Sunday, April 29, 2007

Bleeding Herself to Death

It was a rather ok night on-call yesterday. I wasn't too busy, but was kept going all night. However, my colleague, M, was quite stressed out with a really young lady, aged 33. She came in a few days ago with ascites secondary to alcoholic liver disease and menorrhagia. At that time, her haemoglobin was quite low at 6.1. Throughout the course of 2-3 days, she continued to have menorrhagia, and dropped her haemoglobin to about 5.3.

She has been relatively haemodynamically stable, as she has been receiving constant blood transfusions. However, yesterday afternoon, she deteriorated. She basically was bleeding profusely PV. My day colleagues (junior docs) tried to stablise her, and managed to get the SHO in Obs & Gyn to review her. However, they were not going to bring her into theatre or do any intervention as she was at risk of bleeding (her PT was 1.5). Having alcoholic liver disease was another reason.

So anyway, the only thing that my colleagues were advised was to continue with the blood transfusions. The poor lady was left to bleed all day until we night staff came on. Her condition further deteriorated, in which, her BP dropped quite significantly, became tachycardic at about 160 bpm, and was only saturating at about 80% on 2L oxygen. She was rigoring badly without a temperature. At that time, she has received about 11 units of RBC,a couple units of FFP and pools of platelets, and an infusion of Factor VII. All of us thought that she was going to go into a cardiac arrest. I was there to help M, as she appeared quite distressed about the whole situation. What happened was, she spilled the mixture of Factor VII on the floor while trying to prepare the infusion. It wasn't her fault, as these things happen especially at time of stress. The only thing about it was Factor VII is actually really expensive, think it costs a few thousand quid! So she asked me to prepare the mixture for her.

Our seniors were there to provide help. Almost everyone was involved, the consultant haematologist, consultant gastro, consultant O & G, ITU registrars, etc. It is SO TYPICAL that no decisions were made during the day, and only now, in the middle of the early hours in the morning, everyone begins to take the poor lady seriously. The registrar in Obs & Gyn was called in and she agreed that patient needed to be treated. She phoned her consultant who came into the hospital within 25 minutes. Unfortunately, he wasn't keen on taking her to theatre (her PT has dropped to 1.3). I mean I totally understand that she might eventually bleed to death in theatre, but are there just going to watch her bleed herself to death? Hysterectomy was not an issue as the patient was happy to proceed it with. What about something less invasive, like embolization of the artery?! I know I have totally no experience in this area, but I personally think it might be worth a shot.

So basically, the bottomline was we were pumping blood into her and she was losing it at the same time! Miraculously though, she stopped bleeding totally about 2 hours later and she told everyone that she was feeling great. I found out from M that despite improving marginally, there still wasn't any decisions made as to how to help this poor lady. She was eventually transferred to the O&G ward, where I am sure they could keep a close eye on her menorrhagia.
The cause of her menorrhagia was put down to dysfunctional uterine bleeding.

It is amazing how just ONE patient, could take up all your time and energy the whole night. M was totally knackered and I think the only thing that got her going was her engagement to her now fiance a few days ago. Congratulations to her.

Saturday, April 28, 2007

As Slow As A Snail

Last night, I was working at a rather slow pace. It was not because I was being inefficient or thinking too hard about something. I could not really walk properly yesterday.

Everytime I walk up or down the stairs, walk along the corridor, stand up from a sitting position, I felt sharp pain in my hamstrings. Guess I have no one to blame except myself. Just 2 days ago, I decided to increase the intensity of my treadmill regime, and *ha *ha, no surprise, I strained my muscles.

So no matter how quickly I tried to walk from different wards, the pain in my muscles were killing me. A journey that would normally take just 1 minute, took about 4 minutes. Hence, the slow pace. The pain has improved now, although I realized that my quadriseps got tired fast as I walked up the stairs.

I shall put a hold on the gym just now.

Thursday, April 26, 2007

Heigh-ho, Heigh-ho

Heigh-ho, Heigh-ho
Its work from home I go

I restart my night on-calls this evening. Feeling extremely lazy, but at the same time, glad that in just 7 days, I will not have any further night on-calls till August! woohoo! I really do not mind doing the night shifts. I know, this must sound really weird, but honestly, I think the hospital is really so peaceful at night, ie, no one walking about, no one shouting, no ward rounds, nothing. Of course, you will curse yourself when there are a few sickies to attend to, and that is when it gets really busy. But hey, that's why I am doing an on-call, to help treat the sick patients. It is quite interesting to see the patients and find out what is their problem. If I get the diagnosis correct, I become happier.....it boosts my confidence!

Oh well, I gotta leave soon.

Heigh-ho, heigh-ho
Its work from home I go.

Wednesday, April 25, 2007

Boob Size or Talent?

My friend, CK and I watched The Curse of The Golden Flower yesterday. The movie was quite interesting, as you get an idea of how hatred amongst themselves led to the development of personal plots to kill one another. The king, in the end, lost all 3 sons. During the movie, I thought it was pretty bizzare that every hour belongs to a different chinese zodiac animal.

Although the movie was shown in Mandarin (which should be my mother tongue), I could vaguely make up what they were saying and had to rely on the English subtitles, just like the other kwai lous. How embarrassing!

The making of the movie must have cost alot of money too. I noticed that every female extra, whether tall or short, plump or thin, had their own costume. Every male extra has a pot of crysanthemum to hold on to. And look at the number of soldiers they had. I highly doubt that they were all computer generated. I have to say I was surprised that those people during that era dressed up so sexily. All female extras were showing off their cleavage! haha.

At the end of the show, CK threw a simple, funny but pretty obvious question, "Do you think they hired these actresses because of their talent or their boob size?" If you have seen the movie, I am sure you would know the answer.

Monday, April 23, 2007

Set 2 now completed

Finished my 2nd set of night on-calls this morning. And I have only 1 more set to go! I have to say the time really past so quickly. The weekend on call didn't go as bad as I thought it would be. Pretty quiet, everyone quite stable.

I have 2 days off before I start the other set, so I am planning to chill out! =)

Friday, April 20, 2007

Violence is More Important than A Cardiac Arrest?!

Oh dear, I got into trouble last night.....Well, I do not thing I was wrong, unless my assumptions have been wrong.

Ok. I was in a Ward A, when my SHO paged and asked me if I could go to the ward upstairs (ward B) to check on a patient who was violent. He said a security alert has been released but he was too busy to walk over to the medical block to sort it out, and requested me to go on his behalf. He said I should leave whatever I was doing and go up immediately.

So, up I went. It was the same man who has been causing trouble for the past few days. He was in really bad DTs, and I think, he probably has either Wernickes or Korsakoff syndrome. Apparently, he got out of his bed, spat his tablets at the nurses, punched out, kicked, tried to break the fire alarm, etc. There were 5 security guards pinning him down. Yeap, he was THAT violent.

When I was up there, the bed manager/ clincial co-ordinator was up in the ward too. He asked, "That took you quite awhile to come up." I was like, "I don't carry the page and it was my SHO who asked me to come up." "Well, let me tell you, a security alert takes priority. It is, in fact, more important than a cardiac arrest," he said back to me very seriously. I turned red, as what I normally do, and said, "Oh right. I am sorry. But I do not hold the arrest page, it is the other JHO. And I don't think we get security alert calls." "Well, obviously she needs to be here then. Where is she?" he snapped. I shook my head and said, "I dunno." He was clearly unhappy.

Anyway, while I was trying to sort out what other sedatives I can give this man, I received a page from a different ward. "Hi, there's a man here with COPD, he has desaturated to about 85% on 28% oxygen." I told her that she can put up the oxygen and I would see him shortly once I sort this security alert first.

About 15 - 20 minutes later, I walked down the stairs towards that ward with the desaturating man. I met my colleague, the other night JHO and she said, "There's an arrest in this ward." I was like SHIT! My horror came true, it was indeed the man with the low saturations that arrested!

When I arrived, they had done 2 cycles of CPR. The SHO was looking at his notes, and found that patient was actually not for resus. Hence, CPR was discontinued. Patient died not long after that. I felt really really guilty, because, maybe I could have made him die in a more comfortable manner, ie less short of breath. His wife arrived 15 minutes later. I followed the SHO into the patient's room to provide support and also to learn how to break a bad news to the family.

She burst into tears the moment we told him about his death. I felt absolutely devastated. I thought I was going to burst into tears too. You know, before this man desaturated, I was asked to put an IV cannula into him. He was so bright and cheerful, chatting away to me. And now all of a sudden, during the arrest, he was cold, clammy and pale....and now gone. It was dreadful. I felt really guilty.

The SHO told me that she saw him the day before, and she thought he was going to die within the same day. She added that there was nothing I could do that would prevent him from dying. The nurse gave me a big hug and advised me not to worry either. "These things happen," she said.

Ah well, I am ok now. But I still don't get why violence is more important than a cardiac arrest? Or maybe the bed manager/clinical co-ordinator was just telling me a big lie?

Dear god, I am praying for a peaceful night for once this week! Thank you.

Thursday, April 19, 2007

A Grand Start to The Night

When I first arrived at work, I caught up with the day JHO to find out if he has anything to handover to me. 15 minutes into the start of my shift, I heard the Sister's page going off, like this, "*Teet *teet *teet. Cardiac arrest Ward 9." I was thinking to myself, "Oh no."

I ran upstairs to that ward and found the nurses crowding over a patient who I saw the day before with haematemesis. Mind you, this was the first arrest, in which I was the first medical staff there....urggh!! I saw one nurse on top of his bed, while the other trying to fix the bagging stuff. But no one was maintaining patient's airway. So I quickly did the usual head tilt chin lift thing. The nurse on top of the bed was waiting to start compression. I said, "Don't wait, start compressing." The sister who held the arrest page started to hook the patient up to a cardiac monitor. He was in PEA. While they were doing the BLS, I tried to get an ABG. Obviously, I was blindly ramming the needle into his groin, in hope of trying to get a sample from his femoral artery. I got a sample, and thought it was a venous one, but I analyse it anyway. I ran for my life to the next block of the hospital to get it analysed.

10 minutes into the resuscitation, the whole arrest team decided that it was really inappropriate to resuscitate the patient. The registrar was about to call out the time of death, however, my colleague said, "Wait, I can feel a pulse!" Then, the patient started to breathe. However, he only had a GCS of 3. His ABG showed that he was very acidotic and had a potassium of 7!! Immediately, we gave him calcium gluconate and insulin dextrose.

He continued to breathe and survive for another 3 hours, before he left the world. It wasn't fair to the patient to try another round of CPR. I really think it was good for him. He had hepatorenal syndrome and was grossly ascitic. Having said that, I felt quite sad that he left, because for the past few days, he has been annoyingly funny to be with. You get what I mean? He kept swearing at you when you try to go near him, he kept grumbling the moment you need to replace his IV cannula. He shouts, "Doctor, where are you? Oh for fuck sake, why are you doing this to me? If you're not going to remove this catheter, I am going to pull it out from my d**k."

It was funny at that time. But when I saw him lifeless, it felt so strange. Lucky I was in the same ward as the sister who carried the arrest page. See, I do not hold the cardiac arrest page, it was the other night JHO. So I would not know of an arrest until someone informs me about it.

*phew It was really a grand way to start my night shift. The rest of the night was pretty constantly busy, but no one particularly ill.

May he rest in peace.

Wednesday, April 18, 2007

Set 2 of Night On-Calls

Remember I said that I have to do 3 sets of night calls? Well, I just started my 2nd set yesterday.

Tuesday night was busier than Monday night. On Monday, I had to deal with a nurse who kept pestering me to do things which could be done in the morning by the day staff. For example, she asked me to chase a patient's Doppler ultrasound result, who is being treated as having a DVT, ie, patient is already on subcutaneous injections of dalteparin. Now, what I do not understand is, why are you calling me at 3 am in the morning, to chase up the result of the scan? Patient is already having treatment for DVT, so whether or not the patient has a DVT, is definitely not as urgent as a patient who is having a haematemesis.

Anyway, after being pestered twice by that really irritating nurse, I decided to look up the computer to obtain the report. Hah! Believe it or not, patient has not even gone for the Doppler scan!!! I told her right in her face, "Look, patient hasn't even had his scan." She looked blank and said, "Oh sorry, it was handed over to me that patient went for it." hmm...yeah right.

Last night, a middle-aged woman was desaturating to about 71% on 35% oxygen. and developed frank haemoptysis. She has a background of pulmonary fibrosis, and was admitted with possible pneumonia or a pulmonary embolus. She was and still is under treatment for both. Anyway, I told the nurse to give the patient double jet oxygen. To my horror, they could not find a proper tube to do that, therefore, the patient had to make do with just a nasal cannula and an oxygen mask, which obviiously does not maximise the oxygen delivery compared to a proper double jet oxygen kit.

At the same time, I wanted to check the lady's arterial blood gases (ABG) and asked the nurse where do I find the ABG kit. She pointed to a cupboard. I searched the entire cupboard, but could not find any. I asked her where do they stock the kits up, and she said she'll look it up in the store for me. She came back a few mins later without any ABG kit. I decided to go to the next ward, just right opposite to get one instead. Again, there wasn't any around! WTF?! Both ward are RESIPIRATORY wards, and if you don't even have an ABG kit, how could you possibly be a respiratory ward?! This was really bad and I was quite annoyed to be honest. It wasted my time, walking to the wards upstairs to find the kit.

Oh well, night calls are always peculiar. I need to eat something now before I leave. Ciao!

Monday, April 16, 2007

Pictures Galore!

Mini Eiffel Tower, Petrin Hill, Prague. This tower is indeed an imitation of the Eiffel Tower in Paris, just shorter though.

The famous Charles Bridge, over River Danube, Prague.

Stunningly beautiful stained glass at St. Vitus Cathedral, Prague.

Big red tulips at the Royal Garden, Prague.

The blackish building is The Church of Our Lady Before Tyn, Prague.

The astronomical clock, Prague. This is a cool clock as it shows the movement of the sun through the 12 zodiac signs.

Szel & I standing on Charles Bridge, Prague.

The Great Synagogue, Budapest.

Me overlooking River Danube in Budapest.

A bridge in Budapest.

Sunday, April 15, 2007

All Smiles

I'm back from my holidays! The past week has been really funtastic. Both Budapest and Prague had excellent sunny weather, and yes, I have managed to get tanned! Yippee! (my housemates would know how much I treasure being tanned)

My friend, Szel, and I left on Saturday morning to Budapest. The day started really strangely. At the check-in counter, we were informed by a member of the staff that our flight has been cancelled because the ground workers at Budapest Airport were on strike. We were surprised and went to the Help desk. The officer rechecked our tickets, disappeared for about 15 mins, and gave us the assurance that the flight will proceed as arranged. *phew. I was actually thinking about plan B, just in case we were not able to board the flight.

The first 3 days of my hol was spent in Budapest, Hungary. I must say that I was not totally impressed by the views of Budapest. The scenery was beautiful, but nothing stood out to me as "wow," if you get what I mean. Having said that, I still enjoyed my trip. We booked a room right in the middle of the city. The room was actually part of a 3-bedroom penthouse, with an exceptionally nice view of River Danube. Mind you, we only paid about 24 pounds per person per night, which I thought was pretty reasonable.

The funny thing about the room was the shower curfew. You must be wondering what this is all about. Well, the hostel owner told us that we should not have a shower after 11pm because it would disturb the neighbour of the hostel. Pretty weird eh? We did not obey the curfew and I was the first person to go for my shower at about 5 minutes past 11 pm. As soon as I turned on the shower, someone began banging against the wall of the bathroom. I was shocked. This carried on for about 15 minutes, before whoever that was behind the wall, stopped. The next day, we made sure we had out shower before 11pm. haha. I learnt the reason for the curfew was because the neighbour is a famous Hungarian actress....(so what? fame is irrelevant!!)

From Budapest, we took an overnight train to Prague. The train ride was "interesting." Why?

1. The whole train was not lighted up. It was pretty scary and eerie as it was about 8pm when we got on the train.

2. The train was not like any other train I have sat before. In a single coach, there were 3 rooms. In fact, the structure of the train was pretty similar to the train featured in the Harry Potter movie. There were 2 seats opposite each other, no beds.

3. We were woken up about 10 times throughout the entire journey, for ticket and passport inspections. Waking us up for the inspections were fine, but the way we were woken up was rather frightening. The officer slid open the door to the room with a loud "bang" and mumbled away in Hungarian/Czech, requesting for our tickets/passport. To add to my fear, the immigration officers carried guns! I have not seen such officers with guns before.

We arrived at Prague early in the morning. I LOVE Prague the moment I stepped out from the train. The city is, no doubt, more beautiful than Budapest. Things were much cheaper and shopping was excellent! Prague is a very walkable. Szel and I conquered every part of this picturesque city by foot! We also managed to catch "Carmen" and "Bolero" at Prague's principal concert hall. The performance was short and sweet. Food was simply delicious and the coffee in the cafes....wow...it was THE best. Oh....I would love to visit this place again if I get a chance in the future.

I am all smiles after this short break. =) But, I have to admit that I am pretty exhausted. And I am not looking foward to go back to work tomorrow.

Saturday, April 07, 2007

Happy Easter

Happy Easter everyone!

Enjoy munching away at your easter eggies/bunnies!

As for me, I will be munching on easter chocs in Budapest and Prague! =P

Yeap, I am going on a holiday for a week to those places, so I will update you guys with pics and stories when I'm back!

Cya later!

Thursday, April 05, 2007

Of Spinning Head and Pounding Heart

After a week of hard work, my friends and I decided to have an all gals night out yesterday. Everyone had just worked over the weekend and was in need of some sort of social activity. Therefore, we all decided to head to the nearby pub for some food & ETOH (or alcohol in simple terms).

The place was called Club 500. It looked rather posh from the outside, but in fact, the food is affordable. I ordered a "top tastic penne chorizo arrabiata." It was excellent! The portion wasn't humongous either. To accompany our meal, we ordered a bottle of sauvignon blanc. We began chatting away about our very "fun" working life, bitching about other doctors and complaining about how neglected some patients are in the hospital, in which, as the result of that, led to their preventable deaths. Such a shame indeed.

As the chat went on and on, my friends ordered more wine. So in total, by the end of the night, we had 3 bottles of white wine among ourselves, ie, 3/4 of a bottle per person. Boy! That was quite alot for me. I normally could drink about 2 glasses of wine, however, I had 3 last night.

hehe.

The consequence? Yeap, I ended up feeling hot and flushed, my head was spinning slightly. I could hear my heart pounding in my ears, and I actually felt I was going to be sick. Thank god I did not vomit!! It has been a long time since I felt like that... but besides that, all of us had a great night out together, and I am sure there are plenty to come!

Monday, April 02, 2007

Set 1 now completed

I finished my first set of night shifts this morning! Really glad that I have completed it because my sleeping pattern was taking a toll over me.

On Monday morning, my seniors had red eyes and looked absolutely shattered. Me? Well, I was not in an awful state, except that my eyes resembled those of the pandas with bilateral ptosis and on top of that, I had blurry vision, my stomach was growling viciously, my limbs showed power of 4 out of 5.

I will be off duty for tuesday, and will act as a floater from Wednesday till Good Friday. I know I just had 2 weeks off during CNY, but I will be on holiday again from Easter weekend onwards for 1 week. =)

Unfortunately, after 1 week off, I will be back to complete another 2 sets of nights shifts! Not looking forward to it at all!