Anesthesia oh..anesthesia

Wew.. last month I’d just written once.. that was the worst record I ever had.

It’s all because of anesthesia, which said it was a relaxed stage, but I got really busy n tired there, until I had not read the book until the 3^rd week.

How come?

Daily activity in anesthesia was in the surgery room until at 2.00 pm, where I think there were no much advantages for us to be general medicine. We won’t be permitted to anesthetize patient, right?

What we have to know in anesthesia is how to handling emergency patient, liquid resuscitation, analgesic drugs, etc. and we got about that if the resident gave the tutorial when the operation was went on.

Unfortunately, I included who seldom got the tutorial in the surgery room, so until 3^rd week I still didn’t know much about anesthesia. So I had to borrow my friend’s notes that got many tutorials.

The official tutorial by resident always held after 2.00 pm, so we very often go home at evening moreover the schedule to stay at Kariadi Hospital that also exhausting. Huh..

The unforgettable moment was when I saw patient with “ventricle tachicardy” from fully conscious then gasping until she had cardiac arrest and died, the process last less then 10 minutes. That remind us how big secret of life and die in this world.. Jesus you are my savior..

However, that’s all finished. I got examination with dr.Danu, Sp.An. Hope I got the best I could.. hehe..

Happy Easter…

Examination with dr.Pramanawati

This time I wanna share my exam story in eye department..

First I had pretest in Wednesday 25^th March 2009 that was a case with some question..

My case was Steroid induced cataract that has characteristic posterior pole cataract.

There was gossip that you must not get the highest score in the pretest cause it will make you got hard examiner like dr.Pramanawati or dr.Norma..

But I don’t care with that all, why should I “decrease” my point if I could get higher??

However, I got dr.Pramanawati,Sp.M as my examiner.. I don’t know it’s because my high mark or just a damned original unlucky drawing.. I assumed and hope that it’s for the first one, because it can be an addition for my final mark (until I write this I still don’t know how my final mark..hehee..)

There’s no share book or “buku Curhat” in eye department so I this is the story examination with dr.Pramanawati and I will write story below in Indonesian..hehe..

##….senin 30 maret 2009 saya dan mbak Husna mulai nyari pasien di poliklinik mata dan dapet kasus katarak sekitar pukul 10.30. (kasus ujian katanya katarak mulu ya…bosen juga..hehe..) lalu dikasi tau pembimbing dr.Wijayaningrum kalo ujian diundur hari rabo jam 11, jadi hari itu bikin status pasien dengan agak santai sambil mikir2 gimana supaya ga banyak keanehan pada statusnya..heehe..

and tibalah pada saat yang mendebarkan, rabo jam 11.00 dr.Pram dateng tepat waktu and langsung nanyain sapa yang ujian dengan beliau disuruh langsung masuk…waaa…

kami disuruh membacakan resume kasusnya..lalu mulailah beliau bertanya:

P: dr.Pram H: Husna R: Ronald

P: apa itu iris shadow and bagaimana cara periksanya?

R: bla…blaa…bla… (tau lah nih)

P: kenapa bisa ada iris shadow

R: karena ada kekeruhan di lensa dok..

P: itu baru terlihat kalo kekeruhannya sudah cukup banyak.. pada pasien mu ini visus nya saja masih 6/10 sama 6/8.5 jadi saya rasa belum terlihat iris shadow nya, kalo tidak ada ya tidak usah maksa harus ada!

R: (Uppsss….ketauan dah..emang kami ga periksa kok..heheh..) iya dok..

P: Lalu fundus reflek bagaimana memeriksanya?

H: bla..blaa..bla…

P: di satusmu “kekeruhan tidak ikut bergerak ketika bola mata bergerak” maksudnya gimana?

H: kekeruhannya ada di sentral lensa dok.

P: ya saya rasa ga mungkin juga kalo tidak bergerak sama skali ya…pasti ada lah ya geraknya..

H & P : iya dok (hadoh…cara ngliatnya ikut bergerak apa ga aja bingung…hehehe..)

P: gambaran kekeruhan pada FR seperti apa?

R: seperti bercak kehitaman dok

P: kenapa?

R: hmmm…karena reflek dari fundus nya jadi tidak jelas dok

P: ya..karena bercaknya menghalangi pantulan dari fundusnya.. kalo pada oblique illumination kekeruhan seperti apa?

R: seperti bercak keputihan dok..

P: knapa?

R: yaa…karena dilihat langsung dari depan dok..

P: ya..karena dilihat langsung dari depan jadi terlihat keputihan. Kalau kekeruhan sudah menyeluruh seperti apa?

H: terlihat putih pada seluruh lensa yang terlihat seperti mutiara dok..

P: lalu apa bedanya dengan katarak juvenil dan katarak kongenital?

H: usianya dok?

P: bukan…gambarannya yang kamu lihat kalo sama2 putih smua lalu apa bedanya pada katarak2 itu??

H & P: ( silent,..ga ngerti..)….

P: ya udah, pr ya, nanti dicari.. katarak juvenil tu penyebabnya apa?

H: bisa karena uveitis, trauma, ..

P: bukan..bukan.. yang benar2 murni juvenil..

R: ehmmm karna myopia tinggi dok??

P: ya…boleh…trus apa lagi?

H: diabetes dok?

P: nah..itu yang penting…gambarannya seperti apa?

H: snow flake dok..

P: ya..itu tidak selalu muncul sih.. ya sudah skarang bagaimana kalo kita mencurigai itu katarak traumatika?

R: (udah nyebutin voscius ring, iris tremulans, subluksasi/luksasi lensa, n hifema)

P: bukan…bukan… kalo itu kan sudah jelas,. Skarang kalo matanya tenang, gimana kita curiga kalo itu karna trauma.

R: errr… (setelah mikir lama). Kalo kataraknya pada satu mata saja dok??

P: iya.itu dia..kalo pada satu mata saja, harus curiga karna trauma.. kalo katarak yang tidak berkembang, tiap kontrol ya segitu-segitu saja, tu jenis yang mana?

R: (apalagi ini..lom pernah denger…Silent again…)

P: ya udah pr lagi ya…trus kalo operasi katarak komplikasinya apa saja?

H: bla.bla…bla…(salah satunya nyebut iridosiklitis)

P: bagaimana gejalanya kalo iridosiklitis yang bisa ketahuan waktu kontrol post op?

H: mata merah..

P: bukan..kan abis operasi ya mesti matanya merah to ya,.

R: fotofobia dok..

P: nah itu dia…kalo orang nya waktu kontrol merasa silau harus curiga iridosiklitis dan diperiksa slit lamp untuk periksa kekeruhan COA nya.. lalu untuk mencegah iridosiklitis dengan apa?

R: midriatikum dok.

P: yang mana yang kamu pilih?

R: mungkin yang sulfas atropin dong, karna long acting

P: ya nggak,,. Kalo kamu kasi SA, malah IOL nya lepas nanti, karna dengan SA pupil midriasis sangat lebar,jadi pakai yang short acting aja.. lalu diberi apa lagi?

H: kortikosteroid dok

P: (intinya beliau crita kalau pake kortikosteroid harus hati-hati karna banyak efek samping dan kontraindikasinya, disuruh nyari n dibikin tugas juga) ya udah..hari ini cukup dulu dilanjutkan besok jam 9.30 ya..

…..keesokan harinya, kami berdua ujian lagi, tapi cuma bahas tentang tugasnya aja.. ternyata jawaban untuk tugas yang pertama adalah kalo katarak kongenital tu karena masih cair sehingga terlihat seperti susu, sedangkan katarak juvenil terlihat seperti bubur, kalau katarak senilis seperti mutiara. Lalu untuk katarak yang nonprogresif itu adalah katarak di kapsul posterior. ###

Yeah…it is the review of my exam with dr.Pramanawati,Sp.M, overall she is very kind, not like the gossip that she is terrifying, hope it can help and inspire the next student who will exam with same examiner.. good luck..

my hattrick B in internship

Three department has been passed in my internship, they are Neurology, Pharmacy and Obstetry-Gynecology, and all of them I got mark “B”..uhh..what a disappointing result..

It seems my luckiness, that have 75% role in deciding internship mark, has gone…

Actually In those departments, I got kind examiner in Neurology (dr.Hexanto) and Obsgyn (dr.Suryo), people used to call them God for us that usually give good mark..

Yeah, I passed them quite easy, but they just gave me B..

huh…I’m really not satisfied!!!!

Honestly I don’t really care if I got B in all my internship marks.. I’ve just scared if my bad marks will influence when I apply for resident..

Now, I’ve just can pray…hope in this EYE department God bless me and give the best for me so I can get my first A..hehe..

2nd leg Result Knockout phase Champion League

2^nd leg Result Knockout phase Champion League (10-11^th March, 2009)

Liverpool vs Real Madrid 4-0

(agg. 5-0)

Bayer Muenchen vs Sporting Lisbon 7-1

(agg. 12-1)

Juventus vs Chelsea 2-2

(agg. 2-3)

Panathinaikos vs Villareal 1-2

(agg. 2-3)

Manchester United vs Inter Milan 2-0

(agg. 2-0)

Barcelona vs Lyon 5-2

(agg. 6-3)

Roma vs Arsenal 1-0

(agg. 1-1, Arsenal win on penalties 7-6)

Porto vs Atletico Madrid 0-0

(agg. 2-2, Porto win on away goal)

There’s no surprising result about which clubs that will go through to the quarterfinal.

But there’s one record that Bayer Muenchen made a new highest aggregate goals since Champion Cup became Champion League..

Congratulations for teams who have go through to quarter final, they are 4 English clubs, 2 Spanish Clubs, 1 Germany and 1 Portugal. What a superior English teams in last 4 years.

We will wait for the lottery of quarter final match that will be on Friday 20^th March,2009..

short story in Obsgyn

I’m Back….

Yeah…more than 3 weeks I inactive from all activity, including write on this..

The 5^th- 8^th in obsgyn, when I became senior, was really busy, furthermore I had examination on 7^th weeks.. but I relieve it’s all over..hehe..

Obsgyn is really tiring, but It is very exciting because much stories and experiences I got there, especially in 8^th week when I was in Tugurejo Hospital.

I saw how a mother was died after deliver her baby, it reminded me that give birth a baby is a struggle between live and death for a mother.

I saw how the process “sungsang” or breech delivery that almost become “after coming head”, when the head of the baby is stuck in vagina while the body has been delivered, it also reminded me that breech delivery has many risks, so be carefull..

Totally I got 3 normal “partus”, it is enough for the minimum requirement 2 “partus” in obsgyn…yeah I know I’ve just got minimal “partus” compare with other, even my friend who study in Trisakti University had already done vaccum extraction just in 2^nd week Obsgyn!!!. Wow…

but it’s okay, maybe this is God’s will that indicate one day I should go back there…as a resident…hehe….

who knows..