Harassed

It was a pretty exciting day for me at work today.

It started off with a gentleman with a NSTEMI and sepsis of unknown origin. He went into shock. I was not sure whether it was cardiogenic or just purely sepsis. To complicate matter, he went into fast atril fibrillation and his BP dropped even further. Never have I seen a patient as blue as he was. He was both peripherally and centrally cyanosed.

The second patient was a patient with active variceal bleed. By the time I saw him, he already vomited like 1L of blood! The surgeon inserted a Sengstaken blakemore tube to stop him from bleeding. I remember being a medical student and reading about variceal bleed. As far as I could recall, Sengstaken is used during clinical emergency where there are no other means to stop the bleeding.....and this is normally RARE.

Anyway, me being me, I was panicking. I have no idea how to manage this tube. The surgeon who inserted it started to give me instructions about how to inflate and deflate the balloon...how often I should do them, how long I should leave the tube in..etc...

As he was speaking, nothing was registering in my brain. Everything sounded Greek to me. It was too much information in an emergency situation. Then I went into a phase where I could see his lips moving, but I could not hear anything (i know this is very sad). All that came into my mind was this patient needs to go to HDU because no one in the receiving unit would know how to manage the tube.

The poor man was actively retching and bringing up fresh red froth. He was also actively losing blood from his rectum. The surgeon was busy trying to maintain the balloon of the Sengstaken tube inflated. The nurses were suctioning his mouth. I was trying to get a better IV access in him. It was all abit chaotic at the endoscopy unit.

He was nearly in shock. His BP went to about 109 systolic, he was tachycardic at 176! The nurses wanted to go home because it was 5.30pm already. But there was no way there were going to transfer him back to the normal ward. He has to go to HDU. But the nurses insisted on leaving and they just moved back to the ward against my advice! sigh. What can I do. But this really annoyed me.

Imagine this. Say for example, if I was in the middle of trying to resuscitate a patient (just like what we were doing to the bleeding man), and it was 5pm, which is the time for me to go home, should I just leave and say, "Oh look, its 5 pm. I am going to go home. You guys can carry on resuscitating him." But have we doctors ever do that? A big and loud NO. But why do nurses get away with that?? This remains a mystery. We stayed on to work on him..until he is stable enough and we are happy that he is in the appropriate unit and has a proper management plan in place. (my apologies to any nurses reading this).

Back at the ward, the other nurses were giving me the stares. I felt guilty...but really, it was out of my control. Anyway, he eventually went to HDU...... like 2 hours later.

I felt so harassed. In the midst of all these events, I have the consultant surgeon on the other end of the phone telling me how ridiculous of us medics to leave a man with hepatic encephalopathy in HDU. To be honest, this patient had a GCS of 7 to start with...he obviously had picked up when the surgeons were there to visit the HDU. The HDU nurses were also on my back telling me to step this patient down. But I just didnt have the chance to do that because I was occupied with other sickies.

Then, when I went back to the ward, everyone seems to be looking for me. Imagine this. When I walked out from a particular room, one nurse, one houseman, one DVT nurse specialist, all decided to call my name in unison. I was being attacked at all angles.

Oh man...it was a crazy day. And I'm absolutely drained.

That's Not My Name

Attended their gig at the Barrowlands, Glasgow Sunday night...and boy, they rock! As irritating as their songs can sound on the radio, but when you see them performing live...it was brilliant! =)

They sang a few of their popular songs such as Great DJ and of course, the super catchy "Shut up and Let Me Go!"

In A Difficult Position

I think many of us have been a difficult position before. It could be situations where you have to tell your mum that you broke her treasured vase, or situations where you have to tell dad that you drove his car into the back of another vehicle, or situations where you end your relationship with your boyfriend/girlfriend...etc...there are just so many situations that one could think of, that would place a person in a very difficult and uncomfortable position.

As a doctor, I think the most difficult situations I have faced so far is telling a patient that he or she is dying, or telling their loved ones that the patient is not going to pull through much longer. The other thing I find difficult is the decision making involved in the care of a dying patient. At what stage do you decide that you want to withdraw treatment and just keep the patient comfortable? And when you decide to take away all treatment, you are more or less "sending" the patient to his or her death. But then again, if you continue treatment, you are just prolonging the patient's suffering....and is that justified? Is that fair to the patient? This is tough.

A couple of days ago, I was left in another difficult position. A patient was terminally ill with cancer. To complicate matters, this patient was under police custody and have to stay in prison for a couple more weeks. Now, although I have never lived in the prison before (in fact, I sure hope I won't be at that stage one day), I am aware that it is not comfortable. The environment is gloomy and cold. It is certainly not the best place for a person who only has a couple more weeks to live. But at the same time, I can't allow him to stay any longer in the hospital given that we have treated what we could. It felt cruel sending the person back to prison. My colleague put this thought into my head, "It is unfortunate that the patient has cancer and is dying, but the patient commited a crime which led to imprisonment."

I guess she has a point. However, I couldn't help feeling sorry, but at the same time, I have to do my duty as a doctor, and discharge patients when necessary, to allow medical treatment for other patients.

I rest my case.

Foolish Me

I seem to be making an absolute fool out of myself more frequently these days. I wonder why.

The other day, when I was on call, I actually contacted the consultant who was at home having his dinner, to inform him of a patient whom I was pretty worried about. She was a young lady with funny movement in her left arm, power of about 2/5 in both legs, horizontal nystagmus and GCS 14. Although she was not hyperventilating, her arterial blood gases showed marked respiratory alkalosis. I thought about an urgent CT scan of her brain, therefore, I wanted to discuss this over with the consultant first.

This consultant of mine, is actually the consultant whom I have been attached with since I started working in this hospital. I told him about this patient, and I SWEAR, I heard that he thinks she may have a subdural haematoma. So I asked him, "So you wanna CT her tomorrow?" He said, "Yes."

Horror of all horror, when I went to work the next day, I met up with him to discuss about a few of his patients whom I have reviewed during the ward round. He revealed to me that, "I actually wanted the CT urgent, not the next day. She had it done at midnight yesterday."

I was like "oOpppsss." I asked how did he find out that she didnt get a CT scan in the first place. He told me he contacted the ward to find out whether this lady had been for the scan, and as soon as he knew she hadn't, he requested for one.

I couldn't feel any sillier (if there is such a word). I made a total fool of myself. I kept thinking over the telephone conversation I had with him...sigh...but what is the point eh?

Glad to find out that her CT brain was normal. *phew. Imagine if she actually did have something serious, I would probably just kill myself.

To make matters worse, I told him about a middle aged lady who was admitted with diarrhoea and vomiting, who I thought actually had aspiration pneumonia, because she has been vomiting persistently for like 10 days. He laughed. He said, "How could a young lady get aspiration pneumonia?"

I was abit dumbfounded. I thought aspiration pneumonia happens when your saliva or your vomit or when anything went down the wrong tract (like vomitus too). He laughed further. hmm... and then, I soon realised how foolish I was! How could a fit and healthy lady get aspiration pneumonia, especially when she has no problems with swallowing?! But then again, how do explain cases where healthy patients get admitted because of aspiration of foreign objects, which most often affect the right lung, just because the right bronchus is more vertical than the left?

tsk tsk tsk. i dunno.

sawling, sawling, you really need to stop being so silly and foolish. Silly mistakes you make when you're not thinking properly. hehe.

A Lovely Surprise

I got a little note from the postman to collect a parcel at my nearest post office a few days ago. I didn't have the chance to collect it until yesterday morning.

I do now know about you. But when I get a note saying that I have a parcel to collect, I actually am quite excited about it. I wanted to know who the sender is, and what is inside the parcel.

hehe...so on Saturday morning, I made my way to the post office. I was handed a big yellow envelope, which was very light, but pretty bulky. There was something inside the parcel which was quite big.

The moment I got home, this was what I received!

isn't so cute?? hehe... I absolutely loved it.

It was a gift from my buddy, SS. It was really sweet of her and not to mention, the hardwork put into creating it all. Everything was handicrafted by her!

SS, I am very impressed! Thank you so much!

HUGS! MUACKS!

And Let The Countdown Begin!

18 more days to go...

and guess what?

I'll be back to home sweet home. Yes, back to visit my mummy, daddy, koko, kiki, and my beloved friends. =)

ooh...I can't wait!

It has been a long time since I was last home....to be more exact, it would be 1 year and 10 months! This is indeed the longest length of time I have been away!

The Garden?? sorry, what did you just say? oh...where is The Pavillion? Is there even such a place in KL??

hehe...iIm very ulu, i know. But fear not, when I do get home...explore these places, I will!

right...now I just need to focus on my work...and without knowing it, I would soon be on the flight home!!

=) trust me, I am smiling from ear to ear even when I'm typing this. **tee hee hee

James Morrison - You Make It Real

Oh...I can't wait for his new album to come out!! Love his voice, love his music!

Come, sing with me.

Mmmmm
There's so much craziness, surrounding me
There's so much going on, it gets hard to breathe
When all my faith has gone, you bring it back to me
You make it real for me

When I'm not sure of, my priorities
When I've lost site of, where I'm ment to be
Like holy water, washing over me
You make it real for me

And I'm running to you baby
You are the only one who saved me
That's why I've been missing you lately
Cause you make it real for me

When my head is strong, but my heart is weak
I'm full of arrogance, and uncertainty
When I can find the words, you teach my heart to speak
You make it real for meee, yeaaa

And I'm running to you baby
Cause you are the only one who save me
That's whyyy I've been missing you lately
Cause you make it real for me

Ohhh
Everybodies talking in words
I don't understand
You got to be the only one
Who knows just who I am
Your shinin in the distance
I hope I can make it through
Cause the only place
That I want to be
Is right back home with you

I guess there's so much more
I have to learn
But if you're here with me
I know which way to turn
You always give me somewhere,
Somewhere I can learn
You make it real for me

And I'm running to you baby
Cause you are the only one who save me
That's why I've been missing you lately
Cause you make it real for me

You make it real for me

Bananas Make Me Yellow

I met a funny patient yesterday.

He was yellow, ie, jaundiced. But the problem was, he didn't realise it because he has dementia. To be fair, he was only mildly disorientated. This was what happened.

Me : Hello Mr. X. How are you?

Mr. X : Oh hello dear. I'm alright.

Me : So do you know what brought you into the hospital?

Mr. X : I dunno, doctor. I've got some tummy ache.

Me : Oh ok. I think your GP sent you up because we were abit jaundiced, you know, your
skin is all yellow.

Mr. X : Is that right? I didn't know that.

Me : Look, your skin is quite yellow. (me pointing to his skin)

Mr. X : Oh...I dunno. Sigh. No more bananas for me.


=D I broke into a big grin. Mr. X said that without even smiling or laughing. I guess he really meant what he was saying! kekeke.