today was such an exciting day! met up with prof chen in the afternoon, at abt 1. he wanted to meet up with his mentees. and i'm quite glad he's our mentor cause he's one of the few who mentors actually bother to meet up with his students. heard a few tutors haven't even met up with their charges.

but i think i'm rather blessed to have him as my tutor. very proactive. which is good.

went to icu today and we looked briefly at 3 cases. and 1 of the patients was VERY sick. insanely low bp, venous pressure abt 25, and etcetc. heard the mos mention he prob will not make it... sad. then the other guy was a sad case too. quite young, but fell from the lorry. in icu for 3 weeks already. bumped his head amongst other injuries. very large swelling on his head lor. and his respiration was abnormal. it was something like the respiratory disease ho ting fei mentioned in her tut. oh yar, just recalled, it's the adult respiratory distress syndrome his o2 sat was low, i think abt 86%, can't remember what else was abnormal. ph was normal. but he was put on respirator. sad case. and prof was commenting to us a bit on management of the intensive care dept too. he's head of anaesthesia, so they're incharge of all the ots and icus. and apparently there's a lot more to it, esp abt cost management and profit margins and all tt. really. he was telling us tt the icus have only 19 beds, but take up 1/5 of the hospital's budget. nuh has abt 900 beds. and also abt how he's supposed to ensure tt the ots have at least 85% occupancy rate. cause each cost abt $1000000 to build, and they must make sure it's sufficiently utilised to recoup the cost. interesting arr. there's so much econs in being a doctor.

and we learnt to read a bit of the ecg too. and of course pak ling the GENIUS answered most of the qns. :)

oh, and found out some interesting facts. ho ting fei was from anaesthesia dept in nuh too. she's an anaesthetist. and prof raj was a clinical tutor for surgery, he taught prof chen. and he was saying tt raj was a very good tutor even back then. amazing. how old's tt man already. still looks at most 50.

then afterwards he invited us to go to the ots with him. v interesting. but it was like qian(1) zai(3) nan(2) feng(2). cause only can bring 2 pple into the ots, so only amy and i went. stella was v nice to let us have a go first. so she and pakling went off first. hope they'll go next time. :)

and it was my first time changing into a ot suit. complete with all the funny rubber boots and all.

but we saw part of 2 operations and stood through 1 full skull op. the 2 partial ones were a coronary bypass and the other was another skull surgery - the guy had part of his skull removed in a previous op, but no replacement was put in... don't noe how/why also, cause when we went in, the op was ending already. they were stitching the guy up. heard from a medical student attatchee there tt they just placed a titanium 'skull' in there. but we watched prof chen revive the guy from ga. quite interesting. seeing him give the muscle-excitatory medcine and stop the ventilator and start manual assisted ventilation and wacking the patient on the shoulders to wake him up after the [anaesthetic] has dropped till <0.1, and sucking out salivary secretions and all tt. real eye-opener. and he explained to us alot of physio behind it too.

and 1 interesting thing to note was how the anaesthetic affected the pulse, bp, both at the start of the op and during the resuscitation. and also the measures taken by the anaesthetist to regulate and mantain bp (esp) and pulse. and different things can be used to inc bp. what was used was saline and human albumin (which is supposed to be insanely exp) to raise bp. prof chen mentioned there are alot of other substances tt can be choson as well, but it all depends on the type of op; original anaesthetic used, and of course alot of other factors lar which i cannot remember.

the other 'part' surgey was a coronary bypass. they used the gsv, which is what we've learnt in lecture, but to see it some real is so different. and the smell of burning tissue when they used the cautheter was so gross. but not much from this cause we had to move on to another ot as the case for another head surgery was coming into another ot and prof chen was the anaesthetist for tt op.

and the smell here was worse when they started drilling the skull to get 2 holes at both anterolateral points of the frontal skull bone. and the fluid tt came out was yellowish. gross. and spurted a little when it came out. but was wondering how the fluid got there in the first place, and how would this 1-time draining help at all? wouldn't the fluid accumulate again? prof chen told us tt it's probably due to trauma at first whcih caused a clot, and when the clot was lysed the fluid was left. and 1 other v interesting pt was tt the neurosurgeon was stressing again and again to prof chen to confirm tt no nitrous oxide was given. explaination given by prof was tt in ops tt cause a air space to be left after the gap is closed, like in this cranial surgery, diffusion of no into the air space is greater than it diffusing out. which means pressure will buildup after the space is sealed and the brain will be compressed again. very bad. and i think nitrous oxide is one of the regulatory substances. doesn't take a genius guess though. don't know for excitatory or otherwise.

interesting no?

and amy helped to insert an intravenous plug today. i didn't do anything though. too scared. :) maybe only help to squeeze the saline pack to force extra saline into his cvs to increase venous return to up his pressure when his pressure fell to abt 80. oh. and prof played with us some electical stimulation thing. he was stimulating my ulna. and it felt so weird. amy tried it too. :)

yes, before i forget, want to add tt the nurses were HORRIBLE. haven't seen more unpleasant people in my life. and it's not stress, cause they only talk in tt manner to housemen and medical students. idiot. esp this malay nurse. super irritated at her. and her makeup was so thick too, anyway. but tt's a sideline. thinking of charging her for insubordination. would if she was a medical orderly and if i was comissioned already.

when i left nuh, i was SO gratified. although didn't end up studying for the day, i think the time was well spent. was thinking of asking prof if we could tag along more often, maybe once a month or something. oh. and he discovered tt i was a saf doctor today. and he's quite good, managed to make me feel quite lousy abt signing on. haha. :)

rushed off to church after tt though. was v rush. left at 1800, had a meeting at 1830. needless to say didn't make it lar. reached suntec only at 1900 odd.

*yawn* legs are quite sore from standing for so long today... better sleep now. so late liaoz. goodnight!