A Little Hello

A blog has always been a comfort place to come back to, don't you think? :)

My days had been busy lately. I often came back home late, and if I didn't have any homeworks to finish, I always caught myself lying down on my comfy bed. And falling asleep until the next morning. At 4, I woke up, took shower and rushed to hospital. 

I never knew this residency thing bring me a lot of changes. Tired yet exciting at the same time. Meeting new people provides me experiences. There were several times I thought hard, difficult and not easy, but when I've successfully overcame all, I started curved my lips and smile. I learned lots. :)

One day, I was dragging by my senior resident to a patient we took care together. As a observer, I help my senior to do the everyday-basic examination and all the administration things. This patient was diagnosed with Deep Vein Thrombosis and Ca cervix (Cervix cancer) in advanced stadium, with its complications: hypoalbumine, easily bleeding because of warfarin use, peripheral edema. We could say that this case was dubois ad malam. Even it's so, my senior resident tried his best to bring her at her highest state of health she could. At that day, he wanted to me say some farewell words before she discharged. 

"I apologize for any words that might hurt you mam, I wish you speedy recovery," I said formally. I thought I was running out of words, didn't know what to say any other than that.

"I thank you for all your help, dr. Risa," she smiled, "For all your motivational words. I must be strong as you said."

That moment frezeed me. 

I remembered everyday I came to her, telling her over again to eat at least five boiled eggs to increase her albumine levels. Some days, after I knew she was also diagnosed with depression (she lost his husband in accident, if I'm not mistaken), I told her to be strong, because her only daughter needs her. Some other day I grumbled at her because she only ate french fries from (maybe biggest all over world) fast food restaurant, not eating her lunch that already served by hospital. I said, "This food provides all the nutrition you need, so why don't you finish your luuuuunnnnch?" Then she answered me, "This food is tasteless." "I know but.. You have to eat nutritious food no matter what." :/

Everytime I came for her, she complained about discomfort in her stomach. I couldn't tell her that her cancer already spread to liver and caused those discomfort. Later I found out that cancer has already spread to her lungs.

Malam, I know, but I kept telling her to be better soon. 

"I'll see you in your visit to Clinic," I said, trying to put my best smile. It's heartbreaking to say "get well soon" to patients with terminal ill.

"Sure, I will get healthy soon."*

I also got funny questions from patients. 

"Doctor, during the bypass surgery, do they stop my heart, pull it out and repair it?"

"So my heart is filled with amount of fluid. Where do they come from?"

"Can I go home right now? I already feel better than yesterday."

Some questions are annoying sometimes, but I had no other choice than trying to give the best answer with a big smile. *facepalm*

So, this is a little hello from me after years not writing. Promise to come back as soon as I could. :)

Have a great day!

What I Learned Today

"I met my senior in this sympo, and to me, he spoke out about his resignation. He was once general surgery resident and I'd always thought he made wrong decision by giving up on the chance that dreamt by every general practitioner; being a resident. Today, I know the reasons behind his big decision and I wholeheartedly respect him for that: his father's been seriously ill and he had to earn money for his family. There was one or two things I learned, to not judge anyone without knowing the whole stories, and to be kind to anyone because... Everyone is fighting their own battles." 

Recent Updates

Been awhile since my last post. So readers, how's life been?

I wrote this post while I was working a night shift at emergency room. You must already been cuddling inside your warm blanket at this hour. Sleep heavenly tight then. Please do read this post tomorrow morning. :)

I enjoy my shifts actually, except the part of seeing death and delivering bad news to family of patient. The hardest part is to stay calm when emergency patients come, to stay sympathy when one patient gone, to keep everything fine in line. Learning the art of medicine has never been easy so far, yet when we're able to create beautiful creatures, which means here patients that get better, all your hard work and sleepless night are paid off. Trust me, nothing beats the thankful sayings from patients; the smiles they give after you say "Stay strong Mam, you'll be okay."

Ah iya, we luckily got accompanied by co assistant from UII. I see so much difference between co assistants in Unair and them (yes, the term "Young doctor" is definitely wrong. Colleagues from abroad never use that term for medical residents or co assistants.) 

One day, I knew one of them reading medical physiology book. "I'm re-reading about cell mitosis phases, so I easier can understand how chemotherapy works," he said, when I asked him why he's been so serious focusing on a book. And his answer got me wowed. 

Another time, I got patient with Non Hodgkin Lymphoma referred to our hospital. This patient actually had routinely checked and already got chemotherapy from Soetomo General Hospital (FYI, previous hospital where I worked before), and he referred to our small hospital because he wanted to move back to his hometown, to be near his family. From Soetomo, he brought results of laboratory examinations that not available in Soeroto, and this co assistant, curiously asked me "Why did they examine this? *Pointing out to result of LDH examination*" 

That what makes us different from them. The curiousity levels. :)

Well then I learned a lot from them. Medicine requires long life study that we must not stop at some point. To feel desire for updates, no satisfaction. That's the path we chose living in. May you enjoy yours, dear fellow clinician! :)

NB: About love life? Please skip the questions! 

Be Proud, Doc :)

Last night, I had sleepless night shift. Amount of patients admitted to emergency room of Puskesmas, causing me and two nurses lacked of sleep. Every thirty minutes or one hour one patient came, asking for the medications. Me, with half eyes opened, tried my best to give the examinations and treatments that able to be given in a small health centre. But this, there was one patients stole my attention a lot. 

He was admitted in the early morning, when the sun began to rise, well about 5 or 6 at the morning. I was finishing the medical record of patients before him, and suddenly he came to emergency room 'carried' by 3 or 4 people, and from the far I saw him unconscious and well... not breathing. I run to him, and asking for the Ambu bag and adrenalin injection to nurses. No radial, brachial and carotic pulse palpated at first, then I finally got the pulse palpated, very weak pulse. I thought that was a DOA (Death on Arrival), and be ready to deliver the bad news to the family. I called the patient's name, trying to examine the conscious state of him. No eye opening. No response to pain stimulus. Until I came to the conclusion he had severe brain injury, he was unable to take a deep breath, gasping for air. I could only give oxygen mask,  and massive fluid infusion, and no mayo provided in health centre. I thought he was in poor yet stable condition until I saw him... Stop breathing.

Fast, I called for the help to assist the Ambu bag, found my way to get the plastic chair closer, climbed up to it and started giving CPR. I aggresively gave the intravenous fluids the due to the very weak carotic pulse. and unmeasured blood pressure. 5 minutes at firts, we got no response from patients. I examined his eyes, myosis at left and midriasis at right one. As long as the both sides didn't show maximum midriasis, I thought we still had a hope, then I continued giving CPR for 15 more. 

And finally I saw him coughing... and I could palpate his radial pulse. Strong enough. He regained ROSC. :)

That indescribable feeling came after. Be proud, doc, you all have the ability to provide the best medical treatments, to save one's life. No need to listen to those harassment and bullying, to those direspectful behaviours people show you about your profession. Go. Your patients need it. :)

How to save a life - Grey's Anatomy casts

Shortcut to Bali

Sunny Sunday and we planned to go on a picnic! :D

Candi Cetho (Cetho Temple) had been decided to be our next short trip destination. This temple is located on western slope of Mount Lawu (on the previous post, we visited Sarangan lake, which located on southern slope of the same mountain :D), on the border between central and east Java provinces. One hour needed to get there from our beloved boarding house in Ngrambe. The journey to this temple is challenging and arouses adrenaline,the road went up and downs, but all the anxiety, dizziness, feeling of unwell are paid off with the breaktaking scenery! Green everywhere, you can see the beautiful tea garden on both right and left side, love! <3 p="">

Don't ask for lunch. We again had satay! 

A high gate standing elegantly under the sky brought our memoris to the temple's gates in Bali, the God's island. That's why I named this post "Shortcut to Bali", the atmosphere here simply reminded us to that beautiful island. You must agree with me, no? ;)

In Javanese language, Cetho means clear or pure. As a place to worship the Siva God, this temple is decorated with a phallus statuse statue as a symbol of Siva. Fyi, phallus is statue which has penis look-alike. The main bulding is trapezoid shaped, located on the highest terrace of the land. Until now, this temple is still used by Hindu societies here for a worshiop ritual place. They put ritual sesajen (offerings) on the statue. When we were there being amazed with the scenery, the fog came down from the hills covering the temple area. 

And near the temple, there's a pura up on the hill, named Pura Kalisodo. :D

To sum up today, It was fun! And the trip was totally worth it! 

Looking forward to another trip! Who knows next time we will find 'shortcurt' to New York? :D 

Trip to Sarangan Lake

Whoa! I miss blogging to the moon and back!

Not because I was that busy and not having time to write... Well, I'm just suffering with loss of signal recently. My dearest team mate seccessfully fixed this poor strength signal problem, so here I am, ready to report the things that happened (esp about the holiday things), and be proud to bring you the photos! 

Remember we had one day off on last Thursday? We went to Sarangan Lake that day. Yes, one day trip to one of the famous lake located on East Java! Yeayness! :]

This picture was (not) beautifully taken by me. Not high-skilled in photography. Haha. *sob*

Sarangan Lake (in bahasa, Telaga Sarangan) is a natural lake that lies at the foor of Mount Lawu, southern slope of the mountain to be exactly, in Plaosan district, Magetan regency, East Java. It took two hours more (omagah!!) from Ngrambe, and two victims of its winding road found and diagnosed with travel sickness. I've had taken my dimenhydrinate pill before beginning this long journey, yet still, I felt nausea and heavy dizziness during the killing-two-hours. 

Sarangan Lake is one of Magetan's tourism. Around the lake, there are two-star hotels, motels and cottages.  I thought I'll be able to see the beautiful green pastures that lies beside the lake, and I was totally wrong, there are lots of souvenir shops and food vendors permanently built beside the lake. They sell everything, from the usual tourism shirt (white or black t shirted printed Telaga Sarangan in center of it, capitally) to wooden photo frames (which also the words Sarangan Lake written in its edge), from traditional snacks to various types of vegetables, from sate to mie ayam. *gulp* We had sate (satay) for lunch. But since I had no heart to eat the cute creatures with two long ears, I orderd chicken satay instead of the rabbit one. I just did not have a heart to grill Conny into satay..... :/

Look! 8 out of 10 chicken satay! With extra peanut sauce on it, yum!

I also found Leontopodium alpinum here! The symbol of endless love. :)

The mission won't be complete without renting the boat or horse riding over the lake. We only tried to ride the speed boat and errr...bebek2an (that's the way we called this boat, a floating watercraft designed to look like a duck.... yes, that's bebek2an!) To those who has vertigo or easily get motion sickness or seasick, steering bebek2an is really not recommended. All of us who tried riding this slow speed boat got dizziness right after. About the horse riding... Well, let the prince charming will be the one who rides the (white) horse to pick me up, and me no need to. Ha-ha-ha. 

I did have a great time! One day trip is tiring and exhausting, yet FUN! See you on the next escape! ;)

What makes a "Best Doctor"?

Been in hometown for a while, spending night by traveling around the net world. I found one good page (from here), a very good reminder for us as a GP. This article collects opinions about how doctors in one teaching hospital *guess so* define 'good doctor'. May what I've quoted here helps you, my fellow doctors and colleagues, to walk through the rocky roads to be a good doctor. :)

Miguel Paniagua, M.D., geriatrics: "My father said the day you feel comfortable practicing is the day you should quit, as complacency leads to mistakes. We should always be students of the art and science of medicine."

Salvador Cruz-Flores, M.D., neurology: "A great physician should be caring, compassionate and competent but he or she should also be available and affable. A physician should care more for the person who suffers an illness than for the disease a patient has."

Donald Jacobs, M.D., vascular surgery: "How do you define excellence in the profession? Dedication and commitment to provide the most advanced care and the ability to effectively communicate in a compassionate way."

Terry Moore, M.D., rheumatology: "I would define excellence in the profession as being a physician who updates his knowledge daily and keeps abreast of all new findings, teaches medical students, residents, and fellows well, and is active in clinical, transitional, or basic research. A great doctor not only treats the whole patient medically, but is courteous and fully explains and answers a patient's questions."

John Eisenbeis, M.D., otolaryngology: "Always put the patient first. Think about how you would be feeling if you were the patient. What are your concerns as the patient and, as the doctor, believe and address every single one of those concerns. Worry about your patients. If you do, you won't stop trying to cure them until they are cured."

Julie Gammack, M.D., geriatrics: "A great physician puts the needs of the patient above his or her personal, financial, and professional aspirations....hears, not just listens to the patient, and fosters a caring and trusting therapeutic relationship."

Ali Mehdirad, M.D., cardiology: "Be familiar with the latest literature, apply it to patient care, love what you do, respect, communicate, listen, respond to your patients' concerns and always remember that your patient is number one on your list."

Dulce Cruz Oliver, M.D., geriatrics: "A good doctor is a person who will accompany a patient on his or her journey both while suffering and while enjoying life."

Bruce Bacon, M.D., hepatology: "I think it is a privilege to be able to care for patients and to have their trust. Important attributes are to be caring and compassionate, to listen to your patient's needs, to answer their questions honestly, realizing that they are often afraid of what is going on, and to provide careful follow up communicating with patients in language and terms that they can understand."

Ghazala Hayat, M.D., neurology: "I value being such an integral part of the lives of my patients, having their trust, trying my best to cure or alleviate their ailments and furthering the progress of medicine through research and education."

David Karges, M.D., orthopaedic surgery: "A ‘best doctor' is one who is removed of hubris, who avoids the comfort zone and who strives to continually educate patients, and self, about injury and disease."

Jeffrey Teckman, M.D., pediatrics: "When you respect the intellect, are comfortable with the manner, and sense the heart of compassion you know you've got a ‘Best Doctor.'"

Anthony J. Scalzo, M.D., pediatrics: "We take a sacred oath upon becoming physicians and should never lose sight of what is really important, the health of individual patients, their physical, emotional and spiritual needs and those of their family and loved ones. If one's compass heading is set on doing your very best to heal all of these aspects of human health, then you will achieve best practice and always do what is right for the patient."

Dee Anna Glaser, M.D., dermatology: "I believe that you should treat your patients in the same way that you would want your own family treated. If you have done that, you have done the best you possibly could!"

Bill Sasser, M.D., cardiothoracic surgery: "Be prepared to give your best, always. Sometimes it is hard to be happy, but it is never acceptable to be rude. Let the patient know that you are human. Tell them stories about your life and family. Laugh every now and then."

Tim Rice, M.D., general internal medicine and pediatrics: "Great doctors are good communicators. They have the ability to listen to and understand their patient's concerns, and help them understand their condition. Great doctors care about their patients and people in need and are willing to help in anyway they can, whether the patient is sitting in their office or half a world away."

***

To me, the best answer goes to this:

Lisa Cannada, M.D., orthopaedic surgery: "My golden rule is ‘always treat the patients as if they are your family members.' Make sure you are available to answer questions and that they understand the answers."

Have you been a good doctor yet? :)

Enjoying New Life in Ngrambe, Ngawi

How are you dear readers? :D

It's good to be back again! After a week spent in city of Ngawi, we finally moved out to one of the village named Ngrambe, which located about one hour journey by car from the town. 

We have been already working in Puskesmas Ngrambe for (more than) 3 weeks. So far I can enjoy the new atmosphere I have to adapt. The people here are very friendly and nice. Hope I will be able to make new friends here!

One day, I had a chance to attend DDTK (Deteksi Dini Tumbuh Kembang) which held in dusun Manisharjo.  I was lucky to have time playing with kids, and I loved to take photos of them, they're incredibly photogenic! The midwives and kader were kiiiiiiinnnddd, and when it's finished and we were about going home, they offered us durian. Yum! I have eaten five pongge (okay, I'm ready to blame) until my partner, Mas Ari, said "Yesterday, when I was on my shift at emergency room, I got a patient with heart attack after eating big packages of durian. You must be careful then." I stopped chewing and soon after we arrived in puskesmas (health center), I asked friend to measure my blood pressure. Thank God it showed 100/70, I was afraid I got sudden hypertension attack et causa eating too much durian. Phew. Anyway, look how cute the kids my digital camera caught! They're effin' adorable! 

And today, we held health seminar about HIV-AIDS to barbers who works in Ngrambe. It went well, the audience kept paying attention to what we presented, and the crowd was gooood. Next, another same-themed seminar in Balai Desa. Yosh! 

The post won't be complete without me telling you the culinary track here. Here are some of my fave. No more sushi, no pizza, no friend chicken, but I enjoy the food which tastes delicious. Yet, nothing can beat my mom's cook :p

Most Favorite! Since I am a noodle lover, I acclaimed this is the best noodle in town, eh, village!

Bakso Bakar, suitable for your afternoon snack. :p

And this!! I made Abon Ayam on sunny Sunday with Ibu Kost. She's very good at cooking!

That's enough for this post. Gonna update soon! Wish me not to be homesick and be able to stay strong living separated from home, please. Thank you for stopping by! See ya!