I have the "pleasure" of doing night shifts again. This is my first on call as the leader for the hospital at night team....which actually, scares me, ALOT.
Anyway, over the past 2 nights, I have been in contact with ITU.
Now, my understanding is, contact ITU if you think a patient may need ventilatory support.
And now, what would you do for the following:
Situation 1
A young middle aged lady, with severe COPD and morbid obesity, was admitted with exacerbation of her COPD. She took 2 of her sleeping tablets before coming to the hospital. She was mainitaining her own airway, but was very drowsy. When she falls asleep, her respiratory rate went up and she developed marked wheeze.
Situation 2
A young man with known asthma, was found with respiratory depression. He denied taking any illicit drugs on that day, but did admit that he is a drug abuser. He has a GCS of 14, and his respiratory rate was only 8. Oxygen saturation was 95% on 12L oxygen. He was also in respiratory acidosis.
Now, my impression of the above is they are both fairly sick...and may lose their ability to maintatin their own airway, if they drop their GCS. Therefore, I contacted ITU to keep them informed. However, I was told by the ITU doctor that these referrals were inappropriate?
She even told me off over the telephone. sigh. She was not interested. Well, at least, I have done my bit to provide medical care....
Sunday, August 31, 2008
Friday, August 29, 2008
bye!
SzeLeng, my buddy, has left Glasgow for good this morning.
Good for her...going back home...home sweet home, to her family, bf, etc... sweet.
I felt really strange saying goodbye to her. It was also pretty weird in the way that every ticket she bought was only 1 way. It's not like I am not going to see her again.... but I think it was just very weird. I had mixed feelings. I was happy for her, but at the same time, I felt heavy hearted for her to go. We have been good friends for the past 4 years. She is my shopping buddy, coffee buddy, ranting buddy, movie buddy, etc... We have connected so much and became close friends.
Anyway, take care my dear friend.
Thank you for being there for me when I needed it the most. =)
HUGGIES!
Safe journey...and all the best!
Good for her...going back home...home sweet home, to her family, bf, etc... sweet.
I felt really strange saying goodbye to her. It was also pretty weird in the way that every ticket she bought was only 1 way. It's not like I am not going to see her again.... but I think it was just very weird. I had mixed feelings. I was happy for her, but at the same time, I felt heavy hearted for her to go. We have been good friends for the past 4 years. She is my shopping buddy, coffee buddy, ranting buddy, movie buddy, etc... We have connected so much and became close friends.
Anyway, take care my dear friend.
Thank you for being there for me when I needed it the most. =)
HUGGIES!
Safe journey...and all the best!
Wednesday, August 27, 2008
What Can't Kill Me, Can Only Make Me Stronger
That is the motto I hope to carry with me throughout my life.
For the first time in my career, I actually broke down and cried at work! I seriously could not believe that happened.
I guess I have been having a rough time at this hospital. Last week, I had sick patients every day. Today, I had another person who was really sick, and had to be transferred to HDU.
To be really really honest, I do enjoy looking after the sick patients. It is interesting and rather exciting. You have to find out what the main problem is and also decide what is the action plan. And I think this is why I chose to go into medicine.
However, I think my consultant has not been very supportive. I told him that I have transferred the patient to HDU for closer monitoring, and his reply was, "what are you going to achieve from that?"
I was abit baffled. This poor man had a potassium of 7, which is potentially life threatening; his creatinine was 656 and was completely anuric. The bottomline is he has developed hepatorenal syndrome...and from that, he is going to die. He already has a "Do Not Resuscitate" order, but he would still be for active management.
So I really do not understand what the consultant meant when he asked me what was the point of moving into HDU. He said, "Well, if you want to do that, just do it, then." Now, how supportive is that? I went on to do it anyway. And, at the end of the conversation, he told me, "HAve fun with the sick patients!" WHAT!!?
I felt that he was not supportive of what I was doing. MaybeI should not have moved the patient to HDU, but if he is still for active management, why not?
I felt abit down because of that. And to make matters worse, my fellow colleague, came up to me and asked if I was feeling ok. She placed her hand on my shoulder. And that was it....I didn't know what happened, maybe it was a sensation of self-pity and what not that swept across me...and the tears just started to run down my cheeks. I think it must be all the stress that was cooking inside of me over the past few weeks, and to add on top of that, I was feeling very sorry for the wife of my sick patient..... If my colleague hadn't put her hand on my shoulder, I would have been fine!!!!
I don't know if any one of you were in that funny position ever. When a friend came up and asked if you were ok, and it just kicks you off....hehe.
It was so embarrassing!!! =(
Ah well, at the end of the day, I bumped into my consultant, and he enquired about our sick patient. And his final reply was, "It was not a bad idea after all." I was thinking to myself, if you had said that earlier, I would have felt better. Sigh.
The whole situation did not kill me, but I guess it could only make me stronger!
Here's to another day of adventure tomorrow!
For the first time in my career, I actually broke down and cried at work! I seriously could not believe that happened.
I guess I have been having a rough time at this hospital. Last week, I had sick patients every day. Today, I had another person who was really sick, and had to be transferred to HDU.
To be really really honest, I do enjoy looking after the sick patients. It is interesting and rather exciting. You have to find out what the main problem is and also decide what is the action plan. And I think this is why I chose to go into medicine.
However, I think my consultant has not been very supportive. I told him that I have transferred the patient to HDU for closer monitoring, and his reply was, "what are you going to achieve from that?"
I was abit baffled. This poor man had a potassium of 7, which is potentially life threatening; his creatinine was 656 and was completely anuric. The bottomline is he has developed hepatorenal syndrome...and from that, he is going to die. He already has a "Do Not Resuscitate" order, but he would still be for active management.
So I really do not understand what the consultant meant when he asked me what was the point of moving into HDU. He said, "Well, if you want to do that, just do it, then." Now, how supportive is that? I went on to do it anyway. And, at the end of the conversation, he told me, "HAve fun with the sick patients!" WHAT!!?
I felt that he was not supportive of what I was doing. MaybeI should not have moved the patient to HDU, but if he is still for active management, why not?
I felt abit down because of that. And to make matters worse, my fellow colleague, came up to me and asked if I was feeling ok. She placed her hand on my shoulder. And that was it....I didn't know what happened, maybe it was a sensation of self-pity and what not that swept across me...and the tears just started to run down my cheeks. I think it must be all the stress that was cooking inside of me over the past few weeks, and to add on top of that, I was feeling very sorry for the wife of my sick patient..... If my colleague hadn't put her hand on my shoulder, I would have been fine!!!!
I don't know if any one of you were in that funny position ever. When a friend came up and asked if you were ok, and it just kicks you off....hehe.
It was so embarrassing!!! =(
Ah well, at the end of the day, I bumped into my consultant, and he enquired about our sick patient. And his final reply was, "It was not a bad idea after all." I was thinking to myself, if you had said that earlier, I would have felt better. Sigh.
The whole situation did not kill me, but I guess it could only make me stronger!
Here's to another day of adventure tomorrow!
Friday, August 22, 2008
Ya Man...This is Stressful
What a week!
Its been an extremely stressful week for me.
There was no consultant cover for 1 week. A couple of my patients became acutely unwell everyday, it was as though they were taking their turns.
Why the stress?
Simply because I do not like leaving the hospital without knowing whether my management plan is appropriate for the patient. Yes, I have made a few decisions about how to treat the patient, but at the end of it, when someone who is really sick, ie, peri arrest, I would really appreciate a senior review, either a consultant or a registrar (whom this hospital does not have).
So I start to build up this stress in me...the stress of not knowing whether my plans were good enough for the patient, the stress of whether I was missing something, the stress of having to pass on a sick patient to the night team, without a senior review on the patient, etc...
For the past few days, I was literally at the level of wanting to pull all my hair out and scream. Even my consultant, who returned in the middle of the week, said, "I think you're going to have a nervous breakdown by Friday."
huh?! thanks (with alot of sarcasm).
Luckily, when Friday finally arrived, I was back to my usual self. I was no longer stressed.
But man, I am not liking this hospital system very much!
Its been an extremely stressful week for me.
There was no consultant cover for 1 week. A couple of my patients became acutely unwell everyday, it was as though they were taking their turns.
Why the stress?
Simply because I do not like leaving the hospital without knowing whether my management plan is appropriate for the patient. Yes, I have made a few decisions about how to treat the patient, but at the end of it, when someone who is really sick, ie, peri arrest, I would really appreciate a senior review, either a consultant or a registrar (whom this hospital does not have).
So I start to build up this stress in me...the stress of not knowing whether my plans were good enough for the patient, the stress of whether I was missing something, the stress of having to pass on a sick patient to the night team, without a senior review on the patient, etc...
For the past few days, I was literally at the level of wanting to pull all my hair out and scream. Even my consultant, who returned in the middle of the week, said, "I think you're going to have a nervous breakdown by Friday."
huh?! thanks (with alot of sarcasm).
Luckily, when Friday finally arrived, I was back to my usual self. I was no longer stressed.
But man, I am not liking this hospital system very much!
Sunday, August 17, 2008
WoW!
MICHAEL PHELPS is UNSTOPPABLE!!
He is THE GREATEST EVER!
Breaking a number of world records...and winning a total of 14 olympic GOLD medals!!
Where is he going to find space to display them all??
Wow....I'm totally amazed!
And also congratulations to Elena Dementieva...who took the women singles gold!
And, and...i'm happy for Roger Fed who won the gold in the mens double! NEver really seen him playing in a doubles match before...but good on him...he deserves it.
I hope Nadal wins the gold today! He is the official world number on Monday!
*keeping my fingers crossed for our malaysian hero, Lee Chong Wei, who will be bringing an Olympic medal home, hopefully it would be gold...
He is THE GREATEST EVER!
Breaking a number of world records...and winning a total of 14 olympic GOLD medals!!
Where is he going to find space to display them all??
Wow....I'm totally amazed!
And also congratulations to Elena Dementieva...who took the women singles gold!
And, and...i'm happy for Roger Fed who won the gold in the mens double! NEver really seen him playing in a doubles match before...but good on him...he deserves it.
I hope Nadal wins the gold today! He is the official world number on Monday!
*keeping my fingers crossed for our malaysian hero, Lee Chong Wei, who will be bringing an Olympic medal home, hopefully it would be gold...
Saturday, August 16, 2008
Rainbows!
Red and yellow and blue and green,
Purple and orange and pink,
I can sing a rainbow,
Sing a rainbow,
Sing a rainbow too!
Listen to your heart,
Listen to your heart,
And sing everything you feel,
I can sing a rainbow,
Sing a rainbow,
Sing a rainbow too....
More rainbow! =D
Purple and orange and pink,
I can sing a rainbow,
Sing a rainbow,
Sing a rainbow too!
Listen to your heart,
Listen to your heart,
And sing everything you feel,
I can sing a rainbow,
Sing a rainbow,
Sing a rainbow too....
Rainbow!
More rainbow! =DIts amazing how the rainbow greets me in the morning, on my way to work, and also in the evening, on my way back to home. Its pretty.
Monday, August 11, 2008
30 roundabouts later...a pitta bread and 500 mls of water...i'm knackered...
the journey to my new workplace is really interesting.
now, instead of turning left into the highway, i have to turn right instead. the distance is approximately 27 miles...just 7 miles extra to travel, when compared to my previous workplace.
anyway, the thing i found most amusing was the fact that there were so many roundabouts to drive round. this is no exaggeration....i have to drive around 15 roundabouts!! so in a day, i would have driven around 30 roundabouts to and fro. i wonder why they need these many roundabouts? i think scotland, is by far, the country with the most number of roundabouts on their roads.
i couldn't be any more glad that my weekend on calls are over. i was really apprehensive about it. on the first day of work at this hospital, i freaked out when my bosses told me, "you are it. you are the most senior medical doctor for the whole hospital." I went into a panic. i always had at least a registrar on call with me....but now, i am THE registrar.
sigh. I was so scared and worried about it that the night before my weekend on call started, i dreamt that i killed a patient. in my dreams, this poor lady's face turned from pink to blue to purple and finally, white. i woke up with a jolt. it was so vivid! i looked around, and realised that i was still in my bed at 3 am! its amazing what stress can do to you.
so on friday nite (thats when i began my on call)....everything was chaos. it was a busy day. there were 5 patients that came in all at once, as though they took the bus together to the hospital. my junior residents were taking their own sweet time finishing their ward jobs (which i can totally understand, because it was only the 3rd day into the job as a doctor).
i tried my best to speed up...but by 9 pm, when the night team arrived, there were about 4 more patients who needed to be reviewed. i felt guilty. i mean, i really did try to speed up...but there were just a high influx of patients, and i was constantly bleeped by other junior residents, asking me really super basic questions like, "what should i do for this patient who has been diagnosed with bilateral PEs?" or "how much potassium you think i should prescribe, if his potassium level is 3.4?"
saturday was equally bad. i think i am normally a rather calm person, but on saturday, i felt i was losing the plot. i felt like i needed to scream. but i did not, of course. imagine if i had lost it, the whole hospital would be chaotic. i was anuric, hypoglycaemic, and dehydrated. i only had a pitta bread and 500 mls of water for the whole day....no wonder i felt like crap by the end of the day. i also stole some chocolates from the nurses, just to keep me going.
sunday was marginally better. i woke up quite early in the morning, and managed to catch abit of the olympic women's gymnastics on TV. the other thing that lifted my spirit was the beautiful rainbow that accompanied me during my drive to the hospital. it was so pretty that i actually stopped my car briefly to take this photo with my hp camera. gorgeous no?
am dreading my future weekend on calls. *yaawwnn....time to sleep.
now, instead of turning left into the highway, i have to turn right instead. the distance is approximately 27 miles...just 7 miles extra to travel, when compared to my previous workplace.
anyway, the thing i found most amusing was the fact that there were so many roundabouts to drive round. this is no exaggeration....i have to drive around 15 roundabouts!! so in a day, i would have driven around 30 roundabouts to and fro. i wonder why they need these many roundabouts? i think scotland, is by far, the country with the most number of roundabouts on their roads.
i couldn't be any more glad that my weekend on calls are over. i was really apprehensive about it. on the first day of work at this hospital, i freaked out when my bosses told me, "you are it. you are the most senior medical doctor for the whole hospital." I went into a panic. i always had at least a registrar on call with me....but now, i am THE registrar.
sigh. I was so scared and worried about it that the night before my weekend on call started, i dreamt that i killed a patient. in my dreams, this poor lady's face turned from pink to blue to purple and finally, white. i woke up with a jolt. it was so vivid! i looked around, and realised that i was still in my bed at 3 am! its amazing what stress can do to you.
so on friday nite (thats when i began my on call)....everything was chaos. it was a busy day. there were 5 patients that came in all at once, as though they took the bus together to the hospital. my junior residents were taking their own sweet time finishing their ward jobs (which i can totally understand, because it was only the 3rd day into the job as a doctor).
i tried my best to speed up...but by 9 pm, when the night team arrived, there were about 4 more patients who needed to be reviewed. i felt guilty. i mean, i really did try to speed up...but there were just a high influx of patients, and i was constantly bleeped by other junior residents, asking me really super basic questions like, "what should i do for this patient who has been diagnosed with bilateral PEs?" or "how much potassium you think i should prescribe, if his potassium level is 3.4?"
saturday was equally bad. i think i am normally a rather calm person, but on saturday, i felt i was losing the plot. i felt like i needed to scream. but i did not, of course. imagine if i had lost it, the whole hospital would be chaotic. i was anuric, hypoglycaemic, and dehydrated. i only had a pitta bread and 500 mls of water for the whole day....no wonder i felt like crap by the end of the day. i also stole some chocolates from the nurses, just to keep me going.
sunday was marginally better. i woke up quite early in the morning, and managed to catch abit of the olympic women's gymnastics on TV. the other thing that lifted my spirit was the beautiful rainbow that accompanied me during my drive to the hospital. it was so pretty that i actually stopped my car briefly to take this photo with my hp camera. gorgeous no?
am dreading my future weekend on calls. *yaawwnn....time to sleep.
Sunday, August 10, 2008
i need to keep my cool
i need to keep my cool
i need to keep my cool and be strong
i need to keep my cool and smile
and i need to keep my cool.
SIGH.
i am so exhausted that i actually couldn't sleep...how bizzare is that?!
i need to keep my cool and be strong
i need to keep my cool and smile
and i need to keep my cool.
SIGH.
i am so exhausted that i actually couldn't sleep...how bizzare is that?!
Tuesday, August 05, 2008
Its a Brand New Year!
One year has just flew by me. Can't believe that I have been a SHO for one year. The first day being at work as a SHO felt like ages ago. Its been an interesting but occasionally frustrating year.
Now, its the time to change over. Well, in fact, its time for all doctors to start new. Freshly graduated medical students, will start to be new JHOs. Current JHOs will become SHOs. Current SHOs will either become senior SHOs or registrars.
It feels really strange, leaving all the people at work whom I have bonded with. To be honest, I really do hate changeovers. I think it is even worse this year for me because I'm moving on to a new hospital all alone. No one I know is going there with me. And I have not heard anything good about this hospital so far, apart from the beautiful scenery I get while driving there. The response I have got from my fellow colleagues are " Oh. Good Luck!"
wtf?!
And the whole hospital organisation is bloody disorganised. I have contacted the hospital management a couple of times to find out what my rotations would be, and what are my working hours, etc. All I got was, " We will tell you on Wednesday during induction day." What is that all about?! How fair is it, going to work, not knowing which department you will be in, what time you're meant to finish, whether or not you'll be working over the weekend, and....I have not even seen my contract?!!
I do not even know how much I am getting paid!
Tell me, which job, is like this? It is only in medicine that we face all this kind of shite.
Anyway, thats just my thoughts.
Wish me luck tomorrow.... I am feeling very apprehensive about it. More senior, more responsibility. I do not think I am ready yet. Help!!!
Now, its the time to change over. Well, in fact, its time for all doctors to start new. Freshly graduated medical students, will start to be new JHOs. Current JHOs will become SHOs. Current SHOs will either become senior SHOs or registrars.
It feels really strange, leaving all the people at work whom I have bonded with. To be honest, I really do hate changeovers. I think it is even worse this year for me because I'm moving on to a new hospital all alone. No one I know is going there with me. And I have not heard anything good about this hospital so far, apart from the beautiful scenery I get while driving there. The response I have got from my fellow colleagues are " Oh. Good Luck!"
wtf?!
And the whole hospital organisation is bloody disorganised. I have contacted the hospital management a couple of times to find out what my rotations would be, and what are my working hours, etc. All I got was, " We will tell you on Wednesday during induction day." What is that all about?! How fair is it, going to work, not knowing which department you will be in, what time you're meant to finish, whether or not you'll be working over the weekend, and....I have not even seen my contract?!!
I do not even know how much I am getting paid!
Tell me, which job, is like this? It is only in medicine that we face all this kind of shite.
Anyway, thats just my thoughts.
Wish me luck tomorrow.... I am feeling very apprehensive about it. More senior, more responsibility. I do not think I am ready yet. Help!!!
Monday, August 04, 2008
All About The Medical Profession
Recently, I came across these little descriptions about doctors and medical students. They sound quite funny actually...and if you let your mind wander....you will realise that these statements are very true indeed.
The Medical Student
Runs into buildings
Recognises a train 2 out of 3 times
Hits himself with a water pistol
Don't stay afloat without life preserver
Mumbles to himself.
The JHO (junior house officer)
Makes more skidmarks on a wall when trying to leap buildings
Is run over by a train
Is not issued ammunition
Dog paddles
Talks to walls.
The SHO (senior house officer)
Barely clears a picket fence
Loses tug of war with a train
Can sometimes handle a gun without inflicting self injury
Swims well
Talks with animals.
The Registrar
Leaps short buildings in a single bound
More powerful than a switch engine
Faster than a speeding gun
Walks on water if the sea is calm
Talks with God if special agent is approved.
The Medical Student
Runs into buildings
Recognises a train 2 out of 3 times
Hits himself with a water pistol
Don't stay afloat without life preserver
Mumbles to himself.
The JHO (junior house officer)
Makes more skidmarks on a wall when trying to leap buildings
Is run over by a train
Is not issued ammunition
Dog paddles
Talks to walls.
The SHO (senior house officer)
Barely clears a picket fence
Loses tug of war with a train
Can sometimes handle a gun without inflicting self injury
Swims well
Talks with animals.
The Registrar
Leaps short buildings in a single bound
More powerful than a switch engine
Faster than a speeding gun
Walks on water if the sea is calm
Talks with God if special agent is approved.
Celebrity Names
Do you feel that your brain seems to relate things together even if you were not thinking about it in the first place?? I think this is more pronounced when you're tired.
Now, what the hell am I talking about?!
Let me tell you.
Funny shifts do funny things to my thought process. Last week has been particularly strange. I have been looking after patients with the initials of MG, JL and NJ. And guess what I have been calling them, instead of their proper names?? Macy Gray, John Lennon and Norah Jones.
WHAT?
I do not know how that came up. But their names were so closely related to the names of these famous celebrities, that my brain subconsciously matches their names together...and I started to call them Macy Gray, John Lennon and Norah Jones, respectively. Now how peculiar is that?
My fellow nurses and colleagues were laughing at me. I couldn't help it too...it was rather amusing actually.
Now, what the hell am I talking about?!
Let me tell you.
Funny shifts do funny things to my thought process. Last week has been particularly strange. I have been looking after patients with the initials of MG, JL and NJ. And guess what I have been calling them, instead of their proper names?? Macy Gray, John Lennon and Norah Jones.
WHAT?
I do not know how that came up. But their names were so closely related to the names of these famous celebrities, that my brain subconsciously matches their names together...and I started to call them Macy Gray, John Lennon and Norah Jones, respectively. Now how peculiar is that?
My fellow nurses and colleagues were laughing at me. I couldn't help it too...it was rather amusing actually.
Saturday, August 02, 2008
Horrible End
You know, at the end of 7 night shifts, all you want is a nice little ending to it. I mean busy is fine... but I do not like it to end horribly.
Guess this will never happen. So far, all my night shifts this year have ended horribly. But nothing has prepared for what happened yesterday.
I was extremely upset...was at the verge of crying, but I tried to keep my cool.
I have been looking after a very sick patient in the HDU overnight. He was such a lovely man. Although he was rather unstable, he managed to survive the night. But just before my shift ended, his condition deteriorated further. I was there to review him. I think, or at least, I hope, I have done what I could have done in order to prevent a cardiac arrest. However, he arrested.
At the end of CPR, we had to stop because he was not going to survive. I felt very very upset. Think my colleague could sensed it...and kept asking if I was alright.
To be honest, I am ok with deaths. But somehow, this was different. You know, its like you have put in so much effort to save him, and bonded very well with this patient. It was heart wrenching to see someone die. I know we should not be too emotionally involved with patients...but, doctors are human too.
oh well.
Guess this will never happen. So far, all my night shifts this year have ended horribly. But nothing has prepared for what happened yesterday.
I was extremely upset...was at the verge of crying, but I tried to keep my cool.
I have been looking after a very sick patient in the HDU overnight. He was such a lovely man. Although he was rather unstable, he managed to survive the night. But just before my shift ended, his condition deteriorated further. I was there to review him. I think, or at least, I hope, I have done what I could have done in order to prevent a cardiac arrest. However, he arrested.
At the end of CPR, we had to stop because he was not going to survive. I felt very very upset. Think my colleague could sensed it...and kept asking if I was alright.
To be honest, I am ok with deaths. But somehow, this was different. You know, its like you have put in so much effort to save him, and bonded very well with this patient. It was heart wrenching to see someone die. I know we should not be too emotionally involved with patients...but, doctors are human too.
oh well.
Subscribe to:
Posts (Atom)