Ronald Iskandar

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…

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 inIndonesian..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.PramH: 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..

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..

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..

I’m Back….

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

The 5^th- 8^thin 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..

When I read the newspaper edition 28^th January 2009 (quite late ,yeah) there’s a news about woman in California who give birth 8 babies and they are all live until now.. wow..

I can’t imagine how big her stomach when she was pregnant.

All of the babies are premature of course.. It is very rare multiple pregnancy (Gemelli)with more than 2 babies can pregnant until aterm (37-42 weeks pregnancy)

In this case, she gave birth in 31 weeks pregnancy and the heaviest birth weight is just 1470 gr, and the lightest is 680 gr.

If this case happen in Indonesia, I’m not sure that baby with birth weight less than 1000 gr can survive.hehe..

It is also unclear if the woman use the drug that induce her fertility. But, if case like this often happen. I could not imagine how full this world will be..hehehe..

complications of multiple pregnancy are:

- Conjoined twins (Siamese twins)

- Low birth weight

- Twin-to-twin transfusion syndrome

- interlocking

- compaction

- collition, etc..

So be careful with multiple pregnancy.. hehe..

Entering 4^th weeks in Obsgyn..

It almost made me crazy..

Lack of sleeping..

Lack of studying..

Lack of reading newspaper..

But I have a principle though obsgyn is really tiring, but I still have to share my short time to do other thing, like duty on church or give private lesson..

Even my friend was astonished when he heard that I still can use my very short time in home to giving private lesson, instead of sleeping..

Yeah I admitted that it is really-really tiring.. but I like it all.. include write my life story in this blog..

Just keep trying spare time to do many of your likes.. hehe..

Busy…tired.. huh,..

Full week in delivery room Kariadi hospital has made my life messed up. Pyuh..

A new record has been created for me,..

That was I only sleep 15 minutes in a night…

Wew.. that was in the first night when I had slept well at the noon.

But after that, I was really tired and sleepy..

With so tight schedule in the afternoon and evening, I should use my short time to take a rest.

Unfortunately, I couldn’t renew my record in the following day.. hehe..

and thanks God I don’t get sick except little cold and faringitis

I admit that one week in delivery room I didn’t get much experiences that should I have like do VT (Vaginal Touche) to see opening of the cervix or give birth the placenta..

Huh..

Little disappointing., it’s okay..I still have chance in “Parlu” next month..

There’s 1 case that interesting me, that was there is a woman 14^th years old who gave birth and her baby’s born weight 3900 gr, wew..it’s quite big for Indonesian’s baby.

Moreover, she has no husband. Ah..life is really messy.

“Hey, Ronald.. selamat ya udah jadi dokter!!”

Hah..that was the comments many times Ireceived..

And it also many times I answered

“trima kasih, tapi saya belum jadi dokter”

Yes..I’m not a doctor yet..!!!

I admit my Mom advertised my S1 graduation last 6^th November 2008 on my church’s bulletin “Remandika”. On that advertisement, written “Ronald Iskandar, S.Ked”.

Look! There’s no “dr” in front of my name..

It was difficult enough to explain that to be a doctor, we will have twice graduation. First graduation is for the S1 to get “S.Ked” title, than second for the “dr”.

Yeah, now I’m still studying the profession to be a doctor that called “Co Ass”

It’s similar with profession study to be accountant, psychologist or apothecary.

So you may change your comments like this:

“Congrats for your S.Ked graduation, good luck for next study!!”

Yeah.. now I’m really asking your pray for me, cause tomorrow I’m entering Obstetry and Gynecology, and the first week I will spend a full night in the delivery room.

Hope I will keep healthy and not sleepy.. hehe..

GBU..

HAPPY NEW YEAR 2009 to you all my blog’s readers (seems my readers are quite much..hehe..,) but thanks to you who had spent a moment to read my writing..

Hope in 2009,that’s predicted that will be a difficult year cause many global crisis, will still bring happiness, lucks and peaceful life.

In 2008 I have write my blogs regularly at least once a week, hope in 2009, where my lecture’s activity will become busier and busier, I still can share all my opinion and daily life to all of you.hehe..

In my first writing this year, I wanna comment about the tv shows that I watch in my new year holiday time.. Everytime I changed the tv channels I watched there’s so many infotainment shows like Expresso, Kiss, Was-Was, or whatever, and their programs were almost same, summary all moments in 2008 and what the PARANORMALS said about their visions in 2009.Yeah, in the beginning year like this they became very popular.

Some of them are Putri Wong Kamfu, Permadi, Ki Joko Bodo and the most famous of them is Mama Lauren.

Mama Lauren’s forecasts were not always true, may be just nor more than half of her forecast will happen. But, if really happen, many people will still be surprised with her ability.

Like I remember in 2007 she predicted that there a comedian artist with initial “MT” would be dead. And it happen Taufik Savalas ,who had real name Mohammad Taufik, was dead in July 2007.

Than in 2008 she predicted that there 2 famous Indonesian Politicians would be dead. And it happen in January 2008 when former Indonesian’s President Suharto was dead. Then former big Indonesian’s Diplomat Ali Alatas was dead in December 2008.

I don’t know what vision she saw so she knew that.

But I remind you, that were few of many her forecasts. the One who has all Mighty to know everything is only God.

So don’t you worried if you heard all that prophecy, just smile, much pray, and surrender all your life to God, so you will be blessed in your life.

God bless U all guys..!!!