Saturday, July 23, 2016


Yesterday there is mortality meeting in the department. I didn't know at all that was my case. No one inform me. Luckily i came early and manage to flipped the patient's folder and i was shocked to found out that it was my case. The case that i saw in March.

It is about a 70+ year old man who is a chronic smoker and blind who came with respiratory distress and abdominal distention. Patient was intubated at emergency itself because of impending respiratory collapse. When i saw him, he already intubated. Auscultation of the lung revealed that the patient had prolonged expiratory phase. The abdomen is distended and bowel sound sluggish. I can't commit whether this patient had pneumonia or not as he is already intubated and i can't do thorough examination. So i ordered chest x ray and abdominal x ray. 

The case however directly admitted to medical ward without anyone tell me the finding of chest and abdominal x ray. Abdominal x ray actually showed dilated bowel and chest x ray is fairly clear. The source of infection is likely to be abdomen however surgical team didn't want to go in or do anything. Later on patient succumbed to death after 6 days of admission.

Mortality meeting is something that i myself hate. But everytime there is mortality meeting, i will go despite it is not my case. Someone told me that we must learn from our mistake but the best is that we learn from others mistake and didn't repeat the mistake.

Why i hate mortality meeting? Because most of the superior will be driven by emotion. Plus i believe the good mortality discussion will not highlighting whosever involved. The meeting should be held for the purpose to teach, to find things that can be improved next time.

So about the meeting yesterday, the superior is asking who is the first call that saw the case? I confessed. And i described that i am stucked with other patients as well. Can you imagine the emotion behind the mortality meeting? It was like a court. It is extremely stressful. Then the superior is asking why you're not firm that you want to see back the case.

The more you talk, the more you will be bashed. Better keep quiet. Haha..
Let me tell you another part of the story. I actually can recall most of my 1st call because it is extremely hectic. In March actually, i am heavily pregnant. When i am oncall, i didn't have time even to urinate. I got recurrent urinary tract infection during pregnancy.  And i know the call that day is extremely hectic.
But no one see that. After the mortality meeting, i cried but i consoled myself that Allah knows.

The meeting continued. Why no one ordered CT abdomen? Why suggesting to surgical to do CT abdomen instead of doing it? Why no one is firm enough that this is surgical case? It continues, but my head of department profesionally wrapped it.

Why i am writing this? Because i read one of my junior status in Facebook how depressing she was doing housemanship currently. Someone commenting it is just 2 years of hardship. It is up to you to quit after that.
Yes i agree depending on the path that you will take after 2 years of housemanship.

But for me, i knew that i will continue to bleed as i am in clinical pathway.

Do i have the feeling of quitting? Yes, everyday. Each time i saw my baby, i felt like quitting. I even had experience asking Allah for miscarriage during pregnancy because the oncall is extremely hectic. I experienced threatened miscarriage during my early days of pregnancy. I didn't even know that i will be only given 2 weeks holiday for maternity if i am in master program. Alhamdulillah i am still survived.

I just came back from Patient Blood Management course that was held on Monday and Tuesday this week. For me to being able to attend that course, my husband had to sacrifice to take care of our children. I had to be strong enough to drive there for hours. The course had given me big impact in the way of understanding and managing patient. Maybe later i will write on that course. Believe me, for you to become a doctor, there are thousand of people behind it.

Why you yourself want to become a doctor? Why my parent, husband, children can make a huge sacrifice to support me?

Because to be in this path is jihad and to support someone in this path is jihad.
لَوۡ كَانَ عَرَضً۬ا قَرِيبً۬ا وَسَفَرً۬ا قَاصِدً۬ا لَّٱتَّبَعُوكَ وَلَـٰكِنۢ بَعُدَتۡ عَلَيۡہِمُ ٱلشُّقَّةُ‌ۚ
Kalau apa yang engkau serukan kepada mereka sesuatu yang berfaedah yang sudah didapati dan satu perjalanan yang sederhana (tidak begitu jauh), nescaya mereka akan mengikutmu; tetapi tempat yang hendak dituju itu jauh bagi mereka.

And believe me, if someone told you that it is only 2 years duration, don't trust them. Haha.. There is a lots more in front of you depending on your path that you choose. And you know why your superior is stressed out during mortality meeting and round? Because your job involved lives. Everyone that deals directly with unstable patient is dealing with stress everyday in their life. Everyone is stress. If you go to mortality meeting, you will see your medical officer being bashed and lashed. Haha. Then only you understand enough and have empathy with their life. You know they scold you, bashed you because your job is dealing with lives. If you tag with your medical officer for one day, you will understand the stress. They have to oncall 36 hours, managing few wards with lots and lots of unstable patient, receiving referral etc.

Then why on earth you still continues despite you yourself is bleeding? Because this life is short. There is afterlife and hereafter that is eternity. Compared whatever life that you faced here, it is nothing. You want to rest in hereafter.

Till now for me to become a doctor, i have gone through 5 years medical school, 2 years of housemanship, and 3rd year of MO-shif, one and half year of post graduate study. If i quit, all the experience that i have is not meaningful anymore. If i quit, all the sacrifice made by everyone surround me is not meaningful. My son had been admitted for pneumonia and i am still doing call. He survived and i don't want his sacrife is nothing.

I dream and pray that one day we will have reasonable call, number of patient to deal. I pray that the number of doctors doing call is increase. I pray that we have good government that have enough budget to increase the allocation number of doctors in each department. I pray that i become someone that going to bring  changes. I hope that i will become a consultant that can manage my emotion, understand my juniors. It is lifelong struggle. I am stress dealing with house officer nowadays but i hope that my anger, blabbering when teaching them is for the sake of Allah. Ya Allah, please guide me and my intention.