Apa khabar?
Alhamdulillah saya sihat. Kembali buat nights. Sobs. Yes first night out of four.
So started my shift 8pm- with many jobs. Banyak banyak jobs dalam transplant ni pun tak sebanyak oncall covering Acute Medicine / Care for Elderly Wards- 10 wards x 30 patients. Currently I am covering 30 patients on my own at transplant ward. 300 vs 30. So sis wont complain.
Anyhow.
Sis start my shift as usual.
Nurse datang cakap, "Doctor, boleh tak prescribe ubat tahan muntah yang lain, patient ini muntah. Muntah dia macam coffee ground vomiting campur darah."
To those who wonder how it looks like; cenggini
Me monolog. (Argh sudah). "Muntah darah ni new issue ke lama, blood pressure semua okay tak?"
Nurse; "Baru..blood pressure semua okay..Hb(darah merah) x drop pun."
Me:"Okay, jap lagi aku pi tengok, amik lubricant sekali; aku nak buat examination dekat back passage."
So I went to see his muntah; nampaklah satu mangkuk separuh penuh dark blood. Then I went to see this patient. This patient baru je had 3 hari lepas; transplant untuk buah pinggang, pancreas, usus kecil and usus besar ( Banyak organ kan so we called it as multivisceral transplant)
Patient ni masih OK- blood pressure still normal (127/74)but patient a bit sweaty and clammy. Examination semua OK. Nampak cam penat lepas muntah and sis nampak tissue kesan darah dia lap mulut. Tak buat back passage exam sebab dia ade stoma bag. Apparently, stoma output akan jadi malaena post op and that is normal. Patient cakap surgeon ada cakap kat dia yang dia ni ade risk of bleeding.
Anyway, bab bab bleeding- sis jadi over the top sikit nak pula patient just had his surgery- walaupun blood pressure semua masih OK, sis order 4 units blood (special blood sebab patient transplant ni tak boleh receive sebarangan blood) incase patient keep on losing blood. Bagi some drip fluids- untuk cover darah dia hilang from muntah. Cakap kat Surgical Registrar - alkisahnya sekian sekian so that they are aware kalau kalau patient tiba tiba crash. So we are waiting bloods from lab nak check darah merah punya count lepas muntah darah.
Sekali tengah deal dengan one new patient due for renal transplant tonight; tiba tiba cardiac arrest call bunyi.
Berlari sis pecut- sekali rupanya call itu from si pakcik muntah darah tadi.
Die dah hampir arrested dah, kira hampir nazak. Mata dah naik atas. Bed pulak tak boleh nak diflatkan(geram aku), patient tengah position duduk covered with blood. Hampir hampir nak buat CPR-but I could feel the pulse and pt started coughing. So I did not start. We called cardiac arrest team.
Luckily another doctor was around, registar in renal who happened to be at the ward, I heard he said Igel. Aku cam sedar diri; eh, I am the only airway trained doctor there- kelam kabut start protect his airway dia sebab he is still vomiting blood! So I suctioned his vomit ( he is already on recovery position). Baru nak perform jaw thrust- anaesthetist mai! (yeay)
Surgical registar aku suruh aku undurkan diri and pergi deal dengan renal transplant patient yang due for theatre, kena request urgent blood products prior operation.
By that time, cardiac arrest team sampai and they took over the patient.
Drama drama.
My surgical registrar made me ended up talking to Endoscopy Consultant (specific for transplant patients) on the phone for an urgent endoscopy for this actively bleeding patient.
Patient itu ended up pergi theatre terus for exploratory laparotomy (cari source bleeding) lepas endoscopy was clear. Rupa rupanyanya sambungan blood vessels untuk organ usus kecil dia actively bleeding.
Sekarang patient di ICU. Alhamdulillah. Ribut ribut sis malam tadi, patient still OK. Lepas dok lari lari sini sana; still dapat rasa kaki still bergetar getar kesan terkezut patient hampir arrested tadi.
Itulah al kisah penuh drama di malam pertama kita buat nights. Biasanya it will take only one super sick patient can delay semua benda. But somehow, bila dah pukul 2am, things mula calm down.
Renal transplant patient lagi satu tu tak jadi sebab quality kidney yang didonate tu tak bagus. So sis mula siapkan kerja kerja yang di handover awal shift tadi.
Sembahyang maghrib dekat medical student seminar room, sebab nak jalan pergi Chapel jauh sikit. Nasib baik sempat solat- coz I went straight to solat after assessed patient masa mula mula dia muntah darah. Ada Qiblat Google- so korang boleh pakai ni je nak tahu qiblat mana, takpayah download mana mana app.
Sampai di sini sahaja coretan kali ini. Nanti insyaAllah ketemu lagi.
Najah Daud
0730 24/8/19
