Thread by @twt_malaysia

Ok managed to finish most of my work today & I have some time to tell my next cerita.

Today my cerita is about the time I when I just got posted to Nephrology. I was only about a week old in the dept & all new MOs start with rotation in the ward.(We have a dedicated Nephro ward)

Since I was only a week old, of course I just hung around trying to learn. The team was doing rounds (never ending, I tell u) & we stopped at a particular patient.

As we were discussing about her, her SPO2 (blood oxygen saturation) begun to drop, like rapidly.

Since I was the newbie, the specialist asked me to auscultate (listen) to her lungs.

Why must it be the newbie? I have no idea. It's not that hard of a thing to do. Anyway, so I listened intently & I realised there is no sound in the right lung.

SPO2 still dropping.

A colleague in the background mentioned someone tried to insert a IJC (internal jugular vein catheter) yesterday.

Without hesitating, I said, that's a pneumothorax there from the IJC.

Boss looked at me & said really? & went to confirm it.

SPO2 still dropping.

True enough, boss agreed w me & asked another MO to prepare a chest tube (tube inserted into chest to relieve the air/fluid)

Patient was seriously gasping & SPO2 is around 60-70% now.

I said, I dont think there is time. Better to do a thoracocentesis.

Pin drop silence.

So boss asked other MOs who can do?

My other MOs, are mostly junior in terms of experience as a doctor, but they have more in Nephrology/Internal Medicine.

So apparently, nobody knew, or nobody er, dared to try.

I said, I can do it. At this point, u have to know my last stint in any emergency situation like this was >1 year ago as I was in Klinik Kesihatan for a year.

But some things u learn, u learn for life. So I was quite confident.

A thoracocentesis is basically putting a large bore needle into the space between the lung & to release the air trapped, which was causing the lung to collapsed (that's why patient cant breathe)

Something like this

*pic from Google

So anyway, I quickly prepped the patient & stuck the needle in, keeping in mind the various nearby anatomical structure, so as to not cause more damage.

The swift *whoosh* of air when the pressure gets released is like music to my ears (& also a collective sigh of relief 😂)

Soon the SPO2 begun to climb back up & though the thorocacentesis managed to relieve the pressure, it's only a temporary measure.

She still needs a chest tube, which was done expertly by another colleague.

By the 60 mins, patient is stable & a life is saved.

Ok I didnt tweet just to boast I can do an emergency thoracocentesis.

My point is, many students/HOs asked me how to get into their depts of choice. Even around me, colleagues will try to transfer to another dept any way they can, guna cable, tulis kat suratkhabar ke etc.

Many seem to think being posted outside their dept of choice is a disaster, because u have no interest in it, or u think it's a waste of time because u wont learn anything of use.

And that is wrong.

In any department, any specialty, there is much to learn.

And though we categorise patients to different specialties like medicine, surgery, orthopaedics (O&G and paeds dont count lah), in reality, your patients will have many conditions overlapping.

So it will pay to gain some experience in various specialty, even in primary healthcare setting.

I dont think I will learn how to do antenatal scans or treat methadone patients if I didnt do primary healthcare.

Being a doctor is a lifelong journey, it shouldn't be rushed. It is not a race to reach the finish line.

Technically, there is no finish line. It's a cumulative experience in many aspects of patient care. Sure, along the way u take exams, be a specialist.

But the core of it remains; saving lives, whether u are a HO setting a IV line for blood transfusion or a heart surgeon transplanting a heart.

So take your time to be a doctor, learn from your patients & most of all, be humble & willing to learn from everybody.

I wrote this some time ago, some points are repetitive but I thought I'd post it again, if u want to read.

mmgazette.com/to-the-doctors…

Ok and that's it for this afternoon's cerita! We pick up tonight again with the 2 polls.

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