Thursday, May 31, 2007


Misti commented on the Durian post regarding "you cannot eat liulian during the day or before you go to work. or else burp habis!" , and this reminds me of this particular incidence again.. Hahhaha.. although the event took place 7 years back (in year 2000), I can still remember it clearly. Although I shared this 2 years back, it's worth sharing it back again, since Misti waited eagerly for the story (under the table summore!)

That night, i had a young Malay patient with suffered compound, comminuted fracture of the femur for surgery. He had MVA (motor vehicle accident) at 4:30 pm in the evening, and he took durian half an hour prior to accident. ( i normally will ask the patient when was their last meal and what they took, as stomach emptying under normal condition will take 6 hours. This is important to prevent aspiration of gastric contents into the lungs (hence aspiration pneumonitis) once patient was under general anaesthesia). I called the case around 10 pm at night (6 hours after his last meal). I intubated him with cuffed ETT with cricoid pressure applied, and he was put under general anaesthesia.

The surgery itself took approximately 4 hours and finished around 2 am in the early morning. I reversed the patient from all the anaesthetic drugs and inhalational agents. Upon awakening, the patient vomited out large amount of partially digested durian (almost one bowl), and stink the whole operation theatre. My assistant (GA nurse) couldn't stand the smell and vomited, hence leaving poor me handling the patient alone. The surgeon had left much earlier on (as usual). The circulating nurse was no where to be seen. The scrub nurse was busy cleaning the surgical instruments in the other room. The hospital attendant hadn't arrived yet despite being called earlier on. I had to clean up the "mess"- sucking the remaining durian debris from the mouth, wiping and cleaning his face etc. I really had to hold my breath while doing that. I had to make sure there was no more residual vomitus left inside the mouth and the patient was fully conscious prior to extubation. (Stomach emptying normally takes 4 to 6 hours but the process may be impaired by certain factors, such as major trauma/accidents which might cause gastric stasis. This was well proven in this case, as the food particles stay intact in the stomach even though 10 hours had passed since his last meal).

Luckily there were no other emergency cases following that and I can close the operating theatre. The partially digested durian really stunk, and the smell remained inside the fully air-conditioned operation theatre for several hours. I had encountered with several more disgusting episodes in the past, whereby patients vomited on my clothes, and to make the matter worse, I cannot leave and clean myself or change my clothes immediately coz I have to attend to the patient first, or else they might aspirate their own vomitus or fell down from the operating table. (Some will struggle in the merge of waking up), Some of the patients are aggressive and we have to be alert. Else, might kena pukul buta-buta anytime. Who says being a doctor is glamorous ???


L B said...

LOL, I remember this!!! Really pengsan under table, and fall thru the floor summore!! lidi lidi lidi!!

mistipurple said...


mistipurple said...

i lup you loctor chen.
you are so noble. i lup you lup you lup you. *blush*
you still dare eat liulian ah? if i, i may be traumatised by this episode, lol!
*crawls back under table and laff with LB*

may said...

eww. ewwwww. didn't you tell a similar story before? ewwwwwww. oh yes, that post! ewwww!

Chen said...

hehehe, u have good memory.
Really see ghost liao..
I hope i won't encounter such experience again in the future :P

Pull Misti out since she pengsan-ed under table

Thank u so muchie for lup-ping me
of course i still dare to eat liulian. Why not? Hhahaha...

Yes, i have. Since Misti wanna listened to the story, so I tell it once again loh.. Kkkkkkk..

day-dreamer said...

*holds breathe*

YUCKS! It sucks.

Dunno what to say.

*runs away before dying out of breathe*

nyonyapenang said...

you sure do have a strong stomach ya?
can you imagine, the patient puke on you, and you puke back on the patient.


nyonyapenang said...

soli, soli... i wanna add this...the patient puke liulian, the lokter puke oh chian and ice kacang.....

Chen said...

day dreamer,
don't worry..
that was 7 years ago liao..
the stinko smell all disappear liao :P

nyonya pg,
Yeah, i definitely have strong stomach ;)

wah.. playing puking game ah?
u puke on me, i vomit back on u
cannot imagine that :P

i must eat oh chean & ice kachang first before i able to puke those food leh..

Pink Cotton said...


doc said...

i think you have to start considering regional anaesthesia for emergency upper or lower limb surgery, esp when still in govt service, thereby reducing the risk of aspiration.

the 6-hour gastric emptying time holds only in normal condition. in MVAs, the pain/stress & the opioids given subsequently all delay the emptying, & it is to be assumed the patient has a full stomach, no matter how much time has elapsed.

this case has given me one more reason to dislike durian.

Will said...

ehehehe this story again ah? :P

Redsponge said...

Yerrrrrrr... manyak jijik work hor? hehehe...we will appreciate doctor more lor..;p

Chen said...

pink cotton,
wah.. don't bluek for so long lah
till kena censor liao

the reason why i choose GA over RA for the boy is cos he is still young, and i dun want to subject him to PDPH later on. I prefer to give GA for young kids than RA. Further more I predict the surgery might took quite some time (which is true, in this case 4 hrs), and spinal anaesthesia won't last, unless if i use CSE or epidural.

Throughout all these years, i never have any case of gastric aspiration yet, and touch wood. I'm pretty confident with my intubation skill :)

many haven't read the interesting story yet, especially Misti. She requested to listen to the story mah :P

red sponge,
very dirty huh?
lousy job :P

Daniel Yiek said...

Gross!!! Wont makan durian for the next 10 years

ah nel said...

i remember few yrs back i eat liulian then went drinking with fren sudennly ui fren gf scream

"ha mang ciak liu lian?"


lokter stil da best job coz when pengsan ppl then later can do anything...can used electricity sot kao kao those patient u don like... ;P

Chen said...

10 years? that's a long duration.
10 months sounds better :)

ah nel,
hahaha, it's hard to hide the fact that one had just eaten liulian. Once he/she burp, the whole world will know liao.. :P

yeah loh, after pengsan-kan people, can pinch or slap them kaw kaw too without any worries. Kkaakaka...

angel said...


*cannot imagine*

*dowan imagine*

*looks under table*

*full house liao*

*sits on top of table and eat liulian*

kkkkk.... *sotsotsot*

ehon said...

lol!!! yucks! DURIAN!! vomit other things i dont mind ler, vomit something like that? wah, can faint!

zewt said...

yeah, it may not be glamorous... but it's certainly noble... anyway, i am heavily influenced by grey's anatomy... sigh... so i wanna be a doc.

zewt said...

actually i wanna ask... when my mom suffered from severe hearmorage... there're actually no chance of survival? or was there hope if she was admitted earlier?

ah nel said...

but i manage to hide worr seem like i was looking for the person that burp... ;D

now i noe wat lokter do when ppl unconcious...i mayb wont go penang hospital liao... :P

kyh said...

EEEEWWWWWWWWWWWWWW!!!!!! YUXXXXX 99!!! maybe that's the reason why i dunwan to be a doc! :P

wah u r very professional! i cant stand durian smell if it's liddat! i think i'll oso vomit leh!!! luckily u still lup liulian! :P

mistipurple said...

lupping you at 6.16am and 24/7.
thank you for telling me story. *joins Angel shortwhile on top table eat liulian whilst still chupping place under table with a packet of tissue* LOL, some singaporean style of chupping seats during lunch hour!

Wennnn said...

Ewwww... wah realli pui fuk U loktor... U are very keng ah?? Can still eat liulian after tat.. I think I wud stay far far away from it liao lor if I see lidis....

sengkor said...

luckily last time my cita cita is not a doktor..

Pinky_piglet said...

haha, dr hen, u were unlucky o...
altought i like to eat liulian, but the vomited luilian real make me yuack so much...

rinnah said...

Ok... I don't miss durian all that much now. *looks faintly green at the thought of the smell*

Lamiracolo said...

i just gone through a few food blog then when i start to read ur this post...i'm like *wwuuurrrkkk....wwuurrrppp.....wwwruuuekk...* wanna vomit la...suddenly i'm not in the mood of eating next time i wanna go on diet i will read this post...let me bookmark it first...he he... :)

Doreen said...

Euwwwwww, my god that's just....euwwww. I would have vomitted too in that situation. You doctors are all brave and always under control. Hats off to all the doctors!

eastcoastlife said...

EEEK! Yucks! Really yucky!

I don't want to be a doctor. It has never been my ambition to be a doctor. But I want to marry a doctor. hahaha.....

After all the gory things you doctors tell, I cannot bear to be touched by one, let alone sleep with a doctor. eeeee......

Chen said...

no need to imagine lah..
cos this is something beyond imaginability :P

wah.. nowadays so many people hide under table ah till full house?
*curi Angel's durian*

if I fainted at that time, then jialat loh.. KKkkkkk...
Cannot faint!
Die-die also must tahan :P

But the smell was indeed disgusting leh.. xx(

I never watch Grey's Anatomy
The medical drama series that I watched in the past was Chicago Hope, ER and the earlier House MD.

Regarding hemorrhagic stroke, it depends on the site involved & vessel involvement & severity of bleed. If the bleed involving the brain stem, then the prognosis is poor. Timing is very important too. Early admission can made a difference especially if there's deterioration in conscious level, as measures can be taken to prevent further cerebral oedema and deterioration. Anyway, it still depends on the severity. The overall mortality is still high :(

Chen said...

ah nel,
wah.. u so kuwak :P

Hahhaha, u sked i wanna pinch u ah?:P

these are the "real life behind the scenes" stories which were never shown on medical drama series. LOL

Hahha, these are two different matters leh. I won't be "traumatised" so easily wan :P

if really no seat, can always tapao back & eat mah.. Kkkkk...
imagine tapao durian back & eat in studio
*thanks for lupping me*

Chen said...

I won't be "traumatised" so easily wan mah.. Else hard to survive liao. Life is always full of drama wan :P

Last time my cita-cita is not doktor too. Dunno why i "tersalah jejak" & become doctor pulak? LOL

pinky piglet,
Let's keep fingers crossed and hopefully won't encounter with such events again in the future :P

Chen said...

LOL.. but I still lup durian woh :P

Hahhaha, so this is a good post for dieting? LOL.
Thanks for dropping by :D

Lotsa things are beyond our imaginations, and beyond our control too. This is life, huh..

hahaha, u wanna hear more gory stories? Including those post mortem stories? ;)

_butt said...

eurghhh.. bad timing.. eating while reading this post.. really feel like uwekk now.. UWEKKKK

Chen said...

wah.. dun vomit on your keyboard woh.

ah nel said...

i noe u wont pinch but molest onli... :p

Chen said...

ah nel,
i tot u r used to it liao, since someone has already did that to u in the past..
Neh.. in KTZ SS2 place with many pairs of eyes watching :P

ah nel said...

whre got whre got?

bo lar bo lar...cin cai kong eh!

*shhh...romeo was reading*

Chen said...

ah nel,
i didn't mention name woh..
itu romeo mana tau who am i talking about?

ah nel said...

romeo sit next to juliet u say he noe onot ler!

Chen said...

ah nel,
yeah huh, true also..
i lupa liao,
now only I recall back

*laff die me* :P