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Wednesday, June 28, 2017

First Intubation

Judging from the title, you might be thinking I did my first intubation in my Anesthesia posting. The fact being, I witnessed my first chaotic intubation in my life. 

It is my second day being posted in Anesthesia department and I followed the ICU periphery round. It was supposed to be uneventful, at least that was what I thought. As we saw the first patient, it was a massive toxic epidermal necrolysis patient with poor prognosis, requiring life support. With her family members crying around her, it was such an awful situation to be in. 
Deep in my heart, I know there is nothing much can be done given her old age and poor prognosis of her illness. I didn't know how should I feel, whether I should feel anything and so I just hoped that next patient is going to be better. 

Next patient.
It was a patient presented with oxygen desaturation even with high flow mask, which is an absolute indication for intubation in her case. It was in the ward. Many nurses, doctors were running around preparing for intubation while at the same time, a doctor was doing manual ventilation/ bagging to catch up with the oxygen saturation. Just as I thought everything should go well, the bag seemed not to be able to function as it supposed to be and the doctor had to change the bag for a few times to sort of trying out which one is functioning. At the same time, the pulse oximetry which was supposed to measure the oxygen saturation ran out of battery. With such a chaotic scene, the patient who was struggling in pain was giving some agent to put her into sleep and was intubated.

The doctor asked me afterwards,
'What was your thought?
I only can say 'chaotic'. Nothing else. He said it is important to be calm and know what you are doing even in such a chaotic situation. 
That was it. 

Subsequently the few patients that I saw was relatively ill as well but nobody seems to feel anything. 

2 days of ICU exposure, at the very first day I have already decided ICU is not something for me. 

Image result for intubation
Image credit to google image

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Short update of my recent life, 
this is my fourth rotation of the year, two more rotations to graduation. 

Previously in Pediatrics Surgery, I did enjoy it afterall. 
Manage to assist in a few surgeries which was an achievement for me! The rotation showed me the reality of world, the politics and the system in the hospital. 
The so called 'hierarchy' system in Malaysia is such a bad thing! Why cannot people just work in a team. They have this mentality that people with a higher hierarchy can bully the people in the lower hierarchy.
At the end of the day,  it is just non stop bullying culture. 

I guess that is why practicing in Malaysia is not always something that people wants to do even they really want to contribute to the country. 

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On the other hand, Neurosurgery was like my best posting in the whole five years of medical school. 
With nice supervisor, nice people around and supportive learning environment, I cannot describe how much I love the rotation. 

Ending the post with 2 pictures taken during the Neurosurgery posting. 


With Ms Sharon. 

Till we see again, 
xoxo

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