TODAY, there was actually no class in the morning until the afternoon. And there was no grand ward round in my team. And I have none of any on call shift today, be it ward, labour room, or PAC. It supposed to be a carefree morning..I was thinking..should I just be one of the others, having sweet time in the bed which we HARDLY able to enjoy? Or just mugged myself with tonnes of studies which i yet to do?
But at last, i chose to drag myself up from bed and get ready to go ward. I was grateful to make this move, which led me to a fruitful day with interesting encounters, happenings, and learning experience.
Knowing that there would be ERPOC/ D+C to be done in this morning, which I didn't wanna miss, which I hardly able to come across, at the right time, so unpredictable, as it was an emergency procedure, which used up less than 10 mins to complete, so quick that you might miss it.
I was lucky enough to come across 3 ERPOC cases consecutively: observed 2, and assisted 1. The one I assisted was the most interesting but pathetic. The mother had missed miscarriage @16 weeks POA, without passing out any product of conception prior even after the insertion of cervagem, not like the other 2 cases i observed. After i catheterized the mother, through out the whole procedure, i mainly in charged of holding the Sims speculum. When the doctor fixed the anterior lip of the cervix, dilated the cervix, suctioned and curreted the endometrial lining, the amniotic sac ruptured. Together with the amniotic fluid, the bits and pieces, the remnants, the product of conception, ALL of them flowed down my hand holding the speculum. *Ewwww!!!!* and they felt warm. Of course i was not dare to reveal the ew-ness. They flowed out so quick that by then the scrub nurses and doctor started to wonder where was the fetus. And was then only found that it was flowed down on the drape below the speculum i was holding! And when we all looked at it closer and carefully, it was actually twins! The body was still merged, but there were obviously 2 heads at both ends (1-1.5cm width each) with well-formed eyes and mouth! *Ahhhhh!* It was in light yellow brownish, very soft, macerated, and fragile. The doctor held up one of the fetal head with too much force and accidentally nipped the head off! The head fell an inch away from the unformed trunk. *Ahhhh!!!!* .....pathetic.
After ERPOC, I thought it was time to fill up my hungry tummy. Just when I wanna change back my clothes in the changing room & heading for lunch, a doctor came in asking for a medical student to assist her in a caesarean. Dilemma between food and surgery, I chose the latter. Observing so many caesarean, finally I had the chance of assisting one, and guess what, as the 1st assistant straight away! I would say I had made a crazy decision. First time assist, as the first assistant, in a not-so-easy case! The mother was a primid, with background history of primary subfertility, currently @ 39weeks POA with gestational DM on diet control, and a macrosomic baby. Yes, a macrosomic baby! And I was just nodding my head confidently without thinking much, agreeing to assist the dr. =.='' So, dr and I were anticipating for the arrival of a big baby.
To be frank, I was kinda blurrrr here and there during the ongoing of the surgery, cause it was my first time assisting, and everything was so new and unfamiliar to me. =.='' The initial process of cutting and making incision was still smooth and steady, until the rupture of membrane, when the critical and most exciting part started. I played an important role of applying fundal pressure to push the baby out, while the dr assisted the delivery using forcep. I was not strong enough and the baby still stuck, while the small petite dr using her full blown energy to pull out the baby's head. Time was so precious that every single second counts. Any delay of delivery will compromise the baby. Oh dear...I was struggling hard to push. My hand was shaking. That moment was really dramatic...In the end, the scrub nurse came and replaced me. By then only I noticed she used both of her hands to apply fundal pressure...Eh! I thought could only use one hand to push, like what the dr demonstrated to me before scrubbing in...no wonder i had no strength to push *stupid me* =.=""
Ok, with all the hoo-haa, the baby was out! It was a huge huge big baby! O.M.G. And due to some delay during the process, the baby already passing out some meconium soiling the placenta. Luckily the baby was safe, no forcep mark or any complication, so did the mother. The dr prayed for thankfulness to God, and I continued assisting the dr in holding and cutting sutures, diathermising etc etc. Both of our hands were having tremor and lack of strength, especially dr's. Poor her. But we were trying hard applying and holding the suture firmly in the closure of the caesarean section to avoid future complication to the mother, like incisional hernia.....
I helped the dr to call the labour room for the baby's weight while dr was preparing for the post-op note. The baby weighed 4.37kg!....Oh dear...Huge baby indeed!
After leaving the operation theatre, I rush for the afternoon workshop on O&G surgery. Here I learnt the proper technique of draping, gowning, the role as a surgical assistant etc etc. Through out the session, my hoo-haa experience in the OT just before this kept playing in my mind. Well, if this workshop was held earlier, I would have performed better in the OT, and reduced the blurrness when assisting. >.< Anyway, I was thankful to the dr who was willing to allow me assisting and guide me along the way even though she knew i was first time assisting, and she even asked the scrub nurses to guide and helped me for being new as an assistant. The nurses on shift that time were kind to me.
In between the time slot, I practised examining few pregnant mothers. What so exciting was that, it was my first time to come across a triplet pregnancy!....Before called it a day, I attended a sharing session by the seniors who had just passed their resit ikhtisas. Again i felt tremendously nervous and anxious as it reminded *or should say warned* me that I was running out of time, and that I just have 5 months left along the line to face the final destination of a medical student @.@
Soooo busy without the chance to have my meal. And my tummy was left empty for more than 10 hours...Poor tummy. Nevertheless, it was an exciting fruitful day that I was willing to spend some time jotting down the moment in my blog.
