Tulips Like I Have Never Seen Before

I was really surprised with myself when I told my good old friend that I would meet her in Amsterdam over last weekend. I was kind of worried that my viral illness would spoil the trip...but my tummy was fine. No further diarrhoea, no further vomiting. The only problem was nausea... but that also settled when I arrived at Amsterdam. :)

Tulips were the main attraction in Amsterdam that I really wanted to see. And I was not disappointed. The Keukenhof Garden is certainly a MUST when you are in Amsterdam. Unfortunately, the flowers only bloom during spring time...so I guess, it is best to visit the garden just about now.

The tulips were extremely beautiful, colourful and smelt really really nice. The tulips were fat and sturdy. They stood tall amongst all the other flowers displayed at the Keukenhof Garden. The blue muscari flowers, or also known as the grape hyacinths, had a really strong sweet scent. Somehow, even though my friend and I spent 6 hours walking around the garden, I did not feel tired....In fact, I felt relaxed and satisfied.

Spectacular!

The colours were so vibrant.

The carpet of tulips...















A flower mosaic resembling the dragon. It consisted of over one thousand flower buds, and was created to celebrate the Beijing Olympics.















Colourful...

The Sunset Orange Tulip, was measuring nearly 15 cm in diameter!!!

Arent they gorgeous?















A nice little pond in the garden.















Ballerina Tulips.















More tulips.

Viral Bug Had Hit Me

It has been more than 10 years since I last vomited.

It was really strange vomiting yesterday. The day started off really nicely. I woke up from bed feeling absolutely normal and hungry, as usual. I went on to have my usual cereal breakfast and drove to work. Halfway through my journey, my stomach didnt really feel right. But I thought maybe it was wind.

Anyway, I proceeded to do my daily ward rounds....and about an hour and a half later, I just felt queasy. I could feel a lump building up in my throat. I am sure you know the feeling just before vomiting...you get that sour taste at the back of the throat...that was how I felt yesterday. At that time, I managed to stop myself from vomiting....unfortunately, 15 minutes later, the same sour taste started again....(mind you, about 30 minutes before this, I was reviewing a patient's chronic leg ulcers, and I could bear the minging smell of the ulcers. However, I think because I was not feeling 100%, it kind of exacerbated my nausea).

Quickly, I headed to the toilet...and almost immediately, I vomited quite a huge amount of liquid and my breakfast! yuck! It was not a pleasant feeling. My throat felt sore after all the retching.

I felt so relieved after vomiting, although the nausea and abdominal discomfort persisted. I proceeded to join the ward round after that... I did not want to make a huge fuss about it. Moreover, the hospital was short of staff, and I am not too sick to take leave.

I was not too bad all day. During my journey back from work, I started to feel really nauseated again. I was like *Oh Shite! I was in the middle of a busy motorway...I could not find a place to stop my car properly, and I was going to vomit any minute. It was awful! I did not want to vomit all over my clothes or in my car....so I decided to empty my tissue box and use it to contain my vomit. Fast thinking, eh? :P

Anyway, I managed to park along the hard shoulder on the highway. I opened my car door...and started to retch. But nothing came out. About 5 minutes of rest and with the help of some fresh air, I felt better and continued my journey home.

I slept early and woke up intermittently overnight. I felt slightly better this morning, but had body ache all over. I did not vomit today...but I still do not feel back to my normal self. I looked pale and drained....silly viral bug! I had some dinner...but felt sick after it. Oh well, I just hope that I'll be fine by this weekend! :)

Takut lah...

With reference to my previous entry, I had to face my fear yesterday.

A patient died peacefully in one of the wards. It was 10 pm at night, and I was asked to certify her death.

At first, I didn't think much about it......until, I stepped into the room. There I saw a pale, white female patient, lying on the bed, with her eyes closed and her mouth gaped open. As I approached her body, the scene from The Orphanage suddenly flashed in front of my eyes.

Honestly, I kind of felt scared. As silly as it may sound, I was actually SERIOUSLY worried that she would grab my hand when I auscultate her chest to listen for any heart or breath sounds. Takutlah....

So I hesitated for awhile. I was rather tempted to ask if the nurse would accompany me in the room. However, I reassured myself that she is definately dead, and stop acting like a small kid. Before touching her body, I introduced myself to the dead body and explained what I was going to do. The 3 minutes that I took to certify her death, felt forever!!

*phew I left the room hurriedly and was really glad that the body did not wake up from the dead!

Traumatised by The Orphanage

The Orphanage is a Spainish film about a grown-up orphan who purchased her beloved childhood orphanage with dreams of restoring the long abandoned facility as a place for disabled children.

My friends told me that it is a horror film....and I don't fancy watching films in this category. I was reluctant to watch it initially, but got dragged along by my friends.

The show was actually quite good... The story unfolded very nicely, but it was SCARY!! The scariest scene was where a bus knocked an old lady. A man performed CPR, but she did not survive. Her face was covered with a white cloth. The lead female characterer (lets call her X) approached the dead body and wanted to take a whistle which was hanging by the body's neck. As X's hand inched closer to the whistle, all of a sudden, the hand of the dead the body grabbed on her wrist. *yikes! I jumped!! It was creepy...

This scene has changed my life.... I don't think I can face a dead body ever again by myself. In my medical profession, I have to certify dead bodies. It is not an intimidating procedure (except for the first time performing it). However, after watching this scene, I am really scared... I would now worry that the dead body would suddenly spring into life and open his/her eyes, or even grab my hand!!

I know it sounds silly...but heck... I am traumatised...at least for the next few months! haha.

Dear Oh Dear...

Do not be surprised to see my car's picture or my name in the newpapers tomorrow morning.

I do not sleep well post night on-call. The most I get is 3 to 4 hours. On-calls are on-calls, busy busy bee. So I do not get a chance to catch a short nap. Moreoever, there is no on-call room for medicine....ie, no place to rest anyway. Therefore, driving home from work is extremely dangerous.
Yesterday, while driving home, I started to doze off about 15 minutes into my journey. Lucky me, traffic was very slow...and I was not driving fast. Otherwise, I really do not know what would happen to me. Thank god for keeping me alive till this second.

In the end, I made an exit from the motorway and parked at one of those shopping malls along the road. Almost immediately, I fell asleep.......zzzZZZZZzzzzZZZZZzzz..... the next time I opened my eyes, it was 12 pm! I slept nearly an hour and a half!! gosh.

Passer-bys must have thought I was mad. But I am glad that I managed to nap awhile before continuing the journey. Today, I was not too bad...managed to pry my eyes open throughout the entire journey home. So if you see my name in the papers tomorrow morning, you would be able to predict what happened.

Funny Night

It was a busy night on call. This hospital that I am currently working in was the first hospital in Scotland which adopted the "Hospital Emergency Care Team" at night. The team includes 2 nurses, 2 medical doctors, and 2 surgical doctors, who were responsible for any emergencies or problems that occur either in the wards or the receiving units.

It is scary, trust me. It was only my 1st week in general medicine, and I am apparently, "the second most senior medical doctor on call?!" Yikes!

Anyway, the night started off pretty busy. There were a number of patients who were unwell, you know, the usual chest pain, shortness of breath, abdominal pain, malaena and haematemesis. One of the patients in particular was really funny, but annoying.

He was in his late 30s, with alcoholic liver disease. I was called urgently to see him, as he started to scream in pain suddenly. I rushed off to see him after reviewing a patient with saturations of 88% on 3 L of oxygen. Just as I pushed open the double doors, I could hear him screaming in pain. The nurses looking after him looked pretty stressed.

I went to his bed....and there was jaundiced man clutching his tummy and moaning in pain. I asked him what was wrong...and he didn't answer. I asked him where exactly is his pain...again, no answer. Instead, he took my hands and rubbed them on his tummy. He has a distended abdomen, which apparently just developed over the past 2 days, according to the nurses. I continued to fire him a few questions, but I never got an answer from him. All he did was scream in pain.

During this entire conversation, I heard a voice of another man in the background. This man was saying, "It is all in his head, he does not have any abdominal pain, he needs a psychiatry assessment." I looked at the nurse who was assisting me with this patient. She smiled and whispered, "Don't worry...it is the patient next to him. He is a retired GP, who is likely to be suffering from Korsakoffs."

Right.

The voice continued, "Tell him to shut up and he will be fine." "He does not need anything for the pain. He is disturbing everyone...and now I can't go to bed."

A few minutes later, he suddenly appeared behind the curtains and said, "I can help. Is that the doctor (while looking at me)? Tell her if she needs advice, I would happy to give some." He had messy hair and was walking around the ward with sunglasses. It is amazing how he could find his way around the room, as none of the lights were switched on, apart from the bedlight beside the man in pain.

I could not help smiling, and it was difficult to stop myself from giggling. The man in pain continued to moan despite morphine. What I found funny was why he did not talk...I mean, come on, no matter how painful you are, you would be able to give me at least 1 word answers. Once the morphine started to kick in, his moan kinda slowed down... So I thought I would go and reassess him.

Unfortunately, when I appeared at his bed, his moan grew louder. Again, I attempted to ask him a couple of questions, but my efforts proved futile. Somehow, I felt that he was "at it." The nurses told me that he normally speaks and has not known to be a difficult patient. Strange.

I could not be any happier when I handed my on call pager to the person in the morning!

Pink -> Blue -> White & Cold

I felt so nauseated yesterday.

It was my second day in the respiratory ward. I was not late this time. In fact, I thought the day started just fine....I began my rounds at 9 am sharp.

One patient after another, I finally arrived at a lady patient who has been having recurrent infective exacerbations of COPD. When I saw her yesterday, she was short of breath even at rest, but maintaining her sats above 90% with oxygen. She appeared anxious as well. I have been giving her some oramoph yesterday in order to reduce her anxiety and make her comfortable. Looking through her notes, I noted that her condition deteriorated yesterday. She dropped her saturations. However, she managed to improve overnight.

When I met her yesterday morning, she remained breathless but in fact, I felt she looked abit brighter and less anxious. I asked her how she was doing. She replied, "Oh much better doctor. I was abit unwell last night. But I feel so much better now." I noticed that she did not have her vital signs checked since 6 am this morning, so I asked if the nurse could repeat it. Unfortunately, her saturations were only 81%!!

I sent off her arterial blood gas and gave her some more nebulisers and oramorph. Her saturations improved. I went on to review other patients, while waiting for the results of her ABGs to come back. However, a nurse came up to me and said, "Ling, come now."

I ran over to see the same lady...and there she was, staring straight into the curtains in front of her. I caller her name many times, but she did not respond. Her breathing was laboured. I was like, "Oh no!"

I got the arrest trolley and was about to send out an arrest call...when the nurse told me that she was not for resuscitation. I knew that she was not for ITU or invasive ventilation, but I did not know she was not for CPR. I was glad, in a way, that the nurse pointed this out to me, otherwise, I would be conducting a CPR on her unnecessarily.

In a split second, I noticed her colour changed... from pink, to blue...and then, she was as white as a sheet. A second later, her tongue protruded out of her mouth. I knew her spirit had left her. I gave her high flow oxygen in a final attempt to keep her comfortable. She had an extremely slow pulse of only 1 beat every 5 seconds....and not too long after, her heart just stopped beating. Her hands suddenly felt cold to me....

I felt really sick after the whole event. I felt a lump building inside my throat and oesophagus. It was not because I was going to burst into tears...hmm, I don't know how to describe my feelings then. It was just horrible, to witness a cardiac arrest. I have seen many arrests...but this is different.... I literally watched her die. The only comfort I got was the fact that I gave her more oramorph to keep her comfy. So hopefully, she did not die painfully. I lost my appetite completely after that event.

I could not ask for a better afternoon. The rest of my day was not as bad as the day before. I went home, still thinking about this lady....may you rest in peace, my dear.

Back to the Buzzling World of General Medicine

First day at work in general medicine as a SHO....hmm....did not really go very well.

1. There were cattles and horses running wildly along the highway. Although I left my flat 10 mins earlier, I was 20 mins late to work. Not a good impression at all.

2. Arrived at the hospital. Now where should I report? See, I have been contacting the relevant people...but none of them seem to wanna tell me which dept I was meant to report. So I walked from one secretary to another...before finally told that I would be based in respiratory for the next 4 months.

3. Got the short straw. I had to review patients under this particular consultant who was on-call over the weekend. So obviously, he had many more patients spread over the entire hospital... not to mention those that were already in the respiratory ward.

4. To make matters worse, I had to stop my rounds at 11 am to attend an induction. The induction was to give all new doctors about the nature of the job and our rotas. Damn.... an hour flew by just like that....argghh...still have many patients to review.

5. As I am new in these wards, I did not know where to look for the notes. I did not know the patients very well (which made me spend more time reading through their notes...and it was not easy reading the "cakar ayam" doctors' handwriting).

6. Then, I became the bad person because 2 of the patients were apparently fasted since midnight, but was not on the list for their upper GI endoscopy! So they fasted for nothing...and I was blamed...sigh. All I could do was apologised...but they were obviously not happy. After investigating further, I soon found out that no referral was made by the doctors before me... sigh. How irresponsible!

My legs were like jelly, my lips were cracking, my head was pounding due to dehydration, my stomach was rumbling, my urine was so concentrated... You know, sometimes I wonder, why we are al so concerned about a patient's urine output, when my own output was <10ml/hour as well? This is the reality of medicine I suppose. We work hard to ensure patients are well, but we tend to forget that we are also human, and could potentially become a patient if we don't look after ourselves. And sometimes, patients think we are bionic human...