SLEEPLESS NIGHTS

Assalamualaikum...

Alhamdulillah, segala pujian kepada Allah SWT kerana memberi peluang untuk menulis blog hari ni... dan selawat dan salam buat junjungan Nabi Muhammad pembuka bicara... :)

Arteriovenous Malformation
Semalam kerja petang, that is from 3pm-10pm. Dalam pukul 9pm, there was a case...

19years old, Malay, man came with initial diagnosis of Prolonged Fever. The patient could't talk himself. He was drowsy and really not talking at all. I was quite scared!

What is going on with this young man???

So, called up the father... Upon asking, "Dia demam 2 hari. Batuk selsema. Demam biasa. Maghrib tadi pakcik kejutkan dia, dia bangun, tapi macam tak sedar. Tak boleh cakap." I asked whether had this happened before, he said No. Then, did he had any "nyetok" (sawan), he said No and No history of trauma...

What is going on???

So, I examined him... Called up his name. He woke up but he couldn't talk. He was just making sounds that it sounded like baby talk... So, I tried to ask him if he can lift his hands, his legs... Yup, he could do that... Obeying to my command... But his power of all his limbs, tangan dengan kaki keempat-empatnya, memang reduce power. Dia boleh angkat sahaja, tapi bila kita try resist, dia tak boleh... His reflexes (the thing doctor does when we hit the knee, and suddenlt the knee goes up) were all normal. His pupils were both reactive. GCS of 11/15.

Help me!!!

So, i asked my senior regarding this patient. I couldn't make up what was the diagnosis... So, he examined the patient again... he agreed with my findings... then, he looked at the patient's face. It looked like the face was asymmetrical. His mouth deviated to the left side, loss of the right nasolabial fold, and he couldn't really open his eyes...

So, my senior made the diagnosis that the patient had
LEFT CEREBROVASCULAR ACCIDENT TO RULE OUT ARTERIOVENOUS MALFORMATION.
It meant, patient had left sided stroke in the brain and maybe there was an abnormal artery-vein in his brain that is causing the problem. Arteriovenous Malformation happened in people when they fetuses... But at the age of teenagers, the risk of it getting bigger and rupture is very high, that what I understood from my senior...

What should we do?

The patient needed an urgent CT-Scan of the brain, because, if the vessel in the brain ruptured and needed surgical intervention, then we had to send the patient to HUSM bcoz there's no neurosurgeon at our hospital... So, I was also called into the CT-Scan room and the radiologist oncall showed me that there was LEFT MIDDLE CEREBRAL ARTERY RUPTURED ANEURYSM. That really made me chilling and shaking... It meant that the patient had a big artery called left middle cerebral artery and ruptured already. That's why he couldn't speak properly...

What should I tell the family?

I told my senior regarding the CT-Scan findings, then he said the patient needed to be send from Yellow Zone to Red Zone and I have to call Medical MO Oncall. So, first I had to tell the family first... his father was already crying in front of me...

"Pakcik, jangan risau sangat. Lepas scan tadi, memang nampak ada pendarahan dalam otak anak pakcik. Tu lah dia tak boleh nak cakap. Sekarang, anak pakcik kena tolak ke Zon Merah untuk pemerhatian yang lebih dekat. Nanti saya akan cakap dengan doktor perubatan. Doktor perubatan tu mungkin akan hantar anak pakcik ke HUSM sebab kat sini, pakar otak takde. Nanti dia akan jumpa dengan anak pakcik. Lepas tu dia akan bagitau perkembangan seterusnya tentang anak pakcik, ok?"

Anak2 Pakcik yang lain ada kat situ cakap diorang faham. Tapi, Pakcik... he was holding back his tears...

It was already 10pm. The people for night shift were already there, and my husband was already waiting for me... But I had to call and let Medical MO know about this patient. So, after a while, Medical MO called and after I told him, I went back.... My husband asked,
"Busy ke?" Then, I started telling my story....He said,
"Kan best duduk A&E? Kes2 yang jarang2 jumpa boleh jumpa kat sini? Abang pun tak pernah jumpa kes macam tu."

I couldn't sleep last night... Thinking, my senior was so good at making the diagnosis... If I was alone, I really didn't know what to do.... Really....

Thanks Allah for this great opputunity to learn!!!!


D'VILLAGE
After work, my husband didn't have his dinner yet and I didn't cook yesterday bcoz I was having diarrhea... So, we went to this famous place near HUSM and ate Nasi Kukus. I was very delicious but I was too tired to eat. But the drink... Fresh Orange Juice was good! :) It reminded me the place where we always went when we were in Melaka... Salam Sayang ke??? Tak ingat dah nama tempat tu. Ala... Yang gelas air jus dia besar macam jag! hehe...

NEARLY 3 MONTHS
Yup... The baby inside me is getting older each day and next Monday, he/she's going to be 3 months old... :) My husband dreamt that we had twin, a girl and a boy... So, he decided that next visit to ONG Clinic, we ought to do another ultrasound scan to reconfirm it again... hehe.

Well, actually when my sister-in-law was pregnant, when she went to do the 1st ultrasound scan, my brother saw another sac and he asked the doctor what was that... The doctor couldn't tell him. When they did another scan few months later, they saw there were 2 heart beating... hehe...

You never know, since Ayah said, "Ayah ingat semua keturunan Ayah akan dapat twin." hehe

Night shift tonight and tomorrow night... Takut.... :( Doa sokmo...