Her last word

It was an ordinary oncall day running all over to get the hand-overs done and attended to patients' complains till a staff nurse yelled:

"Dr. Ng, tengok SPO2-nya..."

She was a 53-year-old lady bedded right at the acute cubicle, critically ill with striking features of bilateral gangrenous lower limbs as well as the tip of nose. Her SPO2 dropped to 88% under room air. With immediate attention, I questioned her for symptom of difficult breathing.

"No." She replied softly with a little head shake.

She desaturated further despite the propping up position and the change from nasal prong to ventimask. Gradually, her eyelid drooped and she became unresponsive. Her short while of gasping was typical of Cheyne-Stokes respiration. Auscultation revealed bilateral reduced air entry. Copious frothy discharge started to bubble from her oral and nasal cavities. Carotid pulse was fading.

Cardiopulmonary resuscitation commenced immediately with suction in between aided by two staff nurses. MOs oncall arrived 10 minutes later and certified fixed dilated pupils, asystole with no spontaneous breathing.

Death had occurred. It occurred faster than I could respond. She was just talking to me seconds ago. Vital signs monitor showed a final SPO2 of 45% with undetectable pulse rate.

Residue cardiac activities...

Frankly speaking, my mind went blank through out the 10 minutes of resuscitation. I knew not what else to do or what to tell her husband and son who were behind the curtain. The feeling was totally different from how I used to practice on dummy or how I used to practice breaking bad news to my friend.

Perhaps I am experience lacking. This event had added to my first failed resuscitation.

May you rest in peace.

Dying process begins well before death occurs.
The last sense to go is hearing.
So, do talk to the dying ones.
-The journey towards death, Angela Morrow-

Rainbow

Double rainbows @ Stampin, 6.32pm.

Gracious God has again reminded me the everlasting covenant He made with the living creatures.

Works tired me out, both physically and mentally. As the pre-call-post-call cycles continue, I get less and less time for myself. Spiritually ill-fed, stress for not reading enough. Desperate for the procedures I need to complete in the coming month. Dissatisfaction on things that I could have done better.

Sigh. Perhaps it's just another pre-call blue. Hoping for a better day tomorrow!

Still striving on...

雨后才会出现彩虹，加油！

MBBS (IMU)

DR. NG CHING MUN
MBBS (IMU)
MEDICAL OFFICER UD41
MMC NO: 39104

Tempted to re-make a stamp as above after missing my formal one for 2 months. Just about to proudly declare that I am IMU graduate and bring it glory, suggestion said I might spoil its reputation instead.

True, people look at a thing I have done wrong than a thousand things that I have done right.

Let me wait longer till I have gut to carry on my plan, or to strike off the MBBS (IMU).

Future plan

53y, Para 3
∆ CA cervix stage 1B
Wertheim's hysterectomy done
Vault smear: adenoCA
MRI pelvis: Local recurrence

Radiotherapy completed.

C/O: Difficult SI after radiotherapy.
Otherwise well.

S/E: (Accommodated only one fifth of Duckbill speculum.)

V/E: Short and stenosed vagina.
No mass, no discharge.

Plan
1) KY jelly 2 tubes.
2) TCA 4/12 to repeat vault smear.
3) To make a longer vagina vault if I have chance in the future.

--

Was helpless. Only frequent self finger dilatation was advised.

Another thing I learn was, VE before speculum examination. As you do not know how long the vault is and forceful insertion causes pain.