First Day of Elective Posting in Hospital Serdang

achoooo!!! achoooooo!!! haaaaaaccccchhhhooowwwwww!!!
that's like the sound of me sneezing away!
Ya Allah, I seriously dont know why Im like SUDDENLY sneezing all evening I tell ya!
After tirelessly "working" from 8-5; the last thing I need is a sudden drop in my immune system, wow.

Anyways, Alhamdulillah! Survived first day of actually learning something in Hospital Serdang!. Well, Im not literally saying that my experiences being "exposed" to other hospital was ttly useless, NO! They are certainly valuable, and I am planning to use this posting as wise as possible! Yes! Like my last rotation was at Hospital Gombak (a hospital catering for aborigin people; Orang Asli)..that, was an eye-opener. Especially having Dr. Soh as the attending lecturer, wow! She like to drill, man. She loves to make other people feel awful about themselves and Im not excluded from it. At first i thought her 'strict-ness' was good, in a sense that it pushes you to become a much better individual. Though after three days with her, *=="* she ttly put me into tears because it feels as if the medical profession is not cut out for me. I really felt like quitting. I wanted the time to just stop for a while so that I can really figure out where I am today.

Well, now..all I can say is ALHAMDULILLAH for where I am right now, I might not be able to figure out exactly what tomorrow holds, but I can certainly hold on to the forever-existing Allah the Almighty, for He holds tomorrow!

Anyways, I just want to post this up, insyaAllah everyday of my posting. This is my first day of like real posting, so I apologize if the information is not perfect here, I certainly didnt clerk any patients today, thoroughly. These are just some of the patients that were observed during the ward rounds.
*I got posted at the Internal medicine ward*

1st pt of the day; died by the end of the day *sad*
A 90Yo pt having sepsis secondary to Acute Kidney Injury(AKI) due to CAP *i think its CAPD* Continuous Ambulatory Peritoneal Dialysis.
from her ECG reading, it was reported hat she also had Atrial Fibrillations (AF) and her heart rate was around 150bpm. The rhythm was clearly irregularly irregular. After doing blood culutre; she was foud to be =ve of S. aureus(aerobes) and P.mirabilis(anaerobes). Urine culture showed a large colony of E.coli.
The pt had sign a form of NAR (non-Active resuscitation) *wow*

When we visited her bed, she looked very fragile and was sort of gasping for air, she was on a venti mask of 60% O2. We did not manage to try and talk to her due to language barrier and her old age. Plus, by that time, the dictirs had started their ward rounds so we decided to follow with that instead.

Luckily, during the ward rounds, we met our super senior; graduated in 1998 and is currently pursuing part-time at the govnmnt hosp as a GI specialist. He was super awesomely nice and relaxed! He was never tired of talking to us, he even admitted that he talkes a lot. Indeed he did ==". Anyways, I was very pleased with his teaching. Fater this, I will be off, finding/reading up some information of the things that he had taught us. InsyaAllah.

Our second pt was a 70Yo chinese female with Lung Cancer. We saw her CXR and it had clear opacities on both lung fields and a few rounded lesions visible near her left lung. *Gotta brush up my CXR reading; hehe*
Dr. Paul :) explained to us all about Assisted Ventilation of which the patient was using.

Did you know that the machine is in charge by the anesthesiologist? wow right! She was using a non-invasive Respiratory Machine which was usually given in pt who are 'awake' or not sedated for any reason. The pt had also a case of COPD because her heart clearly looked enlarged too.
Anyways, the pt was placed on a machine known as BiPAP (Bilevel Positive Airway pressure) which means the machine assisted in both her inspiration and expiration. Unlike the invasive respi assistance; this machine does not FULLY control her breathing, it just gives a slight pressure and maintains them during expiration. Dr. Paul described them as like when you out your head outside a moving car. So like, the air from the machine hits your face *mouth and nose area* and pushes air into it. That is why the mask needed to be fully and tightly placed onto her face; using velcro that is. It looked quite uncomofrtable, but hey, if it makes her feel better than that's no harm :)

The administration of a ventilation assistant is typically done after reading the Arterial Blood Gas (ABG) *another topic that needs to be studied again*. Dr, Paul explained that ABG is only reliable when the blood is taken from the artery instead of veins due to the difference in oxygen concentration and after reading a glimpse of the procedure on my trusted Oxford Handbook of Clinical Medicine only did I understood what he was saying, as the process itself was tedious. Pheww.
Anyways, he also said that usually ABG needs to be run on a routine basis for some pt and they ususally do not take arterial blood as poking a needle into your artery for more than once or twice can eventually lead to a development of pseudoaneurysm. Again, wow. Knowledge that you'd only get either from experience or extra reading. Anyhow, ABG is almost always used as an indicator of the treatment efficacy of BiPAP.

Our third pt was admitted due to pleural effusion. After much digging and investigations of course, the doctors had managed to detect liver cirrhosis! Wow, again *blah!*
One of the complications of cirrhosis is pleural effusion, though on of my lecturers had said that is is sometimes quite rare.
Trully its not straight froward I'd say! Dr. paul explained to us that in some pt who has congenital defect of the diaphragm and development of the compartments of the body, a passageway may be formed. Ascites by the lievr cirrsosis may seep into the pleura, as such in the case of this pt. This is especially exaggerated when the pt is lying down flat.
Dr. Paul then explained to us all bout NASH (Non Alcoholic Steato Hepatitis) which was an old term for NAFLD (Non Alcoholic Fatty Liver Disease) <-- I learned this term.
Basically, NASH is a spectrum of a development of disease ranging from a just 'normal' Steatosis' of which most people might have *due to diet and so forth eg.diabetis*
The problem is right now is at the otehr end of the spectrum of which you have Steatohepatitis where the collection of fat causes inflammation of the liver. Till now, there is ongoing research of why this occured in some individual while others remain pretty healty with minor liver steatosis. An interesting topic I'd say.
Its somewhat similar *in terms of the pattern of development* to cancer. But please bear in mind that it is not Cancer. Sme ppl can be very sensitive with that word. Unnecessary scared-ness.

Anyhow, I have come to the end of this post. Really tiring I'd say today was, but I am certainly looking forward of what tomorrow holds! InsyaAllah Im going to be learning how to take blood sample tomorrow. *haha, crawling in clinical; I know!*

Im hoping to meet more of super awesome cooperative nice doctors tomorrow to help me in my learning process.

Till then, Salam alayk everyone :)

p.s: my apologies for any mistakes written here. This is basically most of the things that I have written into my notebook. Sorry if there is any mistakes of grammar or wrong usage of terms. TQ!