i will remember you sacral agenesis

Author: ctjuliana /


"what is your name? siti juliana isn't it?" He asked. Automatically, i nodded my head. "So, which one. Siti or Juliana?".."errr, either one is ok prof"..

"ok now Siti, i am very strict with my time. All i can give to you, is to do the examination and discussion within 10 minutes". Pandangan mate die, pergh..tajam! cuak sangat. Tak mampu nak kate ape2 by tat time. "10 minutes. remember, 10 minutes only!". Die diam sebentar. aku kekagetan. "hmm, ok prof".

"ok siti, this madam Suziana, 28 years old gravida two para one. I want you to examine her abdomen. your 10 minutes begin, now!!"

As i begin my examination, surprisingly he did not interrupt me at all. Maybe because, i examine the patient without running commentary. As i finish my examination. He asked me. "did you have finish examine the patient?".."yes prof".."ok, present to me your finding"

" the abdomen is distended by gravid uterus evidence by cutaneous sign of pregnancy such as linea nigra and striae gravidarum. the umbilicus is centrally located and flat. there is a transverse scar..".. "wait wait, did you say scar?? i want you to look back the patient's abdomen."

"Ni mesti takde scar!!" i whispered silently to myself. As i checked for the second time. hmmm, betol la, "sorry prof, there is no scar. it just a skin fold "...."hmm, proceed"..

"On palpation, the abdomen is soft, non tender and the uterus is nor irritable. Clinically, fundal height is about 38 weeks of pregnancy and the symphisiofundal height measured 37cm. I can feel there is singleton, in longitudinal lie with cephalic presentation. the head is not engaged with four fifth palpable. The fetal back is on the right maternal side. The liquor is adequate and estimated fetal weight is 2.4 to 2.6kg "..

"i think it slightly bigger siti. about 2.8kg".."so how do you know the baby is alive?"

"by listening to fetal heart using.." i never finished yet! he interrupted me, "just now, when im asking you, did you finish examine the patient, you said yes. Is it listen to fetal heart is one of the examination siti?"..."yes prof, it is. i would like to finish my examination by listen to fetal heart using daptone."

"where? just point to me the point you will put your daptone. "its over here prof".

"why??"

"at the anterior shoulder of the fetus which closest to fetal heart".."okey.."

"now, im giving you her LNMP. calculate the EDD and POA"

Tak taulah ape yang nervous sangat!! pegang pen pon terketaq2. Da la terkire salah!! 9 - 3 = 7?? ngek betol. simplest mathematic pon da bercelaru. by tat time, i took very deep breathe. i calculate the edd and poa again. Hah, sebenarnye, the more relax we are. Things become easier. Tapi, exam kan! everything going to be undercontrol. palpitation is everywhere, every pulses!

So, the patient is only 32 weeks. "clinically, she is 38 weeks, calculated poa is 32 weeks of pregnancy. So, the patient has uterus larger than date prof"

"So, if i give you one chance to ask the patient, what the important thing you will ask the patient? Ask her now". Of cos i wont do the same mistakes. Wrong date is very an important point! then, i asked the patient is she very sure of the last normal menstrual period date.

"ok, she is sure of date. What other investigation you want to do next?"

"ultrasound"

"why??"

"To exclude polyhydramnios by assessing her amniotic fluid index (AFI)"

"okey. but just now you said the liquor was adequate"

"yes"

"so.."

" i will look to the parameters to exclude fetal macrosomia"

"what parameters you'll look for?"

"head circumference, biparietal diameter, abdominal circumference, femur length"

"which parameters is specific to assess fetal macromia?"

"abdominal circumference prof"

"hmmm, what other things you will look for?"

"placenta to exclude choriocarcinoma"

"what??chorioangiosarcoma..choriocarcinoma pulak" he begun to prop out her eyeballs towards me. owww owww...."sorry prof"

i heard thicking of his watch. i saw him stopped the time. Tapi.., "okey ade lg 2 minute". he gave me some time for the discussion.

"then, what other things you will look for"

"fetal anomalies such as anencephaly"

"do you feel the fetal head just now?? is the baby has no head siti?" okey i dig my own grave!! matilah.

"sorry prof, i can feel the fetal head. i will look for other fetal anomalies such as spina bifida and oesophageal atresia"

"okey, let say..u do ultrasound. then you found the baby has no ventricle. wut do you expect the mother might has?"

Habeslah. Im totally has no idea!! hentam je la. "as the baby has congenital heart disease, the mother might has heart disease prof"

He prop out his eyeballs back. i heard his sigh. harsh one.huhu

"ok2, i change. let say you found the baby has no sacral bone on ultrasound. the baby without sacral bone, wut we call it?"

Bapak ah soklan..mane aku ingt!!!nape lame sgt discussion nyer nih. bile la mase nk hbes!! aduhai. i cant stand to look at him. i looked into patient's face hoping there is a clue. Ofcos la xdek!! few seconds, he assisted me. "come on siti, sacral..sacral A.."

i was about to answer sacral atresia!! gile lah. naseb bek tak sebut. kalau tak, gali kubur sendiri lagi la nampaknyer. then, prof pon bagi taw.."sacral agenesis la siti, have you ever heard this term??"

"yes prof. i have heard it before"

"okey, if the baby has sacral agenesis. wut you expect the mother has?"

ya Allah, tak habes lagi rupenyer.

"osteomalacia" satu lagi jawapan yang MENGARUT!!!!! tapi make sense wut??hehehe..

i heard his harsh sigh once again. sorry prof.

"come on siti, sacral agenesis.."

"ha, diabetes prof"

"Haih..at last..then, how do you confirm diabetes in this patient?"

"do MGTT prof"

"how you do MGTT? tell patient now how the procedure is" Soklan feveret prof ok! cara nak buat mgtt..

"puan, saya perlukan puan untuk berpuasa dari pukol 12 malam ni sampai pagi esok. Esok pagi puan datang klinik, saya akan amek darah. Lepas tuh saya akan kasi puan minum air gule. lepas tu.."

"how to do the air gule?"

"75g glucose mix with 250-350ml water and drink within 10 - 15 minutes"

"ok proceed"

"saya akan kasi puan minum air gule tu. Dan puan harus datang kembali selepas 2 jam untuk saye amek darah lagi sekali"

"okeyh..finish" he smiled!! to the patient only! Obviously.

without waiting any longer, after saying thank you i left. i waited for him outside green ward.

"prof, saye lepas ke"

prof lift up his shoulders. "no komen"

i walk along behind him. suddenly, prof panggel. "you, come here"

"nothing to worry, i want you to be more confidence next time. you going to be a doctor soon. mane ade doctor nervous2 nih..hmmmm (his hmmm style!scary kot) . the other thing is, its good to be curious. but, dont over curious. i quiet surprise when you misinterpret between skinfold and the scar. and remember till the end of your life about sacral agenesis. okey thats all"

"okey. thank you prof" he left.

wut a long story!! i will remember this moment forever. i wish everything going to be wokey for me and friends. we got 2 more papers to go. the theory exam and the osce exam on this monday.




permudahkan lah ya Allah



6 comments:

Anonymous said...

go0d..insyaallah bley punye~
prof kan baek..tp klu prof x baek pon, ko mmg bley buat nye

myaamirah said...

jue.. im sure.. ko takut sgt.. aku tgk prof tu ok. n sure ko pass... ko sgt pandai.. Muah!

ctjuliana said...

anonymous : thnk you..ezzati ek??

mia : takut sgt mia. terketa2 aku..doakan aku! aku pon doakan kejayan ko.. :)

ainmusa said...

waa ju, seronoknye bavce,insyaAllah lulus semua.aminn :)

ctjuliana said...

ain, amin. amin. amin dan amin. moge lulus smuenyer! :)

Anonymous said...

a'ah..wlcome.hehehe

:)) ;)) ;;) :D ;) :p :(( :) :( :X =(( :-o :-/ :-* :| 8-} :)] ~x( :-t b-( :-L x( =))

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