouch and then roll around at the cavity. Next,, the sponge is cut according to the wound size and is covered on top of the ryles tube. FInally, everything is wrapped up with op-site to secure the position and make sure there is no room for air entry.

At last, the ends of the ryles tube is attached to the suction tubing. And suction pressure is turned to 150mmHg. Alas, the wound has turned into a vacumm state. The Vacumm assisted closure (VAC) done..

Pus is drained out immediately. Initially, patient will feel the pressure and tightness but as he get used to it , i can increase the pressure up to 200mmHg. Hence, this is the end of the procedure. This vacumm assisted dressing can last for a week and then if the wound is clean, we can opposed it with secondary suturing with KIV split skin graft or change another VAC until the wound is totally clean with granulation tissues.

I think the total cost price of the whole procedure is 50x cheaper than the high tech machines..
The most economical method i ever done...
SATISFACTORY....
And i keep looking at the patient's leg the whole evening and looking at the successful intervention that i did for the day..
Ohh... goody..

Da' drug abuse patient

Funny things do happen in our daily life.. Once, i was attending a patient which was a drug user and retroviral disease. He was isolated at one corner due to unknown hepatitis status and had suspicion of having tuberculosis. Initially, i felt empathy on that patient. He looked so cachexic and had hyperpigmentations all around the body. His leg was ulcerated and necrotic.


I was ordered to take an excisional biopsy from the patient's leg. I spent almost the whole morning calling here and there to get the form and also the sample bottles with formalin just for this particular patient. At last .. everything done. And its time to wear like astronaut for double barrier and universal precaution sake. Spending 10 minutes to put everything on~ apron, goggles, mask and double gloves. Finally, i approached the patient.

So, the procedure had begun. I started irrigating his wound with normal saline and povidone.. Weirdly, when i irrigated his wound on the leg, he shouted for help and crying of pain.. He lifted his leg as high as possible and couldnt let me touch it. He sworn that he rather amputate it than letting me irrigating the wound. I dint even cut a single piece of his flesh, he already yelled like someones going to die.Then , he refused to let me proceed with the procedures. Initially, i felt numbed by his reactions. Of all the preparations i made, he refused to take the sample because i irrigated his wound. And the utmost part was that I HAVENT TAKE OUT THE BLADE...

After all the persuasions, i gave up my attempt. When i sat down at a corner to clear off my mind before doing my tasks ahead... something came up.. I was thinking why he cried for pain while he had been injecting himself with heroin everyday.

On the night itself, i stayed up as i had oncall. At 4am in the morning, as usual, i took blood from patients that need daily electrolytes and coagulation profile monitoring. When i scroll thru the whole ward, i stopped at the corner of the ward. And i double checked the bottle... Oh, it was him again. I was predicting something might happen again.

As predicted, when i entered his boundary, he started to screen for any sharp equipments. He saw me taking a syringe and needle. Voluntarily, he gave me his hand.. Before i sucked his blood, he started to give his lecture. He told me ways to take blood and ordered me to take blood from the particular vein in certain angles and directions. I followed what he said and eventually failed my first attempt. So, he started finding other veins for me and ordered me to take from the site he pointed. ( Hmm.. he do have a more advance knowledge in regards of the anatomy of blood vessels than i am.. ).. He kept babbling and babbling.... giving me his very own lectures.. IT WAS 4AM IN THE MORNING.. (ANd it was the crab teaching the duck how to swim) My patience was then escalating up to the boiling point. Swallowing a gulp of saliva, i finally poke his radial artery. He scolded me for blindly poking his veins without even seeing them. And he reassured that i wont get any blood from him as i didnt listen to his advise. Out of nowhere, blood started gushing into my syringe and i finally took 10cc blood from him.

I exhaled soundly as a sign of relief. At this moment, the environment was as quiet as i could even hear the laughter of the nurses at the counter area. Then i realise that his face turned blue and he finally kept his mouth shut.

-------THE END---------

The lesson for the day is to TRUST YOUR INSTINCT...

Tibial pin traction

Finally i was able to do a proper tibial pin traction after assisting for once. My first impression of tibial pin traction was ~ we were inducing harm to the patient rather than for good. Why i made such impressions were because i was standing in the third person's view.. A doctor is applying pin poking and screwing thru and thru the bones and on the other hand the patient screaming for help echoing around the whole ward due to more pain induced by the doctor besides having a femur fracture above it. But , thru deep considerations and weighing the pros and cons, i think its a doing good procedure than doing harm though we just give local anaesthesia to the patient which only contribute a chicken dose of pain relief effect.

After some deep thoughts , i began to realise the fact that in a patient having long bone fracture over the lower limbs , there will be a muscular spasm going on around the fracture area. The strong musculature will cause more displacement and deformed bone.Besides., any mechanical movement will induce more pain via the friction between the fractured bone with the soft tissues. So, the purpose of doing the tibial pin traction is actually to immobilize the bones, reduce the muscular spasm( by using the bla bla bla law) ,to relief pain and for an easier operative procedure. And thru immobilization , there wont be any mechanical movement which can aggravate more pain.

The day when i oncall where i had an opportunity to apply a tibial pin traction for a patient who alleged domestic injury and sustained fracture over the femur.
What i needed was a blade size 11 or 10, local anaesthesia ~ lignocaine, syringe and needles, povidone iodine and normal saline, tibial pin , T- handle (for screwing purpose) and also a bohler braun frame ( for elevation of leg, padding and a connector to the pulley) , lastly the traction weight which is 10% of the weight of the patient.

Initially, i had to mark the place i need to cut which is first to allocate the location of tibial tuberosity, and go lateral 2FB and inferiorly 2FB. the reason to go laterally was that i was not suppose to hit the common peroneal nerve. So, by going laterally, i could push away the nerve avoid cutting the nerve that night cause foot drop. So , after marking the point of incision, we should test for any pre- procedure foot drop. And to compare with the post-procedure foot drop. To see whether the foot drop were induced by us or it had been originally torn as these are medicolegal stuff that we need to be concerned about.

After getting the skin drapped under sterile technique and areas of incision cleaned with povidone and NS, i started giving LA to the patient on the incisional site. Then to test whether the anaesthesia taken effect or not, i had to pinch the skin with forceps. If the area got numbed, i couls start doing a 1cm longitudinal incision on the marking area. And then using a dilator to open up the fascia. Tibial pin applied and screw from lateral to medial. It shud be crossing thru the metaphyseal area which shud be softer than the cortical region. So, when felt a give way, meaning that it had already poked thru the bone. So, another incisionon on the other site can be done~ also 1cm longitudinal incision. Before that, to give LA for anesthesia. After all and all, apply stirrup and place the leg in a BBF and lastly connect to a tractional weight for ~5kg (standard weight).

Make sure that the ASIS-patella-2nd toe are is aligned.With enough padding on fracture site to prevent presuure between bone and soft tissue causing necrosis. leave ankle free to allow exercise and prevent foot drop. For tibial pin care, flavin dressing daily at the pin tract site is a must. And to watch out for tibial pin infection as it could cause further osteomyelitis to the patient.Make sure the countertraction is there or else the whole procedure serve no purpose.

As the rules of dealing with fracture is to reduce, hold and exercise, we need to permanently hold it via platting or intramedullary nail/ interlocking nails base on specialist preference and which are the best for the patient. After operative procedure, sending for physiotherapy is a must to prevent joint contractures by starting with quadriceps strengthening exercise, buttock lifting and ankle foot pump exercise and lastly for Non weight bearing crutches for at least 12 weeks. So that the bone will unite without causing refracture of bone as the load sharing is there.

* image taken from http://wheelessonline.com/tibtrac.jpeg

Suffocated

In the first few days of life, i was so stressed up and tired with jobs, obligations and the worst part is the cooperations with the staff nurses.. In the first few days, i kept making mistakes. I was scolded no matter what i do.. And i got confuse between right and wrong.. A list of mistakes done... eg. filling up the wrong form, forget to sign, writing wrong thing at the wrong place, taking staff nurse trolley, forgot to clean up after use and the list goes on.. There were tonnes of mistakes that i did in one day and got scolded like hell.. i felt suffocated and started to wonder why i became an FOC punching bag ..haizz..
My goodness, why staff nurses can be so fierce.. i got so phobia to them. Am i too young ? Do i really do that much of mistakes? are there any considerations as i was still a newbees there? i knew that there wont be answers for these questions. I started to find a way to solve it, by learning things faster . But then, i notice that its not abt the mistakes that i did.. at times, i got scolded without reasons and being humiliated by them in front of the patients .I knew there was something wrong somewhere.Things didnt go well as i thought to be.With lots of question mark in mind, i consulted my family members. They taught me some management skills and also ways in handling crisis.. My collegues taught me to be more confident in making decisions and be strict at times so that i wont be bullied blindly.
With their help,i was able to go thru these obstacles without problems..