My First Time...

We have so many "First Time" in our lives.. There are "First Time" in everything... Below is a compilation of some of the interesting medical related events that I encountered for the first time in my life.. Surprisingly I can still remember some of the details although that was so many years back. I know I will enjoy reading this post again in the future :) The PRICELESS REAL LIFE experiences !! My Nostalgic Experiences. All these are now history.. HARI ITU DALAM SEJARAH.

1.First time dissecting a corpse/cadaver (real human leh!) : 19+ yr old
I did this on the 5th week of my First Year in Medical Faculty. First time dealing with & touching the real corpses & cadavers !! Don't play-play. Mmmmm...... Surprisingly no thrilled feelings... I was not scared at all. Is this considered as brave? or cold blood? or indifference? or don't care?

Remembering the hatred formalin used to conserve the cadavers to prevent the decaying process - The formalin cause tearing & giddiness to each & everyone of us (poor us) towards the end of the day. There are more juicy details regarding dissection on a earlier post that I wrote way back in 2005. Those who are interested can peep there (including the cadaver pictures).

2.First time conducting delivery : 22+ yr old
This was during my fourth year in Medical Faculty. We need to conduct minimum 10 normal deliveries. My first experience of watching a expecting mother giving birth to a baby is really unforgettable. All the pain, agony, suffering & sacrifices that a mum has to undergo & deal with from the first day of pregnancy till the day when the baby was born. The sacrifices that a mother has to made for her baby.

It was scary the first time I observed the amount of blood loss during delivery. And not forgetting cutting the perineum with the episiotomy scissor during crowning without any analgesia or pain relief. Ouch !! But apparently, the pain of childbirth is much greater then cutting the flesh.. And not forgetting the tearing of the perineum that might occur and the pain that the mother has to endure. There were no epidural for labour pain during those days.

The first delivery that I conducted was a G4P3 Malay lady, and her baby was a baby boy. Forget about the bloody part of conducting delivery.. Dowan u all to throw up :P After sucking and cleaning up the mucous and secretion from the nostrils and oesophagus and clamping of the umbilical cord, the baby was dried and cleaned up and shown to the mother for identification of the baby's sex. Then the baby was placed either inside the incubator (after placing the name tag) or given to the mother for bonding.

After delivery of the baby, that was not the end of the story yet. An IM injection of syntometrine was given to the mother to shorten the 3rd stage and to prevent excessive blood loss and favour the separation of the placenta. Needs to rub the abdomen and massage the uterus, and feel for the fundus of the uterus prior to applying control cord traction or CCT to deliver the placenta. Cord blood was taken for G6PD screening. After delivery of placenta, it was time to clean up the "mess", to evacuate all the blood clots, checking the extend of perineal tear and cleaning up prior to stitching. A great sense of achievement and accomplishment during that moment. Come to think of it, that little baby boy is now 11 years old. :)

3.First time doing Autopsy/Postmortem : 23 yr old
Can't remember what was the first case I performed the real life autopsy liao. This was totally different from dissecting a cadaver cos the body was still flesh, I mean the person had just passed away not long ago. We need to observe 10 autopsies inside the mortuary in GHKL earlier on before performing 3 on our own.

The first time I performed autopsy, I remembered cutting the scalp and opening up the skull...
Removing the rib cages with an electronic saw... Blood started oozing... The good thing was I didn't have to worry about blood loss when I cut the body cos he was dead. (unlike when doing surgery on alive person). Next, Dissecting out the liver, lung, intestine etc etc.... Weighing each organs separately & jot down the weight (just like how the liver was weighed in the wet market) Cutting & slicing the organ into slices to look for any pathology and taking samples for histopathology if indicated. And at the end, we dumped everything (including the brain) inside the abdominal cavity before sewing up the incision with a huge gigantic needle & thread..

4. First time performing surgery (refashioning of finger for crushed injury) : 24+ yr old
This happened during my housemanship time. That night was my second time doing on call duty as the HO on call in Orthopaedic Department. I was called to the casualty by the Casualty MO to perform refashioning of the middle finger for a guy with crushed injury. This was indeed a scary experience cause I never observed how a case of refashioning of crushed finger was done. That was my 5th day working as a doctor in Orthopaedic Department. The MO on call refused to come and just give order via the phone how to perform the surgery when I asked for help. You can imagine how stressful & tensed I was at that moment.. I was sweating when I performed the refashioning. Luckily I didn't tremble :P

Giving ring local anaesthesia to the crushed finger (half of the middle finger was gone). Using rubber band as tourniquet to prevent bleeding. Then clean & sterilize the finger with povidone iodine & isoprophyl alcohol as antiseptic. Nibbing and chipping off the broken bony fragments and smoothen it to the appropriate length.. Cutting off & trimming the excess flesh & skin so that the skin flap is able to cover the refashioned finger, before stitching back the finger stump. Although this was my first time, the end result still looked good.

I prescribed antiobiotics and pain killer for the patient and gave him a date for further follow-up. Other simple surgery that I have performed myself subsequently are such as: tendon repair, wound debridement, I&D, SSG, plating, K-wiring, Caesarean Section, ERPOC for abortion, Tubal ligation (BTL), Appendicectomy, Excision of ganglion, breast lump(fibroadenoma, breast cyst), lipoma, sebaceous cyst, dermoid cyst, Saucerization, Circumcision etc etc.. Those were the days :)

5. First time doing CPR (cardio pulmonary resuscitation) : 24+ yr old
That was during my housemanship time in medical ward. A ESRF patient on Peritoneal Dialysis suddenly collapsed while dialysis in progress. During those days when we were on call in medical wards, we did at least one CPR every night, and at times can be up to 3 CPR per night (the unlucky ones)... This was nothing glamour at all, unlike in tv drama series. There are no heart thumping crescendo music to heighten the tension situation in real life and death emergency situations. No background orchestra music. No back slapping congratulations when able to revive the patient. No one will help to wipe your sweating forehead. No rewards, no compliments and no glory. And such tensed situations arised every now and then. If CPR failed, the next duty was to break the bad news to the family members. Towards the end of the days... a tiring body, an exhausted mind, Sakit tangan, sakit badan....

This is another long winded cheong hei post of my real life experiences. This is not the end yet. I would like to make this into a TAG (itchy hand mah).. My very first own home made tag. I would like to tag these few people to come out with their memorable First Times.. (First time baking a cake? First time io ka chng? First time acting as angelic angel? First time playing guitar? First time killed an ant? First time doing this or first time doing that? Anything will do, as long as it was meaningful and memorable to you).

1. May - A Rather Undignified First
2. LB - The 1st Time Ever I Saw
3. Angel - Five First Time©
4. Pink Cotton - First Times...*wink wink*
5. Ben - 3-in-1 Tag Debts
6. SA - 5 Things Post (About Gaming)
7. Butt - First times
8. King's wife
9. Kenny - My First Time
10. Bernard - My First Time