Cerita Elective Posting - Ajal Maut Tak Kenal Masa

Salam ramadhan buat anda, semoga Iman anda semakin bertambah di kala bulan suci yang menghampiri akhirnya ini. Alhamdulillah, saya diberikan peluang untuk berkongsi satu cerita dengan sahabat2 pembaca sekalian, satu kisah berdasarkan pengalaman saya sendiri, melakukan elective posting selama 4 hari di unit Medical (a.k.a. Internal Medicine) di Hospital Sultan Abdul Halim, Sg. Petani. Banyak pengalaman menarik yang saya perolehi di sana, tapi di sini saya nak kongsi satu cerita jer. 80% of the story will be delivered in English since it is easier.

The story is about a patient named Puan Salmah (bukan nama sebenar) aged 50’s. She was presented to the hospital with septic arthritis (jankitan kuman dalam sendi) of the knee joint which leads to septicaemia (kuman aktif merebak dalam darah).

On the first day of my posting, the patient was just transferred to the ward from the ICU, but later in the afternoon, the doctors noticed signs of developing respiratory failure, as a result, finally the doctors decided to do an intubation, the intubation was successful after the third attempt by a senior MO from Gen. Anesthetic (GA) department, after two attempts from a HO and junior MO failed. From there, I realized how difficult it is to intubate a living human being compared to a model (patung). The patient was then sent back to the ICU since she needed assisted ventilation. I took the chance to accompany the doctor and nurses to send the patient to the ICU.

Yesterday, which is my third day of posting, the patient is back in the ward, and responding well to the doctors. Today, during the morning ward round with the specialist, the patient looked lethargic with shortness of breath, but still responding to the doctors.

But later, after the round has finished, while the doctors are working with case files and I was reading some of the files, suddenly a nurse called the senior MO who was in charge at that moment. Later on, I noticed that the curtain around the patient was pulled and the head nurse was assisting the doctors. Usually, when the head nurse personally help the doctors, it most likely something serious, so I decided to join the doctors behind the curtain.

I was shocked to know that the patient has developed septic shock (extreme drop of blood pressure), the doctors and nurses were extremely busy doing everything they can do to resuscitate the patient. It was the first time for me to see clinically an emergency management of a patient in shock, with multiple IV lines and multiple sympathomimetics administrations with maximum dosage and speed.

Earlier the patient is still responding to external stimuli like pain and voices, but later, with the blood pressure remaining low, the patient become unconscious, so the doctors decided to intubate her, a senior doctor from GA/ICU was called to do the procedure. Despite everything that the doctors did, the patient suddenly went into cardiac arrest (if I were not mistaken) so CPR was performed. I was asked by the senior MO to help the team, we took turns in doing the chest compression while another doctor did the bagging (assisted ventilation with ambu-bag).

Doing CPR on a real patient is definitely a tough job, it’s tiring, so it’s better to have few doctors, preferably with strong hands. My hand was shaking after the CPR, not just because the fatigued muscles, but also due to the thought that I was helping these doctors to keep this patient alive as long as we could. The thought of doing CPR while hoping the patient will come back to life and looking at her motionless face and body, that’s not something that could be described simply by words. The CPR was done for nearly half an hour since at her age, she’s still considered as young.

Then, the final moment came, the senior MO told us to stop doing the CPR, she said there’s no more hope, and we did everything we could. She also told the nurse to call the patient’s sons (around late 20’s to late 30’s) who were waiting outside the cubicle while telling one of the HO to continue the bagging process. When the sons came in, she told them to whisper syahadah to their mother’s ears. I was touched, because she’s a non-muslim, but she calmly reminded the gentlemen to help their mother perform her last syahadah. Even when the sons stopped for a while (maybe due to sadness), she still reminded them so they don’t stop whispering syahadah to the patient.

Akhirnya, saya bersama seorang HO, pergi bertemu anak2 pesakit berkenaan, dan kami menyampaikan takziah daripada semua doctor dan jururawat yang terlibat. Saya juga sempat mengingatkan mereka agar mengambil peluang sepuluh malam terakhir bulan Ramadhan ini, untuk berdoa sebanyak mungkin buat arwah ibu mereka, moga2 memperoleh keberkatan Lailatul Qadr. Lega bila melihat mereka menerima dan redha dgn kematian tersebut sebagai satu takdir daripada Allah S.W.T.

Pengalaman melihat seorang pesakit meninggal dunia di depan mata, mengajar saya, betapa kematian itu tak mengenal masa dan usia. Manakala, pengalaman membantu doktor2 cuba menyelamatkan nyawa pesakit berkenaan, mengajar erti betapa besarnya tanggungjawab yang akan dipikul di masa akan datang. Bukanlah suatu pengalaman yang seronok, tapi bagi saya, ianya satu pengalaman yang cukup bermakna. Juga, pengalaman melihat wajah anak2 yang kesedihan dan kepiluan di saat kematian ibu mereka,tak mampu bayangkan diri saya untuk menghadapi saat itu suatu hari nanti. Moga Allah S.W.T mengurniakan kesihatan yang baik buat ibu saya dan ibu2 anda, dan semoga Allah S.W.T. mengurniakan ‘husnul khatimah’ buat ibu bapa saya yang tercinta dan juga ibu bapa anda. Akhir sekali, moga Allah S.W.T. menjadikan saya dan rakan2 saya, doktor muslim yang cemerlang, yang mampu merawat jasad dan roh pesakit2 kami.

Semoga kisah yang dikongsikan dapat memberi serba sedikit manfaat buat anda yang membaca, sememangnya kematian itu merupakan suatu peringatan yang amat besar. Ayuh beramal sebanyak mungkin di sepertiga terakhir Ramadhan ini, moga-moga dapat bertemu Lailatul Qadr, dan moga kita keluar daripada madrasah Ramadhan ini dgn keampunan Allah dan suci dari dosa, kalau mati pun boleh masuk syurga insyaAllah.

Wallahu’alam, wallahu musta’an.

Lets talk something about Pyrexia (fever )

Had a lecture on Pyrexia of Unknown Origin (P.U.O) today, which kinda reminds me of U.F.O., very interesting actually, might also be among the most interesting lectures in the Tropical Medicine round for me. Ouh, and if you're wondering, the lecture's title means fever (demam, hararah, sukhuniah) with unknown cause, not really unknown actually, more like a tricky, deceiving or challenging symptom for a correct diagnosis.

Normally, fever is actually a symptom of inflammation in the human body due to infection by most commonly bacteria or less common, virus. But in case of P.U.O, the fever is actually a symptom of something totally unexpected like neoplasia (tumour, cancer), drugs, psychological, and even a factitious (fake) fever due to one's extreme laziness to go to work. But hey, I'm not here to write in details about P.U.O. or even U.F.O., you can google both of them, but I'm here to share some interesting tips regarding fever that I got today from my professor who is a specialist in Tropical Medicine and Infectious Disease, and that includes anything related to fever, I think I might as well call him a fever specialist, Pyrexiologist perhaps? haha.

First tip, commonly when anyone has fever, you will put a wet/damp towel on his/her forehead, do you know that this act is actually wrong and only very slightly beneficial? The main aim in improving fever is to reduce the temperature of the blood, not the brain, and even if your intention is to reduce the frontal cortex's temperature, it won't work due to the thick skull, unless if you crack his head open, then it might actually work! The right action is to put the wet/damp towel at few places with rich blood supply close to the skin, and that would be around the neck (left and right), the axilla (armpits) and the inguinal regions (the groin, the junction between the trunk and lower limbs). Put the towels there and the temperature will reduce significantly.

Second tip, do you know that once a fever reach 40 degree centigrade, no drugs will work for the patient anymore? So giving aspirin or paracetamol to the patient at that time is somewhat useless since the body is too stressed to the extent that it is paralyzed from the drug's actions. The quickest way is to put the patient in ice bath to reduce the temperature to 39 degree so the drug can work. Have you ever watch Universal Soldier (1992) starring Jean Claude Van Damme where the modified soldiers were put in ice bath to heal the injuries and prevent overheat? yeah, it's something like that.


Third and last tip, have you ever heard that when you got a fever, you should wear thick clothes and stay in thick blaket to 'sweat out' the fever? This is actually very wrong and very bad, when you have fever, you're suppose to take off your clothes/wear thin clothes and stay under the fan. But you may think "I have sweat out the fever before, it worked lah!", the truth is, when you produce sweat, later on the sweat will be evaporated into the thin air taking away some of the heat from your body, remeber the Physics that you learn in high school? But the main problem is, during the sweating process, your body is producing more heat while it is already feverish. The body might as well scream, "Are you crazy?! I'm already damn hot due to this fever and you want me to produce more heat???" So how to achieve the same effect from the sweat without putting more stress on our body? Easy maa, just put on a pair of wet clothes and stay under the fan, faster and easier meh...

Well, that's all I think, hope you gain something from this little sharing, feel free to add, ask or comment on anything, even my grammar, hahaha.

Thank you for reading, have a nice day and weekend! Ouh, and stay away from fever!

Things that we might not care much

"Abdullah, ta'al wa ta'mal zai-hu." said the Prof. in my clinical round yesterday. She meant, "Abdullah, come here and do like him."
Of course this is not the exact sentence she said, but more or less, that was it. It was a case of Ankylosing Spondylitis and i was the one who responsible to take the patient's history, and performed the clinical examination of his joints.

It maybe was just another clinical round like the other days, but there was something different, something that hit my mind during the class, and i feel like sharing it with everyone else. Before we go far, let me introduce the patient a little bit, he is Mr. Mamduh Abdul Hamid, 50. He was a nice man, he helped me through the history taking, explained his condition slowly and did not get bored out of repeating the same things to me since I'm not that good in arabic, especially when it comes to all the medical terms.

"enta 'arabi meiyah-meiyah." (ur arabic is 100%! = excellent), that's what he said, i think it's not even 50%, haha.

During the class, I was asked by the prof to become the model for normal person. I needed to do the same movements as the prof asked the patients to do, and she wanted me to do it in front of the whole class while performing the clinical examination on the patient in the same time (by observing his movements). Of course, it was kinda funny when a medical student need to act like a patient-model. Medical student cum model perhaps?

"It's like you're teaching the patient to dance, haha." that's what a friend of mine even said, hehe.

Ankylosing Spondylitis is a joint disease, it starts from the spine, and spread to the big joints like the shoulders, hip and neck, and that's what Mr. Mamduh is suffering from. His joints' movements were very limited and it seemed like whenever he moved any of his big joints, it was something very hard and painful to do.

There i was, standing next to him, doing all these movements freely, as a model of a normal person. Then, suddenly it strucked my mind, "It must be hard for him to see me doing all this movements freely and happily despite that we were doing all that for teaching purpose." Just imagine when you have a sprained ankle and cannot move your ankle freely, then you se your friend running here and there happily, you will feel down and disappointed.

What about Mr. Mamduh who cannot move his back, neck, shoulders and hip freely all the time with no hope of short and easy recovery? But there he was, smiling to us the medical students, willing to help the Professors to teach us about joints diseases and examinations so that one day, we would become good doctors, not brainless doctors. May Allah bless him always.

All the healthy joints that we have with us are definitely a great gift from Allah S.W.T. All the activities that we do everyday, walking, running, cooking, eating, praying, playing, even urinating and defecating, all of them were made easy by Allah through giving us these healthy joints.

Have we ever think about it? Have we ever feel really grateful with this great gift? Must we wait until we have a sprained ankle, a torn ligament, or a broken bone before we will feel grateful? But that's human's nature, always takes something for granted. Let us pray that we would never become such a shameful human because deep inside, we always know that all these things are from Him, and He have every rights to take them away from us, anytime He wants. A grateful person is someone who live his/her purpose of life; as a slave of Allah S.W.T.

Remember, every single joint in our body is a great gift from him, and in return, we should do everything that He told us to do, and leave everything that He prohibited from us. Also, live a healthy life so that we will always have healthy joints insyaAllah. And medical students specifically, lets do our best in our studies so that we will become good doctors, not brainless doctors. That's also a way of being grateful, and to help others appreciate their life and health more, to bring them closer to the Al-Khaliq, The Creator, Allah S.W.T.

Wallahu'alam.




p/s: Can't believe OSCE and Radiology exams are in less than a week! Woah!