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Sunday, January 31, 2010

Autopsy

We would have to observe and assist (whenever possible) at least 4 autopsies throughout our phase 3b (i.e. final year). This is part of our syllabus under the department of Pathology, of which the posting is integrated with other postings throughout the year. Yesterday, I went to the mortuary to observe an autopsy. I made a call to the mortuary prior and I was told that there is a case pending. So I decided to come and wait.

As I arrived to the mortuary, I saw a crowd of people waiting at the entrance. As I approached closer to the crowd to get myself through into the morgue, I noticed that they are all Indonesian migrants and spoke Bahasa Indonesia with some Javanese dialect. Then I saw a police officer in plain cloth interviewing a young Indonesian man surrounded by several other relatives who helped the interview as that boy was not very fluent with Bahasa Melayu.

I just noticed how close they are among themselves, being such a close-knit community. I don't know whether all Indonesians are like that, but perhaps it's because they are immigrants. So they stick together so that they can take care of themselves in the foreign country. Or perhaps the deceased was a very kind and generous person. Maybe he was respected leader among the immigrants there.

The autopsy had already started, it seemed that I was a little bit too late. The door was locked. So I went back to my room empty handed.

I've been to the mortuary before & observed an autopsy. It was a Bangladeshi immigrant whose death was classified by the police as sudden death. Initial autopsy was rather inconclusive as there were not much finding upon gross examination. Hence, samples were sent to the lab for further investigation and study. Whole body was examined, including the brain, the abdomen, the lungs, and anything between them. Samples of gastric content was also aspirated for toxicology. The skull was cut open and the brain was dissected. So did the heart, the kidneys, liver, and lungs.

After observing the autopsy, I realized how painful it could be for the deceased. Muslim scholars differ in their opinion regarding the autopsy. I don't want to further elaborate upon this, so for those (especially the Muslims) who are interested to know more please refer to the respective sources. What bothers me the most is the fact that all the organs that have been examined were put into a plastic bag & then tucked inside the abdomen. Brain included. The skull? It was filled with cotton & stitched back.

I don't know what's your opinion regarding this issue, but I really hope that my dead body will never have to undergo such horrible experience. In fact, I think I would write specifically about this in my will. Even if it means that the culprit will get away with their crime (if only I might be murdered in future - God forbid). I also don't have insurance policy, so I don't think an autopsy would be necessary for me.

Ok, that's about it for today. Need to continue studying.

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Reminder to myself: Update the notes that I scribbled throughout this posting into a proper book that I have prepared for the exam.

Growth Study Project

"ape ek indication for IOL... senaraikan byk2"

That's the message that I received from a friend via YM. I was quite surprised when she suddenly asked me that question. After exchanging few messages about the indications for IOL (induction of labor), she continued asking,

"n also ape indication for EMLSCS"

Eh, why all the sudden she asked me these questions? I'm not in O&G posting right now, neither is she. Revision, maybe? Soon after, I realized that she was struggling to finish her Baby Growth Study Project report. But wait, aren't we supposed to observe the growth of a normal child for the project? Then she told me that she wasn't aware of that. The baby that she took for the project was born via emergency lower segment caesarean section (EMLSCS). No wonder she was asking all those questions so that she can put them in the report for the discussion part. Then I asked her how is she going to find the proper baby within this short period of time? The project was supposed to be submitted 4 weeks prior to final exam, meaning that only 3 weeks left from the time this post is written.

"ok... dah convert dah jadi SVD"

erk... "^_^

How convenient it is. I'm not mentioning any name here. But I really hope that she would not do anything like this anymore in the future. As for this time, I think there's nothing much can be done, since the time is really running short. Perhaps I would have to 'close one eye' (pejam sebelah mata) for this time.

Me? Honestly, I never met the mother after the initial meeting at the maternity ward. But I do make some phone calls to ask for the baby's update from time to time. It's not that I don't want to meet her, it's just that we could not fix a time for appointment. She worked based on shift in a factory in Shah Alam. Whenever I was free, she wasn't available and vice versa. Apart from that, another major problem is that both of us don't have our own vehicle and we have to rely heavily on public transportation. I have already obtained most of the information required for the report, but I still don't have the picture of the baby. I have to meet her somehow. At least once. So that I can show my gratitude for her willingness to get involved in this project. Perhaps I should bring along some presents to her baby. So, I would have to ask another friend of mine to do me a favor, by giving me a ride to her home. In return, I would accompany him to meet the baby of his study project.

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Indication for Induction of Labor (always consider Maternal and Fetal factor. Sometimes paternal factor if relevant. lol)

Maternal factors
  1. Pregnancy-induced Hypertension or worse, impending eclampsia
  2. Maternal medical problem
  3. Premature rupture of membrane
  4. Chorioamnionitis
  5. Prolonged second stage of labor
Fetal factors
  1. Fetal distress
  2. Postdatism (>40 weeks)
  3. Intrauterine death (fetal demise)
  4. Chorioamnionitis

Indications for emergency LSCS (considered as emergency when the labor has already took place) .

Maternal factors: life threatening events such as:
  1. Massive blood loss
  2. Surge of blood pressure
Fetal factors:
  1. Fetal distress (may presented with meconium stained liquor)
  2. Cord presentation
p.s. This is based on my memory, should there be any mistake, please leave your comment so that I can make some corrections if any. Thank you in advance.

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Reminder for Myself: Sleep early tonight as you have to be in ward at 6.30 a.m. to cover one new admission. Don't forget to revise on the Mood Disorder topic tomorrow.



50 Days to go

Yep. 50 days before the final MBBS examination. Yet some of you might wonder why on earth do I still have the luxury of time to create this blog? Well, on the contrary, actually my time is running out. With a whole lot of topics to be covered, as well as revisions for previous postings, and numerous case write ups and reports, I believe that I should somehow struggle to the limit so that I can catch up with my studies. But I don't think 5.45 p.m. is the perfect time for study, neither it suits for writing the case write ups etc. My brain needs a rest after hours of on call and interview with psychiatric patients today. Hence, the birth of this blog.

Actually this is not the first blog. I have another blog, but haven't updated it for quite some time. Yet the reason for this new blog is that it focused more on my studies, my life as a medical student and beyond. Hopefully I will pass this coming final exam and able to graduate after 5 years of study (read: torture). hehe.

This blog is meant for personal purpose, sharing my feelings and thoughts as a medical student, soon as house officer and beyond. Hence, all of its contents are meant for personal use and do not represent any organizations or authorities unless otherwise specified.

I will try my best to keep this blog updated on daily basis, unless there is some kind of emergency or if I were occupied with other commitments. Please take note that English is not my native tongue, hence please excuse my terrible English. Thank you for visiting and feel free to drop your comments (be it compliment or criticism).

p.s. I choose to remain semi-anonymous for this blog. Which means that I'm not that particular in keeping my identity secret. Yet I prefer that you respect the boundaries. Thank you.

Reminder to myself: Call the ward for any new admission. And update on the vital signs and progression of the 'transfer-in' patient that I've clerked just now.