Hidup mulia

I just came back from ward teaching with Dr. Wong. It’s the end of 2nd week of my pediatrics posting. I planned to impressed Dr. Wong today so I wake up early and did some revision before seeing her. During our session, instead of giving her beautiful pathophysiology, accurate symptoms and sign, good provisional diagnosis and the differential, I end up giving unrealistic menifestation and odd diagnosis. What a luck la .. Thankfully Dr. Wong is a sweet lady, she just smile at me, probably thinking how ignorance I was. I don’t mind, atleast i voice out my opinion. People always said, Malaysian student are passive. Hopefully I manage to change that perception to Dr. Wong today.

Anyway, those are just the opening statement, what i wanted to write here is about these little people in the wards. As we know, pediatric involve children age from birth till 20 years old. The diseases I saw so far were different. NOt something we commonly see in adult or as for me during my surgical and medical posting. Most of them were admited for respiratory infection, as their immune system are not as strong as adults. There are other causes also like nephrotic syndrom, sle, swollen bread and other foreign body and lot more.

In the ward, I was assign to Siti, a 2 1/2 year old girl who had a maningomyelocele. In layman term, the lower part of her vertebrae didn’t fully develop hence her spinal cord is exposed to compression and if that happens, she might present with neurological disorder like unable to control urination and walking disability. A surgery was done last year to treat her condition however she develop symptoms of urinary disorder. Ultrasound scan was done and show that she had a hydronephrosis of the right kidney. Poor child, her right kidney is dialted and if we don’t help her she migh loss her kidney. Hydronephrosis usually develop due to unidentified obstruction of the urinary tract causing a prolong high pressure in the ureter leading to distended ureter and kidney. They were no KUB plain radiograph hence I was unable to see if there is any obstruction. Her mother told me that Siti frequently pass urine and there was no incidence of abdominal distension before. It is very unlikely to see a tumor in a child hence carcinoma that obstruct the ureter is very unlikely. BAsicly it don’t know why she develop hydronephrosis. 

Siti was admitted electively so that we can teach her mother how to insert a chateter or what we call a continuous bladder drainange (CBD). Siti had a neurogenic bledder where she was unable to control her urination habits, hence we teach her mother how to insert a long tube trough her urethra into her bladder so that siti will be able to pass urine properly.

While listening to the specialist explanation about Siti’s condition, suddenly a father of patient from the bed in front of us scream, doctor ! doctor ! help, my child, my child. I look at him as he was waving while calling for help. The medical officer who was with us attended his call together with me and 2 other staff nurse. At the bed, I saw his son was shakking. He had what we call a generalised tonic clonic attack (GTC). It’s a convulsion commonly seen in many situation mainly among epyleptic and high fever child. As for this child, he had it due to fever which we call a febrile convulsion. Dr. Cindy hold the child and infuse diazepam trough his anus and shortly the convulsion subside. Then we gave him oxygen to ensure adequate oxygen supply to his lung. INsyaAllah he will be fine.

There are lots of nervous parent in the ward. I guess it is their normal nature. LAst night we had another convulsion attack from a different patient and the mother cried. In the morning, i had a mother who blame herself, thinking that  she cause her sons to be ill because she breast fed him, and in the afternoon while in the pediatric clinic, there was a mother who blame the madical staff for what she perceive as negligance that causes her daughter to suffered from cerebral palsy. As parent, i guess i can understand why there very irritable. Who doesn’t, if someone you love and care so much, fall sick, you also fall sick right !.

I do realize all this before I enter this posting and I was worried that i might not be able to clerk a single child because their parent might chase me away. However things wasn’t as bad, they welcome me to see their children and allow me to examine them. Perhaps thats is the kind of trust you get by wearing the  white coat. Eventhough i might not be able to treat their child, atleast i’m there to listen.