When I reached at 9.45pm, Red Zone was like a war zone, 7 patients in a 5 bedded area, with 3 of them waiting to be sent to ICU, CCU (ICU for heart patients) and HDU (eh, not as bad as ICU, but still bad) respectively. Jumped in, immediately to help out, one of the patient's X ray really caught my attention. This guy, involved in a motor vehicle accident, came to us with severe abdominal pain and difficulty in breathing. X ray shows this weird looking solid shadow over the right lower heart area, what in the world is that? None of us knew, until the CT scan was done. It was the SPLEEN!!! Got stuck in the chest area, through the perforated diaphragm.

By midnight, Red zone was already slowing down, and now down to 1 single patient. Referral from Grik. Also a motor vehicle accident, a motorbiker vs lamp post. He was sent to us for a brain scan and also for Orthopaedics to fix the broken right thigh bone. His blood pressure was low all the while, he looked as white as a paper. Darn, bleeding somewhere, but where??? And to our horror, his blood level dropped from 11.5 (done in Grik), to 4.9 in our centre!!!! (thats alot of blood loss, literally enough for another person to live)

Left thigh looked really swollen from the broken bone, but never looked that bad to cause such a drop. Bedside ultrasound showed no evidence of bleeding from the internal organs. Urgent blood transfusion requested. Surgeon and Ortho teams were called in for review. Up to now, a total of 12 packets of fluid were given, buying time, before the blood products came. Urgent CT abdomen was done, showed multiple fractures at the pelvic bone, 3 different sites (pelvic bone fracture can cause massive bleeding, up to 3L!!!!). Blood then pumped in, condition improved, with his pressure fluctuating within the normal range. Finally, he was admitted to the Ortho ward, after the family's attempt to transfer him to a nearby private hospital was rejected by the doctor in the private centre.

Time now is 3.15am. And just when we thought, ok-lah... time to rest and relax... and bell decided to sabotage our plan...

A 60 year old gentleman, known to have blocked vessels in heart, and had a pacemaker inserted 3 years ago, came with the complaint of palpitation. ECG showed supraventricular tachycardia, and I thought, this is easy. IV adenosine bolus given. No response. 2nd dose with double the amount given, again no response. 3rd dose- similarly no response. WTH. Heart rate climbing to 160. Just as we were preparing the 2nd drug, verapamil, his heart decided to change its rhythm, to make things a little more interesting....

Now, he has non sustaining ventricular tachycardia. BP checked- normal, conscious patient. decided to go for amiodarone instead. Rate came down a bit, to 100-120, now, time to get help from medical team. When help finally arrived, his rate is stabilizing at 80-90, normal rhythm, with occasional weird looking wave, probably from a misfiring pacemaker, so said the medical MO on call. When the patient was finally admitted to CCU, it was already 6am.

To complete the night shift, the final and 3rd case came at 7.05am, symptomatic anaemia (lacking of blood) probably due to long standing kidney disease. When we finally settled the case, it was 7.40am, 20 minutes more to go, before my shift's over, all I cared was to have a good breakfast and a good 'night' sleep.... Not many, only 3 cases, but enough to cause a sleepless night.

It is official, now, my name is in the record book di. One of them.

But it is not something that we celebrate, here in my workplace.

• 6.10pm, Mr K arrived, whose heart decided to stop working 10minutes ago, even when he was in the ambulance. CPR has already been commenced then.
• History: he (in a motor vehicle accident) was the driver in the car which collided with a motorbike, but ironically, the motorbiker only sustained some minor abrasion wounds. Possibly, the driver had a heart attack before losing control of the wheels, and then knocked down that biker.
• CPR was continued in the ER, no response, adrenaline and shock delivered once.
• More CPR.
• Then, again delivered for second time, similarly no response.
• More CPR.
• For the third time, delivered again, no response.
• Certified at 6.35pm, after more than 30minutes of CPR, cause? I dont know, planned for postmortem.
• Went out to break the bad news, while others started cleaning, and packing.

Darn, it's been a long time, since I had the last one, going through all the adrenaline rush only to certify in the end, and then to break the bad news to the family members. After all of this, the usual self confrontation happens, "have I done enough?" or "is there anything else that could have been done better?"

And, it is tiring. (self confrontation)

Err...the question is right at the end of the clip, so do watch the whole thing..haha...

Yup, irony...Got a few days break, but instead of rejuvenation, I actually got more tired. Partly, I guess, it was not a well planned break.

Physically, from all the drivings, checking out the progress of reno work at new house, some paper works with the hospital office- promotion and renewal of APC and some church related works. Also there was this inter departmental futsal tourney at SportsPlanet, played a total of 4 crazy futsal matches, after nearly 1 year without any games. And now, my bilateral hamstring, quadriceps and lower back are punishing me for my indiscipline.

Mentally, had to prepare a sharing, for the weekend. Again, no one else to blame but myself. Poor time management and frequent thought blocks, slowing down my work. Spiritually? not too great either, dont even talk about breakthroughs, not even doing the maintenance work well. Crap~~!

Just wanna recommend a site...

Been "stalking" kennysia's blog lately, and the more I read, the more I feel like saying, "caya-lah" to this guy, winner of Best Entertainment Blog at Nuffnang's Asia Pacific Blog Awards.

One of his master piece.

Why The 1Malaysia F1 team is never gonna work

This conversation took place in a clinic, run by a group of Christians to provide free medical treatment to the local community. (I had just finished seeing some one whom came to follow up on her hypertension, and collected her regular monthly supply of 2 drugs, without paying a cent!!!).

Me: (asking the pharmacist/ drug dispenser) Do we have many patients like the previous lady? Who would come every month to collect her medications, for FREE? (can be very costly!)

Madam ST: yes, and we prefer to have more of these patients....

Me: (to myself, what???? serious? Rugi besar lor~!!!!)

Madam ST: ...... so that we can get to know them better, and build a stronger relationship with them, before sharing the Good News with them!!! (with much enthusiasm)

Me: I see, I see... (malunya aku, for someone who have just preached, not long ago, about the importance of building relationships with others in sharing the Gospel, talked so much about RELATIONAL evangelism)....

***looking forward to my next session with them, am positive, that will be able to learn much from this work with His faithful servants, in the other part of the city (from my place ma)***

#Case 1#

A middle aged lady, a well known politician, in this state, presented to the ER with some itchy rash on her body. Cases like this, can be managed even at the GP level. But she chose to visit the ER, and even made some phone calls before coming. Upon arrival, immediately she was sent into critical area, with the specialist on call rushing to see her, as instructed by the hospital director. She was then discharged well, in less than 15minutes time.

#Case 2#

A middle aged lady, a well known attendant with the same hospital, came to ER with severe lower backache, radiating down to right leg. She is known to have PID, or more commonly known as slipped disc. Analgesia was given, she requested for admission, but was quickly turned down by the attending doctor from the respective unit. Reason given was, ward is full (no, it's not), PID is a long term condition, doesnt require short term admission. So, she was discharged with multiple painkilling drugs, even though she was still in great pain. (mind you, PID is indeed VERY painful)