Dreamer’s Journals

Stase anak di Tangerang itu CAPEEEEEEEEEKKK…emang udah seminggu sejak gue dari sana sih, tapi baru skarang aja gue pengen cerita hehehe…tangerang itu di bagian anak cumkan seminggu, dan kita dibagi dalam dua paviliun, paviliun anyelir (kelas VIP, 1, 2, 3) dan Paviliun Kemuning (kelas 3 only, plus satu yang semi di-ICU-kan), nah seperti apa kedua paviliun itu, bakal gue ceritain skalian dengan pengalaman pa gue disono

hari pertama sampe hari ketiga gue kebagian di Anyelir..Suasananya enak, ruangannya bersih dan bagus, pake AC dan kita punya ruang diskusi dimana privacy kita para ko-as terjamin, baik dari pasien maupun perawat..Errr..sebenernya, perawat disini rata2 baik, dan segalak apapun mreka, toh kita gak terlalu banyak brurusan sama mereka dalam hal kerjaan utama kita yaitu Followup..TAPIIII..ada satu suster BRENGSEK yang berbicara sama koas kayak bicara sama maling yang ketangkep basah di rumahnya, kayak kita orang bersalah, bentak kiri-kanan…yaah, harusnya sih itu udah biasa ditelinga kita, karena kita juga tau kok watak2 suster di RS pemerintah, JARANG YANG RAmAH!!!makanya pasien juga gak betah..SAYANGNYA die melakukan kesalahan, yaitu die membentak2 GUE..dan gue gak terima dibentak2, masak sekolah dokter tahun kelima, udah gelar drs. Med masih dibikin kayak sampah ama suster..pertama gue cuek, gue tinggal, masuk ruang diskusi, tapi setelah gue duduk..tiba-tiba HATI RASANYA TIDAK SENANG!!jadilah gue samperin balik si suster dan bentak2 habis juga, diakhiri dengan "KALO NGOMONG JANGAN KURANG AJAR!!" dan Bantingan pintu ruang diskusi pas gue ninggalin tuh mbak suster..Semenjak itu, gak pernah die brani walaupun cuman sekedar ngomong ke anak2 koas, dan lucunya hari selasa dan rabu gue bahkan gak liat tampangnya..kayanya kali ini die kena batu

Okey, cukup tentng suster itu..hari2 brikutnya disana dilanjutkan dengan ronde, dan rondenya tuh NGAREEEEET banget..Jam 1 baru mulai, so kita paginya bermalas2an juga gapapa hehe..ronde pertama n ketiga dokter anaknya sangan KINCLONK!!!kalung segede-gede gaban kayak orang gipsi, dandan poles dempul, badan kayak ibu2 gendut tapi pake kaos ketat dan celana banjir..rondenya ANEEEEH skali..die ngasih terapi tuh kaya gak liat status, lebih mirip orang jualan obat dengan merk-merk obat beterbangan dari mulutnya..tapi yah, disamping itu, die punya satu nilai plus, yaitu die pinter!!dan cukup baik karena mau ngajarin kita, terutama dalam hal pola pikir2…yaah…dokter yang agak dilematis

Dokter yang ronde dihari kedua sangaaat berbeda jauh, baik rondenya maupun dokternya memiliki style yang sangat kita kenal seperti ronde di RSCM..dan die juga sangat baik, memperhatikan status n kerjaan kita, ngajarin kita satu2..salut juga buat dokter ini..

Hari ke 4 kita udah mulai switch ke kemuning…dan disini, segala2nya beda…kerjaan kita bakal lebih berarti karena PPDS sangat memperhatikan status bikinan kita, dan SANGAT CAPEEEEEK..bayangin, PPDSnya itu mau ronde pagi2 jem 7 - 1/2 8..so what did I do??..malem jm 11 gue ke bangsal bikin draft follow up pasien gue buat besok pagi, biasanya selesai jm setengah satu..terus tidur, n paginya jem 5 gue udah harus mulai follow up, so pas PPDSnya dateng kerjaan udah selesai..bener2 parah, untungnya karena mulainya pagi, selesainya juga cepet, so banyak waktu tidur siang *Fiuuuhhh…

Di kemuning ini sialnya adalah, gue dapet kamar 1, yang paling deket dengan kamar kerja, dan karena posisinya yang strategis, kamar itu diisi oleh pasien2 yang GAWAT!!!biar gampang diawasi..so agak di-ICU-kan (Intensive Care Unit)..jadilah kasus2nya tuh pengobatanya banyak yang "beyond my reach"..nulisin obat yang dikasih aja udah panjang banget..untung  kerjaan gue masih lancar2 aja…

and actualy there is this one patient that has a very complicted matters..a boy, 4 ang a half years old, weight 11 Kg, has been attended to RSUT since last week with working diagnosis meningoensefalitis TB refering to his LCS study (BTW I’m the one who perform his lumbal punture, V^______^V ), his GCS (Glasgow Coma Scale - conciousness score) is 8 (the range is 3-16, normal ppl should have 16 GCS), complicated with a severe fever 40o celcius (almost Hiperpireksia - 41,1o C), hiperventilated, and tachycardia..in short, he has meningoensefalitis TB with Sepsis..this one pasient really frustrated me..his fever wont heal, and he keeps shaking, despite 3 kinds of antipiretic agent has been administer in a relatively high dose and frequency…(Novalgin, Parasetamol po, and Ibuprofen supp)..he got 2 kinds of antibiotics..and i don’t know what else can be done..warm compress has also been performed, but his whole body is as hot as a toaster..i handled this patient 2 days with this condition..and at the third day, the worst happen..his extrimities are cold, his Blood presure is droping, he became more and more hiperventilated, despite of his cold legs and arms..his torso is still like a toaster..He is going into a septic shock condition..so we administer dopamin and dobutamin to support his cardiovascular and renal function, and load him with Normal salin to keep his hydration status adequate..whats worst, his breath start to weakening..so from 7.30, i Pump his breath with a bagging tools..do it for almost two hours..luckily soon  my friends job are finish and they can replace me for a while..this patient is supose to be at ICU, but there is no room..so there is nothing we can do accept maintaining his heart and lung function…at noon, pass my working time, which by then he is handled by my friends..he passed away..well..no regrets..his conditions are worst and we have done everythings possible..i guess we never leave tangerang without the scent of the dead..hehehe

Last nite i’ve just watch grey’s anatomy with my sister..4 first episode..I decided to try to watch it coz many of my fellow med-student says its a good TV series, and i thuoght "Hei, i’m a 5th years med-student, perhaps watching it may serve me some good purpose"..so now i’m gennao give some of my early comments..both about the medecine technicly and the "film" aspect" of it..Well, perhaps 4 episode its to early to judge the whole content of the movie, but who said i was gonna..

so here it is..

The Film it self is quite good..not VERY good, just QUITE..i like the part where it can realy describe how live is as an intern..its a TORTUROUS!!!48 hours without sleep..eat junck food..enslaved by your senior who act like a boss..doing silly things like taking and organizing the lab result..always run to the scene everytime ur pager is beeping, and sometimes for a silly reason..Missed your own party when everyone is having fun at your house, and u cannot make it home coz you are stuck at the horpital for some CITO (emergency) operation..got alittle bit "kuper" coz in a week, the only ppl u see is those who work with u at the hospital..but u can’t say a thing about the slavery coz they (the resident doctors) actualy kinda decided your live and dead at the hospital..they taught u, work with you, recommended u for promotion..and they expect hard work!!

The only downside of this movie, sometimes i think, it need just aliiiitle thrill..coz at some points, it can be boring..and its not good for a series

Now we move on to the TECHNICAL aspect!!!at the first episode, they got a case..a girl, 15 years old, having a "grand mall"siezures..(i actualy forgot whats the grand mall stands for) with no history of trauma "yet" to be found..brought with a helycopter (I WISH WE HAD ONE AT RSCM!!!!) and directly send to the surgical division..wait a minute..WHAT ON EARTH IS SHE DOING IN SURGICAL DIVISION..normaly SHE IS SUPOSE TO BE AT PEDIATRICS DIVISION..the pediatricians will be the one who handeled the patients, thinking about the diagnosis, and decided what to do with her..if any surgical treatments are needed, then she will be consulted to the the surgeon, and will be transfer is the case is turn out to be a surgeons case..NEXT,,having a siezure they give him 10 mg intramuscular injection of diazepams..my question is, WHY INTRAMUSCULAR??it supose tobe INTRAVASCULAR, and if u can’t get into the iv line (intravenous line) u gave her rectal diazepam..NEXT..she is attended for siezures with no history of trauma or fever, and they decided to run CT scan..HELOO!!! she should be runing EEG test, the Working Diagnosis of this case should be Epileptic siezures..why the hell is CT scan is the first in their head..Okey, lets move on again shall we..the CT is proved to be just fine, so does the blood test, but she is still having siezures..after a carefull history taking, it is then known that she is a dancer (actualy somthing starts with "P", but i forgot what is it, so i just call her dancer) and had a history of a minor trauma while training (not right before the siezures), but no complains and she was doing just fine..so they thought with any chance, she is having as intracranial hemorage, and so decided to run a CT angiography..and yes!!they are right, congrats..she is have a minor subarachniod hemorage..and has to be operated..BUT!!!if she realy having a subarachnoid hemorage, then the first CT-SCAN alone should have got it!!but the first CT is clean..i dont get it whose fault is this, perhaps they got one lame radiologist reading the CT-scan and can’t identify a subarachniod hemorage with a CT-scan alone..

Okey, and the last thing is..for commoners, if u watch a scene where there is a patient with a flat electrocardiogram (ECG), and they start to cast some "LIGHTING BOLT SPELL" right to the patients chest..i’ll tell u, its BULLSHIT!!!..Defibrilator (the lighting bolt spell) is used only in two cases, VF(ventricular fibrilation) or VT(ventricular tachycardia) ECG, not on flat (asystole) ECG..if flat ECG is what u get, then u should resusitate the heart and lung and administer some shympatomimetic agents (i’m not going into details, there is a protocol for this situation alone)..U DON’T cast LIGHTING BOLT..its a waste of mana..err..wrong..a waste of force power..err wrong again, i played to may games lately

okey..thats for the comments..

Its now sundays, there is a Kyokushinkai karate tournament held at binus, and i’m planin to watch it with my fellow martialist.. a full contact bare hands fighting, that is something, hehehe ;D

Ooo..and atlast..THiS COMPUTER IS WELL FIXED!!!U don’t know what kind of misery i have, with this computer keep erroring all the time..but now its all good, so i’ll reborrow the KOTOR Starwars CDs from bertus and reinstall it, and play..long live the sithlo….err no REPUBLIC!!!!!HAHAHAHAHA

and BTW, i just got a SWEEEEEEEEEEETTT surprise from my recently recieve e-mail..Its a strawberry..and "only one"…and it makes me  ^_______________________________^

Love - devotion
Feeling - emotion

The return to innocence