I think I am maybe too emotionally attached to my patients. But, I am only human, and as a human, you cannot control your feelings towards a person. At least that is what I think.
I have been with this particular patient of mine for nearly 4 weeks now. When I first got to know him, he was a chirpy lovely elderly man who was being investigated for a "lesion" in his liver. And as probably expected, this so-called lesion turned out to be HCC (hepatocellular carcinoma). Throughout these few weeks, I have to say, he was gradually deteriorating. Day by day, he was becoming more lethargic, less talkative and totally lost his appetite. I guess that is just how fast cancer can overwhelm a person. Whenever you asked him how he was doing, he would say, "I am brand new, dear. I feel fine, my dear. Just do whatever you need to do dear. I do not mind at all."
Today, for the first time, I saw him in tears. He was in extreme pain from his liver, and experiencing bad diaphragmatic irritation, which caused him to have recurrent hiccups. Even then, when I asked him how he was, he told me he was ok. When I saw him like that, I couldn't help to feel so sorry for him. Things weren't better when his family members (who are all lovely people) were there with him. His wife had to leave the ward as she was devastated by the sight of his suffering.
Tears began welling up in my eyes. But I told myself that I should not cry. I know that he doesn't have much time left to live, as even the gastro consultant, who specialises in liver, thought that he was not fit enough for any treatment. At the moment, we are just trying to provide symptomatic relief. Poor man. God bless him.
I do not think I can work in palliative care. I would be really emotionally attached to my patients...and I would probably be frustrated most times. =(
Thursday, May 31, 2007
Wednesday, May 30, 2007
Macam-macam
Think this is my first post with a BM heading. These few days can be summarised as "macam-macam." Few pretty random/strange/ things happened.
1. A patient didn't get his MRI neck done. Why? The reason was "Oh, we only do MRI neck on Mondays, and since it was a Bank Holiday, patient has to wait till next week." Now...patient has already been waiting for more than 1 week for this MRI....and now he has to wait further. Great! Because of the delay in this scan, patient's transfer to rehab was delayed....and this is not good at all.
2. A patient has been pretty abusive, both physically and verbally, to the nurses and other members of the medical team. I was given the 'fun' job of accompanying him down for a CT scan, just in case he needed sedation to calm him down. At the radiology department, patient was reluctant to speak to anyone. I had to answer on his behalf. When he was asked to put his hands down by his sides, he refused to do it. But when I asked him to do it, he listened! Basically, he was listening to me. Today, he was really breathless and refused to use the nebuliser. However, when I went into his room and asked him to use it, he agreed.
hmmm...I felt really rewarded by the fact that the patient was actually listening to my advice.
3. A colleague of mine just can't stop crying all day on Tuesday. It wasn't like she was having a rough day....but I think she was being too hard on herself. She was upset about the fact that she had 7 discharge prescriptions to fill in. She was crying about a missing CSF sample. She was in tears about an urgent echo. I did not know how to console her, but I tried anyway..... Today, she again told me that she felt like crying! And I was like, "Crying will not help you solve the matter." I did not mean it in a harsh manner, but I really felt that I need to make her realise that crying is not going to make the situation any better.
4. "OUUUCCHHH!! YOU CRUEL BITCH! You like hurting people don't you?" shouted an elderly lady to me as I took some blood samples from her. I blushed as expected. I didn't mind her calling me that and it was really funny.
5. Consultant asked me, "Ling, have you seen the flat that I am planning to buy? It is off X street." "Oh ok...sure let's have a look, " I said. "Oh, you'll be my neighbour then. I live at Y street. Whoa, that is a really nice and beautiful flat." "Guess how much is it?" asked the consultant again. "Don't know." "It is about 400 thousand pounds." "Oh, that is quite pricey, considering that I am only paying 240 for my rent a month." I felt the whole conversation really awkward, because, I have seriously, never met a consultant who would share these things with me.
There you go. 5 rather random or unusual things that happened over the past couple of days.
1. A patient didn't get his MRI neck done. Why? The reason was "Oh, we only do MRI neck on Mondays, and since it was a Bank Holiday, patient has to wait till next week." Now...patient has already been waiting for more than 1 week for this MRI....and now he has to wait further. Great! Because of the delay in this scan, patient's transfer to rehab was delayed....and this is not good at all.
2. A patient has been pretty abusive, both physically and verbally, to the nurses and other members of the medical team. I was given the 'fun' job of accompanying him down for a CT scan, just in case he needed sedation to calm him down. At the radiology department, patient was reluctant to speak to anyone. I had to answer on his behalf. When he was asked to put his hands down by his sides, he refused to do it. But when I asked him to do it, he listened! Basically, he was listening to me. Today, he was really breathless and refused to use the nebuliser. However, when I went into his room and asked him to use it, he agreed.
hmmm...I felt really rewarded by the fact that the patient was actually listening to my advice.
3. A colleague of mine just can't stop crying all day on Tuesday. It wasn't like she was having a rough day....but I think she was being too hard on herself. She was upset about the fact that she had 7 discharge prescriptions to fill in. She was crying about a missing CSF sample. She was in tears about an urgent echo. I did not know how to console her, but I tried anyway..... Today, she again told me that she felt like crying! And I was like, "Crying will not help you solve the matter." I did not mean it in a harsh manner, but I really felt that I need to make her realise that crying is not going to make the situation any better.
4. "OUUUCCHHH!! YOU CRUEL BITCH! You like hurting people don't you?" shouted an elderly lady to me as I took some blood samples from her. I blushed as expected. I didn't mind her calling me that and it was really funny.
5. Consultant asked me, "Ling, have you seen the flat that I am planning to buy? It is off X street." "Oh ok...sure let's have a look, " I said. "Oh, you'll be my neighbour then. I live at Y street. Whoa, that is a really nice and beautiful flat." "Guess how much is it?" asked the consultant again. "Don't know." "It is about 400 thousand pounds." "Oh, that is quite pricey, considering that I am only paying 240 for my rent a month." I felt the whole conversation really awkward, because, I have seriously, never met a consultant who would share these things with me.
There you go. 5 rather random or unusual things that happened over the past couple of days.
Monday, May 28, 2007
Diagnosis Wenckebach
Check this out! My friend, Saw Sian, who just graduated with distinction from med school, sent me the link to this awesome video.
Congratulations to you gal! =) Proud to have a friend like you.
Anyway, this video is hilarious and creative. Will never approach Mobitz Type I or Wenckebach the same way again! =)
Sunday, May 27, 2007
YYyyaawwwwnnnn..................
MmmmhHHHhhmmmmmmm
*yyyaawwwnnnnnnn
Sigh.
I am exhausted. The past week has been really busy except on Thursday. A few sick patients on the ward, one ended up in CCU. Another patient has worsening kidney function, and is extremely septic....he is brewing bacteria in his urine, and blood. The only antibiotics that the bacteria is sensitive to are gentamicin and tazocin. We really have to keep a close eye on his kidneys. So everyday, I will have to speak to the pharmacist and the microbiologist about what is best to do. It doesn't get any easier, especially when both of them have conflicting opinions.
Friday wasn't particularly busy. But I had to escort a patient down for a CT scan, just in case I need to sedate him for the procedure. Strangely, the patient was very cooperative and he was really not abusive at all! (I got a bruise on my arm last week because of him). I spent nearly an hour at the radiology department. When I arrived back at the ward, so many other things had to be sorted out. I had to speak to a patient and his family about his liver biopsy result. Informing them the result was quite scary, I have to say. I had to recompose myself and think about what I was going to say and how I was going to do it. There was a huge group of them, all very anxious to know of the result. Unfortunately, the result wasn't a good one. =(
I left work at a ridiculous time of 7.30 pm (everyday except Thurs)!! 2 and a half hours later!!!!! I know, I know, lots of other doctors back home work longer than me...but over here, finishing 2 hours later is against the law. haha.
Finishing late + eating crap + half spring/summer weather = intermittent GI disturbance + hay fever + watery eyes + exhaustion. Believe it or not, I fell asleep halfway through Pirates of The Carribean 3! (ssshhh!!! But I have to say the show was quite boring and too long).
I felt like shit on Friday. I had to cancel my trip down to Ayr to visit SzeLeng.
Now it is Sunday......arrghh....will be on call for the next 7 days. Great!
*yyyaawwwnnnnnnn
Sigh.
I am exhausted. The past week has been really busy except on Thursday. A few sick patients on the ward, one ended up in CCU. Another patient has worsening kidney function, and is extremely septic....he is brewing bacteria in his urine, and blood. The only antibiotics that the bacteria is sensitive to are gentamicin and tazocin. We really have to keep a close eye on his kidneys. So everyday, I will have to speak to the pharmacist and the microbiologist about what is best to do. It doesn't get any easier, especially when both of them have conflicting opinions.
Friday wasn't particularly busy. But I had to escort a patient down for a CT scan, just in case I need to sedate him for the procedure. Strangely, the patient was very cooperative and he was really not abusive at all! (I got a bruise on my arm last week because of him). I spent nearly an hour at the radiology department. When I arrived back at the ward, so many other things had to be sorted out. I had to speak to a patient and his family about his liver biopsy result. Informing them the result was quite scary, I have to say. I had to recompose myself and think about what I was going to say and how I was going to do it. There was a huge group of them, all very anxious to know of the result. Unfortunately, the result wasn't a good one. =(
I left work at a ridiculous time of 7.30 pm (everyday except Thurs)!! 2 and a half hours later!!!!! I know, I know, lots of other doctors back home work longer than me...but over here, finishing 2 hours later is against the law. haha.
Finishing late + eating crap + half spring/summer weather = intermittent GI disturbance + hay fever + watery eyes + exhaustion. Believe it or not, I fell asleep halfway through Pirates of The Carribean 3! (ssshhh!!! But I have to say the show was quite boring and too long).
I felt like shit on Friday. I had to cancel my trip down to Ayr to visit SzeLeng.
Now it is Sunday......arrghh....will be on call for the next 7 days. Great!
Wednesday, May 23, 2007
Bad Practice
I HAVE NEVER SEEN AN ULTRASOUND GUIDED LIVER BIOPSY.
Now, is there any point in me asking for consent from one of my patients who was scheduled to go for it on Tuesday morning??!
Who is the person performing the procedure?
The radiologist.
Who insisted that the patient needs to be consented in the ward before going for the procedure?
The radiologist.
This is what the GMC Good Medical Practice said about the issue of "Consent:"
If you are the doctor providing treatment or undertaking an investigation, it is your responsibility to discuss it with the patient and obtain consent, as you will have a comprehensive understanding of the procedure or treatment, how it is carried out, and the risks attached to it. Where this is not practicable, you may delegate these tasks provided you ensure that the person to whom you delegate:
However, I am NOT the person undertaking the investigation.
I DO NOT have sufficient knowledge of the procedure, or how it is carried out and the risks (I know a few points...but not completely).
And it is never "not practicable" for the radiologist to obtain the patient's consent.
So tell me, why do I need to be the person consenting this patient? I have explained it to the radiologist himself, and the answer I got was, "Patient NEEDS to be consented before he leaves the ward. If you are not able to do it, get someone more senior than yourself. Otherwise, if I do not see the consent form signed, I will not do the procedure."
That is absolute pish! wtF?!
Even my SHO has not seen the procedure and she definitely was not happy to consent the patient. No one any more senior than myself was in the ward. Therefore, at that time, I had to consent the patient myself. I do not have any other choice. At the end of the day, if patient didn't get his investigation done, I will the one blamed.
It is totally illegal and it just shows super duper bad medical practice. And the radiologist just wanted things to go easy for him, ie, send the patient down, do procedure, and send patient back up to the ward. I know time is a factor, but it should never prevent anyone from abiding good medical practice. Anyone beg to differ??
Now, is there any point in me asking for consent from one of my patients who was scheduled to go for it on Tuesday morning??!
Who is the person performing the procedure?
The radiologist.
Who insisted that the patient needs to be consented in the ward before going for the procedure?
The radiologist.
This is what the GMC Good Medical Practice said about the issue of "Consent:"
If you are the doctor providing treatment or undertaking an investigation, it is your responsibility to discuss it with the patient and obtain consent, as you will have a comprehensive understanding of the procedure or treatment, how it is carried out, and the risks attached to it. Where this is not practicable, you may delegate these tasks provided you ensure that the person to whom you delegate:
- is suitably trained and qualified;
- has sufficient knowledge of the proposed investigation or treatment, and understands the risks involved
However, I am NOT the person undertaking the investigation.
I DO NOT have sufficient knowledge of the procedure, or how it is carried out and the risks (I know a few points...but not completely).
And it is never "not practicable" for the radiologist to obtain the patient's consent.
So tell me, why do I need to be the person consenting this patient? I have explained it to the radiologist himself, and the answer I got was, "Patient NEEDS to be consented before he leaves the ward. If you are not able to do it, get someone more senior than yourself. Otherwise, if I do not see the consent form signed, I will not do the procedure."
That is absolute pish! wtF?!
Even my SHO has not seen the procedure and she definitely was not happy to consent the patient. No one any more senior than myself was in the ward. Therefore, at that time, I had to consent the patient myself. I do not have any other choice. At the end of the day, if patient didn't get his investigation done, I will the one blamed.
It is totally illegal and it just shows super duper bad medical practice. And the radiologist just wanted things to go easy for him, ie, send the patient down, do procedure, and send patient back up to the ward. I know time is a factor, but it should never prevent anyone from abiding good medical practice. Anyone beg to differ??
Monday, May 21, 2007
What A B****H
One of my patients was meant to attend his EMG on Friday 10 am at a different hospital. However, there was a problem with his transport on Friday. Apparently I was informed by the ambulance that it was booked for 2pm not 10 am. Miscommunication!!!!
Anyway, the patient's EMG was rescheduled today at 2pm. And I wrote in the notes, "Patient's EMG has been rearranged for Monday 2pm. Pls arrange transport for the patient to ensure he doesn't miss this appointment again. Thank you."
Here is my conversation with her:
Sister: This patient can't go for his EMG. I can't get transport for him.
Me: He has to go. Can't we even get a taxi for him?
Sister: We have to send a nurse escort with him...we cannae do that cause we are short of staff.
Me: Alright. Well, just try and see what you can get.
Sister: It is at 10 am right?
Me: No...it is at 2pm...I wrote it clearly in the notes.
Sister: Ok.
Time now is 12pm.
Me: Sister, did you manage to arrange transport for him?
Sister: It is not our fault that he didn't go for his EMG on Friday.
Me: I never said it was your fault. There was miscommunication somewhere.
Sister: Fine.
...........silence. She didn't speak to me after that until she met me at the stairs when she was about to go home. Correct me if I am wrong, but did I even blame her for patient's missed appointment?
What a *toot!*
Anyway, the patient's EMG was rescheduled today at 2pm. And I wrote in the notes, "Patient's EMG has been rearranged for Monday 2pm. Pls arrange transport for the patient to ensure he doesn't miss this appointment again. Thank you."
Here is my conversation with her:
Sister: This patient can't go for his EMG. I can't get transport for him.
Me: He has to go. Can't we even get a taxi for him?
Sister: We have to send a nurse escort with him...we cannae do that cause we are short of staff.
Me: Alright. Well, just try and see what you can get.
Sister: It is at 10 am right?
Me: No...it is at 2pm...I wrote it clearly in the notes.
Sister: Ok.
Time now is 12pm.
Me: Sister, did you manage to arrange transport for him?
Sister: It is not our fault that he didn't go for his EMG on Friday.
Me: I never said it was your fault. There was miscommunication somewhere.
Sister: Fine.
...........silence. She didn't speak to me after that until she met me at the stairs when she was about to go home. Correct me if I am wrong, but did I even blame her for patient's missed appointment?
What a *toot!*
Friday, May 18, 2007
Bad Start, Bad Finish
*phew
What a day man! And I went to work today thinking that I would be able to finish on time. Wishful thinking indeed.
Had a bad start in the morning. I felt extremely guilty for what happened. It all began with the sister asking whether a patient, with poor renal function, needed to be given a drug that would protect his kidneys prior to his angiogram. To be honest, the cardiologist has seen the patient multiple times before this, and they are well aware of the patient's bad kidneys. So if they thought that the angio was going to bring more harm to his kidneys, they would have decided on a different investigation. Therefore, I told the sister that, "Yes, patient is going for his angio. Cardiologist didnt give me specific instructions about giving that drug to protect his kidneys."
Sister wasn't really happy with my answer. Then, my consultant to the ward came in, and the sister immediately approached him and said, "I spoke to the resident about this patient's poor kidney function. She said we do not need to do anything about it and just send the patient down for the angio." The consultant himself wasn't sure whether or not we should be giving any kidney protective drugs, and suggested that we contact the cardiologist about it. I couldn't get hold of him, so I left a message with his nurses, who advised to leave the patient in the ward first until the cardiologist gives the green light to proceed. After another 20 minutes, I finally managed to get hold of the cardiologist, and he wasn't too concerned about the patient's creatinine of 320. Off the patient went for the angio.
It was a total chaos during the whole event. Because, patient was transferred from bed to trolley. Patient was then transferred from the trolley to the bed when the nurse advised to keep the patient in the ward first. Then, once green light was given, patient was moved from his bed to the trolley again! Imagine the total chaos! I have to say I felt totally responsible for it. It totally ruined my thought process for the whole day. I apologised to the nurses for the chaos and also to the sister. She wasn't happy at all. And finally, when I met my consultant again later in the afternoon, I told him that I was really sorry about the event this morning. He said I shouldn't put the blame on myself because, really, the person who is going to do the angio should be responsible for the patient's kidneys. Oh well.
The day went on alright after that. However, about 4pm, an arranged admission arrived....and he wasn't the easiet patient to clerk in. The only information I have about the patient was a sheet of clinic letter. Patient himself was quite vague about the reason for his admission. Then at about 5 pm, a patient of mine went into acute urinary retention. I tried to pass the catheter twice, but no urine was obtained. Instead, bright red thick blood came out from the catheter. I was concerned that he might have clot retention in his bladder. I phoned the urologist on-call, and only about an hour later she arrived. As expected, she shoved a big rigid catheter into that patient, and out came 2 litres of urine!
At the same time, another patient became very septic...and so I had to sort him out. It was only at about 7pm that I managed to print out my blood request forms for the weekend. I left the hospital at 7.30pm! =( I was hungry, tired and slightly frustrated. So SzeLeng had to bear with my rants all night! haha.
So it was a bad start to the day, and undoubtedly, a bad finish too....sigh. Just glad it's Friday!
What a day man! And I went to work today thinking that I would be able to finish on time. Wishful thinking indeed.
Had a bad start in the morning. I felt extremely guilty for what happened. It all began with the sister asking whether a patient, with poor renal function, needed to be given a drug that would protect his kidneys prior to his angiogram. To be honest, the cardiologist has seen the patient multiple times before this, and they are well aware of the patient's bad kidneys. So if they thought that the angio was going to bring more harm to his kidneys, they would have decided on a different investigation. Therefore, I told the sister that, "Yes, patient is going for his angio. Cardiologist didnt give me specific instructions about giving that drug to protect his kidneys."
Sister wasn't really happy with my answer. Then, my consultant to the ward came in, and the sister immediately approached him and said, "I spoke to the resident about this patient's poor kidney function. She said we do not need to do anything about it and just send the patient down for the angio." The consultant himself wasn't sure whether or not we should be giving any kidney protective drugs, and suggested that we contact the cardiologist about it. I couldn't get hold of him, so I left a message with his nurses, who advised to leave the patient in the ward first until the cardiologist gives the green light to proceed. After another 20 minutes, I finally managed to get hold of the cardiologist, and he wasn't too concerned about the patient's creatinine of 320. Off the patient went for the angio.
It was a total chaos during the whole event. Because, patient was transferred from bed to trolley. Patient was then transferred from the trolley to the bed when the nurse advised to keep the patient in the ward first. Then, once green light was given, patient was moved from his bed to the trolley again! Imagine the total chaos! I have to say I felt totally responsible for it. It totally ruined my thought process for the whole day. I apologised to the nurses for the chaos and also to the sister. She wasn't happy at all. And finally, when I met my consultant again later in the afternoon, I told him that I was really sorry about the event this morning. He said I shouldn't put the blame on myself because, really, the person who is going to do the angio should be responsible for the patient's kidneys. Oh well.
The day went on alright after that. However, about 4pm, an arranged admission arrived....and he wasn't the easiet patient to clerk in. The only information I have about the patient was a sheet of clinic letter. Patient himself was quite vague about the reason for his admission. Then at about 5 pm, a patient of mine went into acute urinary retention. I tried to pass the catheter twice, but no urine was obtained. Instead, bright red thick blood came out from the catheter. I was concerned that he might have clot retention in his bladder. I phoned the urologist on-call, and only about an hour later she arrived. As expected, she shoved a big rigid catheter into that patient, and out came 2 litres of urine!
At the same time, another patient became very septic...and so I had to sort him out. It was only at about 7pm that I managed to print out my blood request forms for the weekend. I left the hospital at 7.30pm! =( I was hungry, tired and slightly frustrated. So SzeLeng had to bear with my rants all night! haha.
So it was a bad start to the day, and undoubtedly, a bad finish too....sigh. Just glad it's Friday!
Wednesday, May 16, 2007
Don't Write Me Off - Hugh Grant
Finally, I've found this song... the nicest part of the movie, Music and Lyrics.
Tuesday, May 15, 2007
Kept My Cool
Doctor, doctor, come here now.
Doctor, when will I be going home?
You have to wait for the liver doctors to see you first before you can go.
Ok. When will that be?
I have contacted them yesterday, and she told me she'll see you today, some point in the afternoon.
Right ok. Will I be going home then?
Erm...that doctor will decide whether or not you can go home.
1 hour later...
Doctor, doctor, can I have a word with you?
Yes. What can I do for you?
When will that liver doctor see me?
As I said, some point in the afternoon....I do not really know.
So, will I be going home then?
It is their decision.
30 minutes later......
Doctor, come here.
Yes.
Can you chase that doctor up?
Well, I will phone them if they do not come by 3 pm ok?
But doctor, today is my birthday, and I want to get out from the hospital.
Happy birthday. I know you would like to get discharged, but it is not me who decides that.
Will you ask them to see me?
Yes. The liver doctor said she'll see you today.
Trust me...this went on and on for the whole day! It was nearly every hour that he kept asking me the same questions over and over again. Honestly, I was quite tired of answering him and being polite. But I can't be rude to him either. So I kept my cool ....until I reached home, when I started to rant away to my housemate.
Oh dear, I know...ranting AGAIN! It's addictive!
Doctor, when will I be going home?
You have to wait for the liver doctors to see you first before you can go.
Ok. When will that be?
I have contacted them yesterday, and she told me she'll see you today, some point in the afternoon.
Right ok. Will I be going home then?
Erm...that doctor will decide whether or not you can go home.
1 hour later...
Doctor, doctor, can I have a word with you?
Yes. What can I do for you?
When will that liver doctor see me?
As I said, some point in the afternoon....I do not really know.
So, will I be going home then?
It is their decision.
30 minutes later......
Doctor, come here.
Yes.
Can you chase that doctor up?
Well, I will phone them if they do not come by 3 pm ok?
But doctor, today is my birthday, and I want to get out from the hospital.
Happy birthday. I know you would like to get discharged, but it is not me who decides that.
Will you ask them to see me?
Yes. The liver doctor said she'll see you today.
Trust me...this went on and on for the whole day! It was nearly every hour that he kept asking me the same questions over and over again. Honestly, I was quite tired of answering him and being polite. But I can't be rude to him either. So I kept my cool ....until I reached home, when I started to rant away to my housemate.
Oh dear, I know...ranting AGAIN! It's addictive!
Monday, May 14, 2007
Need to Split Myself
Monday. Never liked Mondays unless it falls on a public holiday.
I was really busy today. Wished I could split my body into 2, so that one part of me joins the the consultant ward round, and the other half joins the registrar round. However, life is never simple...and you can never divide yourself into 2 seperate bodies. So, that's why, I ended up being busy. There were a few phone calls to make, bloods to take, scans to request...which really, weren't too bad. Having said that, I ended up staying late because there were a few sickies and at about 5.30 pm, my consultant approached me and said, "This man is sick. I need you to do these things. But, you do not have to do it, just hand it over to the on-call JHO."
Well, if I was being unkind, I would have handed over the task. However, I put myself into the on-call JHO's shoes. And if I were handed over these things.....I would not be impressed at all! So, i decided that I should just quickly do them all, and just ask the on-call person to chase up the results and review the x-rays.
As expected, the longer you stay in the ward, the more jobs you end up doing, which was the case this evening. The nurses kept asking me to do a few things or ask me to see a certain patient, until the extent that I told them, please do not ask me anymore!!! Otherwise, I would be stuck there till 9!
Sigh. Tired....didnt really sleep much. Off to bed soon.
Damn it...I can't stop thinking about the things I need to do in the morning in the ward.
hmm...think the first thing I should do is bleed that man.....then, insert a iv cannula, followed by a synacthen test...etc...oh yes...chase results....argh....
Stop....shut my mind up!
I was really busy today. Wished I could split my body into 2, so that one part of me joins the the consultant ward round, and the other half joins the registrar round. However, life is never simple...and you can never divide yourself into 2 seperate bodies. So, that's why, I ended up being busy. There were a few phone calls to make, bloods to take, scans to request...which really, weren't too bad. Having said that, I ended up staying late because there were a few sickies and at about 5.30 pm, my consultant approached me and said, "This man is sick. I need you to do these things. But, you do not have to do it, just hand it over to the on-call JHO."
Well, if I was being unkind, I would have handed over the task. However, I put myself into the on-call JHO's shoes. And if I were handed over these things.....I would not be impressed at all! So, i decided that I should just quickly do them all, and just ask the on-call person to chase up the results and review the x-rays.
As expected, the longer you stay in the ward, the more jobs you end up doing, which was the case this evening. The nurses kept asking me to do a few things or ask me to see a certain patient, until the extent that I told them, please do not ask me anymore!!! Otherwise, I would be stuck there till 9!
Sigh. Tired....didnt really sleep much. Off to bed soon.
Damn it...I can't stop thinking about the things I need to do in the morning in the ward.
hmm...think the first thing I should do is bleed that man.....then, insert a iv cannula, followed by a synacthen test...etc...oh yes...chase results....argh....
Stop....shut my mind up!
Thursday, May 10, 2007
Tuesday, May 08, 2007
My Birthday Pledge
Its just about over 4 weeks before I become a quarter of a century old =(
I know....QUARTER of a CENTURY?! Over these past 2-3 years, time really flew past so quickly. Anyway, since I have lived nearly 25 years of my life, I decided that I need to set a few goals that I MUST achieve before my birthday.
1. NO more chocolates from now. After that? hmm...shall decide then.
2. RUN 3 km in 30 minutes effortlessly. (now can only managed about 2.5 km in 25 min)
3. STOP ranting about the daily happenings in life.
4. EAT more heathily.
5. SMILE more. Frown less.
6. READ 3 books.
7. LOSE some weight.
8. GO wall-climbing.
There. ok...I shall be abit more realistic. I should achieve at least 5 of them before my birthday.
Wish me luck!
I know....QUARTER of a CENTURY?! Over these past 2-3 years, time really flew past so quickly. Anyway, since I have lived nearly 25 years of my life, I decided that I need to set a few goals that I MUST achieve before my birthday.
1. NO more chocolates from now. After that? hmm...shall decide then.
2. RUN 3 km in 30 minutes effortlessly. (now can only managed about 2.5 km in 25 min)
3. STOP ranting about the daily happenings in life.
4. EAT more heathily.
5. SMILE more. Frown less.
6. READ 3 books.
7. LOSE some weight.
8. GO wall-climbing.
There. ok...I shall be abit more realistic. I should achieve at least 5 of them before my birthday.
Wish me luck!
Friday, May 04, 2007
Yet Another Violence
A day after that patient chased me out of the ward, the next night, a patient in the DTs smacked a nurse right in her face. The poor lady was shorter than me and thin. She fell and hit the wall. Her right cheek was swollen and red.
I do not understand why do we need to admit people who drink too much alcohol. Once they get admitted, all we do is provide them with a few days worth of banana bags to replenish their vitamin deficiency. During their admission, they obviously go into alcohol withdrawal, whereby, they become violent, and agitated. We have to give them tablets/injections to calm them down. They normally get discharged within a week. And guess what? They go back to the pub and continue to drink their hearts out! A few weeks to months later, they get admitted again with too much alcohol. It is a vicious cycle indeed!
They do not appreciate what we are doing, so why are we even treating them? Instead, we get verbally and physically abused. And all the money spent on buying those tablets/injections to calm them down. They are bloody wasting our money, time and energy! I really can't stand them....but lucky me, patients with too much alcohol are so abundant here. sigh.
I do not understand why do we need to admit people who drink too much alcohol. Once they get admitted, all we do is provide them with a few days worth of banana bags to replenish their vitamin deficiency. During their admission, they obviously go into alcohol withdrawal, whereby, they become violent, and agitated. We have to give them tablets/injections to calm them down. They normally get discharged within a week. And guess what? They go back to the pub and continue to drink their hearts out! A few weeks to months later, they get admitted again with too much alcohol. It is a vicious cycle indeed!
They do not appreciate what we are doing, so why are we even treating them? Instead, we get verbally and physically abused. And all the money spent on buying those tablets/injections to calm them down. They are bloody wasting our money, time and energy! I really can't stand them....but lucky me, patients with too much alcohol are so abundant here. sigh.
Wednesday, May 02, 2007
Scariest Moment!
It was 2.15 am, when I walked into ward X to insert IV cannula a patient. L, my colleague, was there with me as she did not have any jobs to do at her side of the hospital. Once completed, I heard funny noises at the other end of the ward. With the inquisitive nature that I have, I decided to walk towards the sound.
The funny noises/grunting came from a male patient whom I saw just a few hours before to insert an IV cannula. At that time, he was talking to me. However, when I called out his name at 2.3o in the morning, he didnt respond. He had his eyes opening spontaneously, but it was just staring blankly into the open space. His limbs were not shaking or stiff. hmmm...I thought he was probably having a seizure of some sort. The nurses informed me that he was admitted with alcohol excess and a probable head injury.
So I asked the nurse to do a set of observations on him. His vital signs were normal. I decided to put his bed flat down, just to make sure his airway wasn't compromised, but the grunting persisted. Then suddenly, his limbs started to shake violently, and as expected, he went into tonic-clonic seizure.
The entire seizure lasted about 30 minutes. I gave him 2 shots of lorazepam which finally stopped his seizures. He was not cyanosed during the attack, but I decided to put him on oxygen anyway. During the whole event, my cardiac arrest page went off, and I was like "Oh fuck!" Fortunately, the call was for anaesthetist only. It wasn't that I was worried about attending a cardiac arrest, I just didn't think I would be able to leave the patient.
After the seizure, his eyes were wide open and he was still not responding verbally to me. Since he was having a long fit, I decided to take some blood samples and an arterial blood gas from him. Whilst palpating for his pulse, his hands suddenly turned into fists! I thought it was a bit strange and continued to feel for a pulse. However, he suddenly sat up on his bed and stared at both me and L, with the MOST VICIOUS eyes I have ever seen in my entire life so far.
He had the eyes of a murderer. I know, it is not like I have seen a real life murderer (*touch wood), but his eyes were just full of anger, hatred and violent looking. Immediately, I stopped doing what I was planning to do, and told L to move back. Lucky L moved away quickly, as he punched out at her, nearly hitting her chest. I shouted at the nurse to call security.
I was trying to calm him down with the help of another nurse, but to no avail. He knelt on his bed, with his oxygen mask still attached, and continued to stare at me with those really malicious eyes. Horror of all horror, he moved forward with his knees towards me, and toppled down the bed, arms first. I was like, "L, I think we need to move back." L was already walking away from him, while I thought maybe I should help him up.
This patient got up almost immediately, and stared back at me. I turned around and started to walked really quickly away from him towards the entrance of the ward. L was ahead of me, and ran towards the ward opposite. I looked behind and saw that he was chasing after us. "Oh my god, he's after us. Run!" I shouted. We were outside the ward, before I saw security running up the stairs to Ward X. The patient stopped at the hallway and stared at me.
Security took hold of him and put him back into his bed. He was punching and kicking out at them too. The nurse that was with us was hiding under the table. Finally, after being pinned down by security, he flipped back into his normal self. He started talking, and demanded that he wanted to speak to a doctor, which was me, of course.
There was no way I was going near this man without further sedation. So I gave him a shot of haloperidol and that seemed to calm him down slightly. An hour later, he was still pretty agitated, but less violent. I gave him a small dose of lorazepam, and thank goodness, he fell asleep after that.
This morning, when I went back to the ward to do a few things, I overheard a patient talking to another, "That wee lassie was chased out of the ward last night." The other patient said, "She's a doctor, aye?" "Aye," replied the man. I heard them giggling softly away. I couldn't help but smile at what I heard.
I do not know why he became so violent after his seizures. It wasn't so much the fact that he punched out at us, it was his eyes that were so so scary (and the chasing part)! After the entire event, me and L were both shakened. Later in the morning, we talked about the episode again, but we started giggling. It seems quite funny now, but it certainly wasn't funny at that time. Hope I don't get haunted by his eyes!
The funny noises/grunting came from a male patient whom I saw just a few hours before to insert an IV cannula. At that time, he was talking to me. However, when I called out his name at 2.3o in the morning, he didnt respond. He had his eyes opening spontaneously, but it was just staring blankly into the open space. His limbs were not shaking or stiff. hmmm...I thought he was probably having a seizure of some sort. The nurses informed me that he was admitted with alcohol excess and a probable head injury.
So I asked the nurse to do a set of observations on him. His vital signs were normal. I decided to put his bed flat down, just to make sure his airway wasn't compromised, but the grunting persisted. Then suddenly, his limbs started to shake violently, and as expected, he went into tonic-clonic seizure.
The entire seizure lasted about 30 minutes. I gave him 2 shots of lorazepam which finally stopped his seizures. He was not cyanosed during the attack, but I decided to put him on oxygen anyway. During the whole event, my cardiac arrest page went off, and I was like "Oh fuck!" Fortunately, the call was for anaesthetist only. It wasn't that I was worried about attending a cardiac arrest, I just didn't think I would be able to leave the patient.
After the seizure, his eyes were wide open and he was still not responding verbally to me. Since he was having a long fit, I decided to take some blood samples and an arterial blood gas from him. Whilst palpating for his pulse, his hands suddenly turned into fists! I thought it was a bit strange and continued to feel for a pulse. However, he suddenly sat up on his bed and stared at both me and L, with the MOST VICIOUS eyes I have ever seen in my entire life so far.
He had the eyes of a murderer. I know, it is not like I have seen a real life murderer (*touch wood), but his eyes were just full of anger, hatred and violent looking. Immediately, I stopped doing what I was planning to do, and told L to move back. Lucky L moved away quickly, as he punched out at her, nearly hitting her chest. I shouted at the nurse to call security.
I was trying to calm him down with the help of another nurse, but to no avail. He knelt on his bed, with his oxygen mask still attached, and continued to stare at me with those really malicious eyes. Horror of all horror, he moved forward with his knees towards me, and toppled down the bed, arms first. I was like, "L, I think we need to move back." L was already walking away from him, while I thought maybe I should help him up.
This patient got up almost immediately, and stared back at me. I turned around and started to walked really quickly away from him towards the entrance of the ward. L was ahead of me, and ran towards the ward opposite. I looked behind and saw that he was chasing after us. "Oh my god, he's after us. Run!" I shouted. We were outside the ward, before I saw security running up the stairs to Ward X. The patient stopped at the hallway and stared at me.
Security took hold of him and put him back into his bed. He was punching and kicking out at them too. The nurse that was with us was hiding under the table. Finally, after being pinned down by security, he flipped back into his normal self. He started talking, and demanded that he wanted to speak to a doctor, which was me, of course.
There was no way I was going near this man without further sedation. So I gave him a shot of haloperidol and that seemed to calm him down slightly. An hour later, he was still pretty agitated, but less violent. I gave him a small dose of lorazepam, and thank goodness, he fell asleep after that.
This morning, when I went back to the ward to do a few things, I overheard a patient talking to another, "That wee lassie was chased out of the ward last night." The other patient said, "She's a doctor, aye?" "Aye," replied the man. I heard them giggling softly away. I couldn't help but smile at what I heard.
I do not know why he became so violent after his seizures. It wasn't so much the fact that he punched out at us, it was his eyes that were so so scary (and the chasing part)! After the entire event, me and L were both shakened. Later in the morning, we talked about the episode again, but we started giggling. It seems quite funny now, but it certainly wasn't funny at that time. Hope I don't get haunted by his eyes!
Tuesday, May 01, 2007
Impressive
I saw THE most impressive chest x-ray yesterday. My colleague, L, was asked to see a man who dropped his saturations last night to 76% on errmmm, I can't remember how much oxygen. So she decided to request a chest x-ray in order to further investigate the problem.
We took the x-ray film from its folder, and gosh, we saw total right lung collapse! His entire right lung field was white on the x-ray and, he had the most impressive tracheal deviation I have ever seen!! The entire trachea was shifted to the right, and we could even see the branching of the bronchus, shifted into the right lung field. It was the perfect x-ray to show medical students.
Apparently, it was caused by mucus plugging, and L had to ask the on-call physiotherapist to come in to give us a hand.
We took the x-ray film from its folder, and gosh, we saw total right lung collapse! His entire right lung field was white on the x-ray and, he had the most impressive tracheal deviation I have ever seen!! The entire trachea was shifted to the right, and we could even see the branching of the bronchus, shifted into the right lung field. It was the perfect x-ray to show medical students.
Apparently, it was caused by mucus plugging, and L had to ask the on-call physiotherapist to come in to give us a hand.
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