It is half past one in the morning now.
I have been wanting to scribble something down on this blog all of this past month but the inertia has been too great. And frankly, I’ve just been too lazy to organise my thoughts.
Truth to be told, I am STILL too lazy to sort out some of these ideas floating about in my head. The effort to translate all the complex magic that happens down at the level of my cortical synapses is just too immense. So pardon this piece of incoherent
27 June. Day shift. Weekend. W’s hospital. Spinal delivered for trial of forceps. Strangely, no detectable effect AT ALL after 20mins. Repeat attempt at spinal x4-5 times to no avail– hitting bone everywhere! Slim lady (which makes this even more frustrating!). Decided to call the boss in. During this time, the Obs reg re-examines the lady and decides that the baby has turned and we can do a non-rotational forceps under a pudendal block. They crack on, and as I stood there feeling like a massive failure for not being able to get my spinal in, I suddenly hear the Obs consultant (who had come in to help) say in a hushed tone “cord prolapse.” Upon hearing the 2 words that spelt out an Obstetric emergency, I had my lady anaesthetised within 2 minutes. It was a difficult delivery– the surgeons really struggled to pull the baby out. They tugged and pulled and yanked and huffed and puffed. I have never heard 2 surgeons panting so hard and sounding so stressed before. Then, they asked for terbutaline to help facilitate the “pull-out.” Danggit, I have never given it before. Thankfully, by then my consultant (who had been called to come and save my failed spinal earlier) had arrived and he sorted out the beta-agonist whilst I gave the rest of the anaesthetic. Eventually, the baby was delivered… but not without the Obs consultant suggesting that the Paediatric registrar organise a neck Xray for the babe– he was THAT convinced that he might have broken something during the delivery (p.s. the baby was absolutely fine by the way and needed no such Xray)
6th July. Night shift. W’s Hospital. I was the Obs anaesthetist on call that night. Called to take a patient to theatre at 3 am in the morning for a category 2 section (planned C/S for next day due to previous 3rd degree tear, but had come in the wee hours of the morning labouring). No valid G+S. Antibodies on booking bloods. Known previous PPH. With her previous PPH history (which increases her risk of bleeding again this time) & the absence of any suitable blood to give her in case she bleeds at section, I felt that the indication for section was not strong enough for me to bite the bullet and take her to theatre. I discussed my concerns with the Obs reg who said that she was happy to wait 1-2 hr for cross-matched blood to come from the regional blood centre. Unfortunately, the lady delivered very quickly during our wait and ended up with yet another tear. Nightmare. I became especially uncomfortable when I then heard the Obs reg go about telling everyone (including her boss) that “The Anaesthetist” was not happy to take the lady to theatre. That annoyed me majorly– 1stly because it was a joint decision, and 2ndly because as a senior Obs reg, she should have been unhappy to take the lady to theatre without me telling her so. Anyway, I was so worried that patient would put a complaint in because she had sustained another perineal injury because of our delays. I had to go back and explain to her why there was a delay– and the fact that she could have died if she bled torrentially with no blood that I can give her…I explained that even if I did give her the O-ve blood we had in the fridge, she still could have died from a massive transfusion reaction given the antibodies in her blood. Thankfully, the lady was actually quite happy to have “done it herself,” and did not mind that she had not been cut open or subjected to the above-mentioned risks.
Same night. Emergency alarm went off in the labour ward for x2 prolonged fetal bradycardias. “Section! Section! Section!” And so I tried to “quickly” pre-op this lady. Badly controlled asthmatic– Salbutamol 8x/day. On oral prednisolone. Bad chest ongoing for the last 2 months. Also had a previous general anaesthetic to which she had a “severe reaction” to– unclear of details. Told never to have a general anaesthetic again. Mm… As she told me more and more of her problems, my heart sank lower and lower. There were no Anaesthetic clinic letters found in her hand-held notes. I was thinking “Damn, I could kill her with a GA. MUST SPINALISE HER.” By the time I completed my pre-op, the obstetricians had given the lady some terbutaline and the fetal bradycardia had recovered. They did not want to take her to theatre anymore and preferred to “watch and wait.” Now, I normally wouldn’t mind that at all, but I was SO KEEN to get this lady sectioned in a controlled fashion. I explained to the surgeon and the patient that given her medical & anaesthetic history, a general anaesthetic for an emergency category 1 section could very well trigger off a severe bronchospastic attack/ allergic reaction that would be detrimental to both mother and baby. I really really did not want to give this lady a GA. Nevertheless, the surgeons were adamant that there was no indication for section anymore & they did not want to do it (the lady was still considering her options). What followed was a chain of phone calls to both our consultants and my consultant finally put her foot down to say that they can choose not to take the lady to theatre now. However, if she did rock up our way with yet another severe fetal bradycardia, we will do it under a spinal at all costs. It was crazy for me to hear that- what a difficult decision it must have been for the boss to say that! But I guess we had no choice… our primary responsibility is to the mother. The silly Obs reg then comes up to me and insists I put an epidural in the lady. I said no– the lady was not requesting one & did not need one for medical reasons. I knew the reg wanted me to site an epidural in case the lady needed to go to theatre– which was NOT the solution to our problem at hand at all. I will not be able to top the epidural up fast enough for a category 1 section. And if she needed to come for a category 2 section- I know I have time to perform a reliable spinal. Obviously, said obstinate obs reg did not (or refused to?) understand what I was saying; she later digs out an Anaesthetic clinic letter & comes up to me smugly to say that the advice on it was for the lady to have an epidural. I was so annoyed! I really do not need you to tell me how to anaesthetise my patients thank you very much. I later confirmed with my consultant that my decision was right (Ha, in your face!). Anyways, despite all that, THANKFULLY, the lady was fine for the remaining 2 hours of my shift, and by the time I left for home she already had a healthy baby in her arms. WHEW.
6th August. Started my new job. Let’s be having you neuroanaesthesia. Please let me love you rather than hate you.
I have had my hand on the panic button since I realised that there are only 3 weeks left before the dreaded exam. Unfortunately, there is no sympathy from the other Anaesthetists. Everyone just says “Well, we all had to do it in the past. It is your turn now.” Revision is horrible. It is worse when you have to try and squeeze it in after your long, exhausting days at work, or when you have to try and snatch snippets of time during your on-call days/ nights to revise. It is awful when you have to sit indoors when the sun is shining & tempting you to go and play in its warmth outside. It is gross when it makes you desire to scrub the kitchen, vacuum the house, or clean the toilet instead. It is irksome when you force yourself to get up at 4am to study simply because you went to bed too early last night and did not manage to learn anything. I have become so exam obsessed now that I am in “revison mode”. You only have to mention a casual topic and I will try and go through in my head what I might have learnt about it. Take induction day on Wednesday for example… I started going through the topic of cell salvage the moment the blood transfusion lady came to talk to us about the Trust’s transfusion service. When the fire safety officer came round to talk about fire safety, all I could focus on was how to treat severe burns. Everything in life just seems to lead back to revision at the moment. My first thoughts when I wake up are “What are the structures surrounding the stellate ganglion?” or “What is the treatment for phantom limb pain?” Days off are spent at the Anaesthetic school office going through past papers. This is making me so miserable. BUT, I just have to grit my teeth through it, hopefully pass it, and then freedom shall be mine!
For now, pain.
The troubled world we live in:
3 freaking plane crashes within a fortnight in the month of July. A Malaysian airlines commercial jet was shot down in Ukraine by pro-Russian seperatists. A TransAsia flight from Taipei to KaoHsiung crashed amid bad weather. And an AirAlgeria flight also crashed in Mali. These air disasters are making me extremely uncomfortable… especially considering the fact that I fly so much.
There is war everywhere. Ukraine is fighting Russia. Israel is fighting Palestine. North Korea is still trying to stir up trouble. Christians are being persecuted in Iraq.
There is an Ebola epidemic in West Africa. There is no cure for the virus. People are starting to worry about Ebola travelling and spreading by plane. The human race could be wiped out by this virus before we self-destruct with all the war & fighting.
God, help us all