Too early?

Is there such a rule that states a person should not put up a christmas tree in the house 4 weeks before christmas day?

Well I hope not!

Because I just set mine up a few days ago! =)

hehe...I have been looking for the so-called "perfect" tree a few weeks ago...well, to be honest, ever since I saw christmas decos in the shopping malls. I thought about getting a nice lovely black tree, rather than the traditional green one.

So I went hunting, you know, whenever I went out for a little shopping spree. Finally, I found the perfect tree! I am sure everyone would agree that you can get almost anything from Argos. Yeap, I stopped by Argos last weekend, and looked through their christmas catalogue.....and hold and behold, I saw a tree that I liked.

It was a 6 foot tall ash black xmas tree.....the fact that it was discounted, made it even more attractive. So I purchased it without much thoughts. I also bought new white LED lights to match it.

When I got home, I could not wait to put it up.... (I know, it is pretty pathetic). To be honest, I am sucker for things like this. I like to see nice little things in the flat, I like to feel all christmassy....I mean, it is only once a year...so I might as well enjoy it to the max. hehe.

Anywho, with some help from Kevin, my brand new tree is all set up! There are a mix of red, gold and purple baubles. It looks absolutely lovely! It is so therapeutic just looking at it, especially when the white lights flash around. I actually look forward to turning on the lights when I get home from a tiring day at work. All I need now is to get a few christmas pressies to put under the tree.

It is amazing how simple things in life can just make it so much more colourful.

30 days and counting down to Xmas..... =P

Doubting Myself

I just completed a set of night shifts. I was really frustrated last night...because of A nurse in this haematology/oncology ward. I am happy if she wanna tell me what to do...but to say that she's not happy with my instructions until i speak to the consultant? now....does she think i'm rubbish? or what?

There was a very sick young boy last night. I told her I was going to check his blood gases (ie, to check the oxygen level in his body). And this nurse said, "Oooh...no...you cant do blood gases. It's not appropriate in these patients...we do not do blood gases in this ward."

I was like what? How can you say that? How do you know its appropriate or not? It isn't very helpful to say such a thing especially when somebody is so ill. Blood gases are indicated if a patient is extremely short of breath, and is not able to maintain his own oxygen saturations such as this poor sick boy.

So then, I thought, right, maybe I'm not doing it right....I doubted myself...which was so silly of me. Anyhow, I contacted the consultant to inform him about this ill patient, just to inform that about what I have done so far and if he has anything else to add. He also advised me to check his blood gas....

Later, she refused to give this poor gentleman paracetamol until I speak to the consultant first?! Now....i think that's just taking the mickey. Apparently this man has been sneaking some paracetamol of his own, and has been told against doing so. But that story was a good 3 days old. If worried about an accidental overdose, his LFTs and coagulation screen would be off by now. But they aren't. His temperature has been sky high all day and night...clearly he hasn't taken any! She said she's not happy to give him paracetamol, unless the consultant gives the heads up. Luckily it was nearly 7 in the morning when this incident happened...and I didn't feel too guilty contacting the consultant. Imagine, making the phone call at 3 am???

We were all trying to work in the patient's best interest, but I didn't understand why it didn't feel that way.

Would You Like An Eye Opener?

It was 8.30 am in the morning. I was on-call overnight, and was just trying to get things ready for the morning ward round.

While looking up a patient's blood results, a heard a patient calling me.

"Doctor, doctor, can I go home?" said patient G.

I turned around to see who that was...and soon realised that patient G was admitted overnight with an impulsive overdose of his epilepsy medications. He was drowsy initially, but he had obviously improved.

"No, not yet. The consultant needs to review you first."

"Oh ok. Errm, can I get a bottle of vodka please?" asked Patient G.

"Errmm...no. This is a hospital. You can't get vodka in here. Would you like a cup of tea instead?" I replied.

"No doctor, you don't understand. I need my vodka. I normally drink some first thing in the morning," added patient G.

It was very unprofessional of me to chuckle to myself after he went back to his bed. But, I found him really amusing, because he was really honest about needing an alcoholic fix.

This is a classic patient we normally see in the hospital. He clearly has an issue with alcohol dependence....and he would score a point with the CAGE questionaire, for needing "an eye opener" to steady his nerves in the morning. With the help of a nurse, we managed to sit him down, and offered him chlordiazepoxide instead. Unfortunately, it didn't work very well...and he started to pace up and down the ward. We had to give hime some benzoes to calm him down before the consultant finally discharged him home.

Unexpected!

All of us at work were really shocked to learn that one of our patients, XX, collapsed and died the morning after XX's hospital discharge.

XX has been in the hospital for nearly one month. XX was diagnosed with multiple PEs. We had organised various investigations to find a cause for her multiple PEs, as she was very young. All investigations were negative. As XX was clinically better, we discharged her, with follow up arrangements.

Who would have expected XX to die the next day?

No one.

Maybe it was purely coincidental. Maybe XX was going to collapse the next day, and it could have happened in the hospital, where we could all jump on her chest and start resuscitation. But somehow, one could not help but wonder whether we have all missed something, or under-investigated her.

RIP.

Please Give Me a Chance to Speak!

Oh dear....this job is really emotionally challenging at times.

Today, I spent 1 hour on the telephone just trying to explain to an extremely dissatisfied, and misinformed daughter of a patient about her father's care.

I mean it is alright if she does not have a clue about medicine, or she has no idea about what tests we are doing to investigate the cause of her father's initial presentation.

But what I really could not understand was how could someone not even attempt to listen to what I have to say! I mean, come on, no matter how unhappy you are about any part of the care, just please, give me a chance to explain and provide you with more information.

She was extremely unpleasant to me over the phone, which, is fine, I mean, I can tolerate that. However, whenever I tried to say something to explain the situation, she just spoke over me.

She felt that catheterising her dad, who came in with acute urinary retention: "appalling."

The fact that we were not able to perform a 24 hour Holter because her dad was uncooperative (ie, kept pulling it off his body): She thought we were not doing anything.

She did not believe me when I told her that her dad was very confused and agitated. She said it was all because of the sedative meds we gave him. Ok, yes, we sedated him alittle because he was at danger of harming himself by trying to tug at different things.....But, the fact that the reason he was acting like that was due to underlying sepsis has been absolutely pushed away by her!

I dunno. I really felt like giving up at the end of the conversation. She was not listening to what I have to say, and I felt that there was not much point in even explaining things. I just wish, sometimes, people would just listen first, before jumping into any conclusions.

8 weeks into the job....and?

It has been just over 2 months since I've moved onto a new job. It is really strange, i know, but somehow, I miss the lack of staffing levels in my previous hospital, miss my old work colleagues, and miss all the banter.

I have been asked the same questions a few times over the past couple of weeks.

"So how do you find your new job?"

And my reply would be, "Its alrite."

Funnily enough, the person would say, "Why? You don't enjoy working here?"

hmm... I think using the pharse "not enjoying" is incorrect. In fact, I do like it here. I mean, I have a registrar who I can turn to, the consultants are so friendly, and almost everyone I have met so far has been extremely pleasant (apart from the odd few people).

I guess, most people think that working in this hospital is like a dream! Probably because it is a very big district hospital, with almost every specialty under the sun. But working in such a big space, means you dun get to know everyone well. I used to recall knowing all my fellow SHOs, which nurse is dating who, or what scandals there are amongst us doctors, but now, there is no such bonding. In fact, there is hardly anytime for that.

Everyone is just busy with their own jobs.

That aside, the job has been pretty hectic, and just like every other hospital, we are short of doctors!

?

I wonder whether I am asking too much out of life. Maybe I should try to be more understanding, or maybe I should just accept things as they are.

Come on, let's face the fact. You can't change the environment you are in, but you can certainly change the way you react to the surroundings. So if somehow hurts you, or if something bad takes over your life, you should really just take control of your emotions and act wisely. No point in throwing tantrums, or making yourself feel miserable about the whole issue.

Life is indeed a bumpy road. But somehow, you can only hope for that much to happen. The rest all depends on faith and fate.

I dunno. I am only ONE human out of the billions of us on this planet. But, I hope that somebody would appreciate me as I am, and not take me for granted, sometimes. I guess I can only wait and be patient; time will soon tell, but I hope that by then, I won't be tired of waiting.

Boiling Me Up!

I dun understand why some nurses can be so irrational!

Dun get me wrong, majority of nurses are fantastic. They know what they are doing, they care for their patients and understand the politics in hospital.

Yesterday, I was bleeped by a nurse from a ward at about 4.30 pm. She asked me to admit a patient, who was just transferred from A&E. I told her that I was in the middle of a meeting, and I would be unlikely to make it there by 5pm to clerk the patient. She repeated herself to me. Again, stating that there is a new patient that needed to be clerked in. So, I told her again, I understood what she was telling me. but I am unlikely to be able to make it there by 5pm. And told her that, it is probably best to get the on-call team to clerk the patient.

She put down the phone.

I finished my meeting at about 5.10 pm. Suddenly, I was fast-paged by the same ward again. Fast-paging is only used if there is a clinical emergency. So I answered the call. It was the same nurse again, and this time she said, " I'm calling about the same patient. She is now vomiting, and you still havent clerked her in."

I replied, "Is she unstable? Is she vomiting profusely for the past 20 minutes? Are her vital signs unstable?" She said,"I just wanted someone to write her up for an anti-emetic." I was like it is now past 5 pm, and I still have hundred things to sort out, why didn't she think of asking the on-call team to sort the patient out? and the fact that she has misused the fast-page just boiled me!

Anyhow, I told her nicely that it was probably best to get the on-call team to get her to prescribe the medication, and even gave her the page number. She was annoyed, and wanted my name, to file a complaint against me.

Now, I personally do not think I was doing anything wrong. The patient was not critically ill. The patient just needed some symptomatic relief. I do not see why she could not get the on-call team to sort it out. Moreoever, we all have to try our best to adhere to the EWT directive. I felt rather pissed off actually. It wasn't like I was sitting down drinking cups of tea, and ignoring my work! sheesh.

Go Away, Kidneys!

Kidneys.


The vital organs in your body that helps to get ride of our daily toxins. When the kidneys stop working, the human body struggles to function properly. In certain cases, in which, the kidney becomes dysfunctional, dialysis may or may not be deemed appropriate.


I never liked renal medicine as a student. I found it all so complicated. I could not get my head around which part of the nephron absorbs or excretes what. (Yeap...I am still confused!)

My first day weekend on-call was about 1 week ago. I was given the task of covering the Renal Unit. Oh how exciting....NOT! I hardly have any experience in renal medicine as a SHO....the only experience I had was when I was a junior house officer. At that time, all I had to do was to do the paperwork when admitting patients, perform ECGs or blood tests, and treat patients with high potassium levels in their body.

I have to admit I was pretty intimidated by the on-call itself. The day didnt start too badly...but as the time passed by, things started to go haywire.

Renal patients are chronically ill. They always seem to be unwell either DURING or AFTER dialysis. Why is it so? I still haven't found the answer. They seem to have extremely difficult veins for cannulation. I recalled spending at least 30 minutes just trying to find a suitable vein for IV access.

All of the sudden, there were 3 people kicking off in the ward. One was having his/her dialysis, the other 2 were patients post-dialysis. All scoring a EWS* of 5-7!!

I did not know where to start. I decided to go to the patient with the highest score. This person apparently just finished dialysis, and became "funny." Yeap, it doesnt get any more specific than that. To be honest, I didn't understand what the nurses meant by the word "funny"....so I decided to assess the patient myself. He was semi-conscious, speech kinda slurred, breathing really fast. I went through a few differentials, and came to the conclusion that he was profoundly septic.

The other patient had 5Litres of fluid removed from his body...and, surprise, surprise, he was profoundly hypotensive!

The last patient who was unwell during his dialysis had an "unresponsive" episode, which recovered after 5 minutes.

The weekend just kinda went into such trend. A few sickies at the same time. I guess it has given me good learning opportunities in managing ill patients. But I still do not like renal medicine.

Tickle tickle....

A cough certainly takes a long time to heal!

I developed this tickly dry cough last week...and it is still here.

For the first time in many years, I've decided to spend some money on a cough mixture, like simple linctus. I would not say that it tasted nice...it was quite sweet actually. But it didnt really help to relieve my cough.

The moment I closed my eyes, the cough became worse. I coughed and coughed, until tears started to roll down my cheeks. I took some hot water to see if it helped....no, not really. My throat was just SO TICKLY. Later, I realised that the cough was worse when I was lying flat on the bed. So I laid on the bed at about 60 degrees angulation. I continued to cough, but guess, my tiredness took over me...and I finally fell asleep.

I can say for a fact that the sleep was disruptive. Many a times I woke up coughing. I was so sleepy when I got up this morning. The cough was better in the morning...but it irritated me a lot at work. It felt like I was the ill patient in the hospital!!

As a result of the cough, my voice has changed. My patients and their family members could not really hear me clearly.

I am attempting to sleep earlier tonight. Hopefully the cough will be less annoying.

Come and gone...

I'm feeling quite sad at the moment. Mum, Dad and Bro came to visit for 2 weeks...and I sent them to the airport this morning. I just couldn't believe how fast the time flies when you're enjoying yourself.

We actually didn't do much. The weather was not good at all....it was raining everyday of the week, except on Wednesday. We saw the shy sun for about 2 to 3 hours most evenings. The wind was very strong and chilly too. But anyhow, we managed to make a few short trips to the surrounding area.

First stop, was Glasgow. I know I just moved down from Glasgow...somehow, this town is very charming. I honestly miss Glasgow. I miss the good food, the lovely cafes, the hussle bussle of Buchanan/Sauchiehall Street, the Scottish pipers....and the Accent! yeap......I miss hearing them say "cannae," "doon," "wee."

I took my family to savour the delicious Rumours cafe (malaysian cafe) in Glasgow....The wa tan hor made my day. The next day, I took them to eat brunch at Berits n Browns. Mum & dad were intrigued by the pancakes with bacon....and I must say, they were impressed with it!

On Wednesday, when it was sunnier, we decided to make a trip to Alnwick Castle and Garden. I was NOT impressed at all. Firstly, I paid 18.50 pounds each to enter...and the garden was not THAT pretty. I heard alot of good things about the garden....but I was rather disappointed. Guess I went in with high expectations. I had seen more beautiful gardens than this, and paid half the price to enter!

The only beautiful thing in the garden was the fountain cascade. The Castle was better though. It was huge, and well-maintained. We visited the part of the castle that was used for the filming of Harry Potter.

Alnwick Castle (this was where Harry Potter was filmed)

The rest of the week was spent driving to nearby towns, such as Durham, York, Redcar, Whitby and Scarborough. We kind of just visit the main attraction in each town...and spent time sitting down in a cafe sipping coffee, or eating dinner.

Scarborough was rather interesting. Guess most people will know of Scarborough from the song sang by Simon and Garfunkel. The beach was not bad. I was amazed by the local people there, who were half-naked on the beach, exposing their body to the strong chilly wind. They were also dipping themselves in the sea?! It was so cold!!! And I could not see any sign of a shiver on their faces or body!!!

Anyway, the highlight of the trip to Scarborough was the food. I managed to convince my parents to share an ice-cream with me. They would prefer to drink a hot cup of tea than eat something icy! Guess what I got?


Yeah!!! Let me introduce you to the Mega Treat ice-cream! There were 6 flavours in it...and boy, it was good! Dad was shivering halfway through the ice-cream, but insisted on eating more...haha.


Good times.....wished they could come up more often. Its back to reality for me. Its a long week ahead for me...but I'm sure it will pass quite quickly.

Time Out

My car has timed out on me...... it has failed its MOT today! =(

arrghh.... what a lovely start to my 1 week holiday eh?

I could only drive my car from the test centre back to my home. It is illegal to be driving a car without a MOT in the UK.

So, I have to find a repair centre to fix my car. Apparently, due to an accident 2 years ago, the damage to the car has started to present itself. The radiator is leaking loads, the metal thing that holds both of my front car tyres is twisted,....and as a result of this, the tyres have worn out. The exhaust pipe is "funny"....etc...

The lady at the MOT counter said, "I suggest to go to your insurance company to make a claim."

I was rather shocked. It sounded as though my car needed a massive operation! I can't imagine how much this repair is going to cost me.......and my agony has been prolonged with the fact that it is bank holiday monday here. Therefore, I can only get a quotation for the repair, at the earliest, on Tuesday! This is so frustrating.

If I make a claim from my car insurance, I would lose my NCB! I was thinking, if the price is about 500 pounds, I would pay it on my own, but anything more, I will ask the insurance company to fork it out.

Also, in view of the damages, I was thinking that maybe this is an excuse for me to get another car! I could get a higher CC car, with air conditioning? ahh..i dunno. It is a question of whether to pay few HUNDREDS to fix the car, or pay few THOUSANDS to get a new one......decisions, decisions!!!

Sigh. And now, I have just paid at least 150 pounds to rent a car for the week, just so that I can take me family around visiting....

This is just so troublesome, and stressful too.

Getting Out of My Comfort Zone

A new chapter begins this month.

1. New job

yeap...the new job started in the first week of august. It kicked off with an induction on day 01. Then, I had 1 day off, before I started my night on calls. It wasn't too bad...guess I was expecting worse. The only bad thing about starting off with night on calls was I didn't know how the whole hospital functions! I didnt know how to do simple matters, like taking blood cultures or even obtaining a radiology card to request for a chest x-ray!

The hospital at night also works so differently from my previous job. There were no nurse practitioners, no clinical support worker. And, we have to walk around carrying PDAs?! We receive our task list via the PDA....I thought it was rather fancy...but actually, carrying that gadget is so troublesome! I have to remind myself to tick the boxes on the PDA and also, charge the battery when it runs low.

System is different, but I'll slowly pick it up, I'm sure...its all about adapting!


2. New flat

=D yes....finally I can rent the whole flat by myself! woo hoo!! hehe...I have moved into a 2 bedroom flat, which is literally less than 2 miles away from the hospital....it is SO convenient. No more long distance travel....I can wake up later, get ready slowly, and I can leave my flat later too.... such pleasure!

Did I tell you about the pleasure of living on my own?? I get the whole flat to myself, of course! haha. No more loud music when I am not up for it, no more dirty sink or messy kitchen, more space for me in the fridge, no one intruding into my roon without permission....and no more using my laptop behind my back! yay! it is simply fantastic!

oh...I also got myself a little something....keke....yes....it is not little actually. In fact, it is a 32 inch LCD TV! I know, I know, 32 inches is not THAT big....but heck, this is my first TV, purchased with my own hardwork! It felt great.... The size of the TV is just about right for my wee flat. =) I am loving the fact that I can seat on my sofa, and enjoy watching what I wanna watch....I wasn't really able to do that in my previous flat coz me housemate used to watch all the soaps on the TV all night.


3. New environment

A survey 1-2 years ago said that M'bro is the worst place to live in the UK! Now, that is really intimidating for a newbie like me. I moved from a lively city, Glasgow, to a quieter place like M'bro. Not saying that Glasgow does not have its rough bits, but I don't think it is in the top 10 of the worst place to live.

Anywho, the area I'm living in doesnt seem too bad. The buildings and restaurants definitely do not look as interesting or eye-catching as Byres Road or the Merchant City. I have yet to pass by a nice looking cafe....I really miss hanging out in TinderBox or Berits n Browns.

I miss my shopping in Glasgow!! The best shopping experience here would be in Gateshead Metro Centre, which is a good 1 hours drive from here. Otherwise, the nearest retail park is at Teeside...which is actually decent. You can find the usual high street shops, just in smaller sizes. There is also a TGIF! haha.

The weather here also seems warmer and drier than cold wet Glasgow!


4. New look

I was really tired of my bob hairstyle...and decided to just go back to my short hair. My hair is now easier to manage. Drying it takes only a few mins, no styling necessary, the messier, the better!


5. Dreaming of a new MacBook!

Trust me, I have been dreaming of this for more than 1 year now. I kept telling me friends that I will buy it soon...but until now, I'm still stuck with this old notebook, which is extremely temperamental. It hangs whenever it wants to, it resets itself automatically without being told, it loads things which I did not ask for...etc...you get the idea. I have reformatted it before, but the problem persisted. So I really would like to change it, bcoz it is doing my head in. Guess it is time to make my purchase soon...but having spent so much money buying stuff for this flat....think I should postpone it will next month.


hmmm.....

The only thing lacking here is my friends and K in Glasgow. Sigh. Glad that he's coming to join me this weekend...and mummy n daddy will be here too!!!! how exciting! =)

My first weekend here was pretty boring. I spent most of the time at home, reading and cleaning up the flat. Guess I need to find more things to do, and of course, make new friends to hang out with. Moving down here has certainly opened up a new chapter in my life....and as much as everyone hates changes, I think it will only make you stronger, and it pushes one to get out of his/her own comfort zone.

CHEERS TO MY NEW FLAT!

What is the point?

What is the point of being a consultant?

What is the point of having your own outpatient clinic?

What is the point of having a timetable created to your own needs?

What is the point in smiling but not listening?

What is the point in what is the point??



And more importantly, what is the point in even bothering?!
.........................uurrgghhh............I DON'T KNOW!!

I am so frustrated today. I don't understand how a consultant can be so slow in reviewing patients at the outpatient clinic. This consultant has a timetable created to suit his/her needs...but he/she has failed to follow it correctly!!!

I mean, how difficult is it to complete your ward round on monday, rather than postponing it to another day, in which you are busier?

There are at least 30 patients in the outpatient clinic awaiting review...and this consultant only saw 5 of them?!

HELLO??? ARE YOU HAVING A LAUGH??

arghh well. What is the point in even moaning as I can't change the situation? I just have to suck it up....that's what it is.

26 days and counting

I can't believe there's less than 1 month before I move down!

All the chaos and stress in applying for a new job began about 6 months ago....and finally being told I have secured a new job down south a few months thereafter, seemed so long ago.

I am having mixed feelings about it all. I have to admit that I am slightly excited about the whole thing, you know, moving down to a new place, new environment, entering the English health board, and, living in a new flat on my own (for the first time!).

On the other hand, I don't like the feeling of leaving my current cosy flat and a few of my friends here in Glasgow. In fact, I feel extremely heavy-hearted to leave Glasgow itself! I can't believe I actually just said that. I recalled the first time I moved down here from Dundee, I felt so miserable....I didn't like the environment, didn't like the transportation system, didn't like the people....but that's all changed now.

As much as the weather is always wet, I think I would really miss it. There were Scottish bag pipers playing their tune while I was walking along Buchanan and Sauchiehall Street last weekend. And I thought to myself, "Man, I am going to miss this....the shopping is great, and where in England, would you hear the sound of bag pipes whilst shopping?"

I soon found out that the people here are friendly....and the transportation system is pretty reliable.

Anyhow, I think it is always difficult moving out from your comfort zone. I mean, why would someone leave a place that he or she is so comfortable with?

This will be a new challenge for me.
26 days and counting....

Was That Even Necessary?

Why do people need to act like a complete arsehole?


I had a few encounters with my work colleagues recently during my weekend on call. I am a pretty easy going person. But I really could not tolerate those who are irrational.

I received a referral from the A & E department about an elderly gentleman who is now having difficulty swallowing and persistent vomiting. As a result, I was told he looked quite dehydrated. I said, "That's fine...just send him up to our medical ward for further assessment." Later, I received a phone call from the managers that his admission was highly inappropriate. First of all, I was told by this colleague of mine that I do now know this patient at all (which is very true...I have never met him before...so therefore, assessment is even more imperative, no?). Then, our conversation went on like this:


Colleague X: What are you going to do about his swallowing problem over the weekend?


ME: Well, there isn't much we could do over the weekend, until he comes extremely unwell, he which he may require an urgent endoscopy. Otherwise, we should give him IV fluids and make sure he hasn't aspirated."


Colleague X: Exactly. You can't do anything for him over the weekend. If he were to get a scope...you can only do it on Monday, so why bother admitting him?


Again, I had to repeat myself.


Colleague X: I find it really hard to understand why someone with your capabilities would want to admit that patient from A&E.

I was utterly shocked and speechless.


ME: OK, look. If you think this patient is well enough to go home, why don't you document that in his notes, and discharge him from A&E. From my point of view, as I haven't laid my eyes on the patient, I would not know if he is fit for discharge. If anything happens to him, I am the one responsible because I am the person on-call.


I was arguing over the telephone! It was embarassing because I was speaking in the medical assessment bay where new patients were waiting to be seen. After a good 10 mins worth of arguement, we both put the phone down. I felt that it was complete unneccessary. I mean, I know we were verging on being short of beds, but I honestly could not simply discharge a patient without seeing him first. And I hate to say this, but, you are only in charge of the beds....you are not trained to assess whether the patient is fit enough to go home!!!

Urgh...I felt so frustrated after that.

Then, the next day, I received another mouthful from another colleague. This time it was because she thinks the patient has no comprehension of what was going on. She was unhappy that I told the patient about her diagnosis of cancer, and that she her prognosis was poor.

The thing is, this poor elderly patient of mine was clearly living the last few days of her life....and she hasn't been told what was causing her to feel so unwell. When I first assessed her, she could tell me the events leading to her hospital admission, she was well orientated to time, place and person! So on that basis, I felt she was able to understand what was going on.

This fellow colleague of mine, (lets name her Colleague G), was again being inappropriate.

Colleague G: Look, I find it shocking that you think she has even the slightest understanding of what is going on. She is completely off her head. She mumbles all the time! And you told her she has cancer?

Me: I completely respect that. But when I saw her, she was orientated, and was able to tell me her history. And she is my patient, she has the right to know....especially when she is so ill.

Colleague G: Well, I find that hard to believe. I have been a nurse for more than 20 years...and I know for a fact that she is utterly confused and has no comprehension.

Me: Ok...I know you have the experience. But even if she is that confused, she still has to be told.

I left the scene....and about 1 hour later, I received a phonecall from Colleague G. Mind you, I was on-call that day.

Colleague G: Ling, just for your information, I went back to ask the patient if she remembered talking to you. She said, she recalled that a doctor saw her, and she said something was wrong with my tummy. But she couldn't remember what was wrong with it. So there you go, for your information, she has NO CLUE what is wrong with her!

I was like WHAT?!!! Do you actually need to purposely call me to just prove a point?? Is there any need to do so??

No there isnt! Even she doesnt remember, I am still responsible for her, and she has the right to know.

Me: Ok then. Thank you for letting me know. (I was gritting my teeth while saying that). bye.

Man....what is wrong with these people?!

OR,

Maybe I have lousy clinical judgement. I dunno. This is so frustrating.

The Best Gig Ever!

Today this will be
the greatest day of our livesbefore it all ends
before we run out of time

I LOVE TAKE THAT!!!!
They were my childhood favourite boyband! =D

It was my first time seeing them LIVE...and their CIRCUS tour 2009 was simple fantastic, extravagant, colourful....and simply mesmerising! They were supported by Gary Go and James Morrison.

The gig was at the Hampden stadium. I was glad I managed to get seating tickets, because the standing ones were so packed! The entire stage was designed to look like a circus. There were acrobats, a giant silver robotic elephant, fireworks, fire....... it was simply amazing!

They kicked off by singing "The Greatest Day." Then, when they started to dance their usual routine for Pray!!! It was really nice to see them reunited again. Every member of the band had the chance to take the lead vocals.

I love their outfits...they wore smart suits...and then, dressed up in clown uniforms, and painted their face in front of the audience. They each had a go at the unicycle too!

Also, when they sang my favourite song, "Back for Good," they created rain to resemble the music video. Take That sang most of their hit songs and songs from their current album "Circus."

This was certainly the greatest GIG so far!! The ticket was pricey...but I can understand why. 230 people were involved in it! Here are a few pics I took! And, I can't believe I spent some money buying their merchandise! I am really a big FAN!!!!

Bring on more good music, Gary, Howard, Jason and Mark!!! =)

The Greatest Night!

At the merchandise store....I got myself 2 Take That baby Tees!!

The tour trucks!

James Morrison

Let the circus begins!

Mark

Take That in clown outfits.

Simple, yet Memorable

A lovely homemade Japanese cheese cake...baked by Jaclyn. It was moist and tasty. Thank you so much doll!! hugs!

My birthday was pretty simple this year...and I, personally, like to keep it simple. We all had a simple homecooked meal, followed by the cake. Then, I opened my pressies....very pleased with them. I received a cute little ladybird pendant and also Bobbi Brown's eye make up palette! =D I was, and still am, beaming from ear to ear. In addition to that, I received more earrings and a pretty bracelet. Guess, a girl can never get enough of accessories, eh?

Yet Another Year

whoa.. thank god, i'm still here!

Yeap, its my birthday today. I can't believe how fast time has flown by! I am just glad that I'm still the same, apart from the worsening eye bags and wrinkly face. =P

I did not run any marathon or 5k or 10k last year. I did not travel to any EU country either, surprisingly! The year was filled with work most of the time, and moaning about the stresses at work. I spent alot of time sorting out paperwork for job interviews and also to allow my supervisor to gauge whether I'm fit enough to pass this year.

However, I did manage to get some time off to go back home, which was lovely!

Also, I've noticed that my immune system has been super low. I have been ill, again and again. Glad to say that my sore throat and cough are both away....but I am now bothered with Hay Fever! sigh....the pollen levels are quite high these days.... I have been sneezing my nose off so much....scratching my eyes too.

This year, I will be faced with a new challenge. I will be moving down south, working a brand new environment, and coping with living by myself. Excited? I don't know actually. I'm having mixed feelings about it all. I am pretty excited about the new hospital, but not too excited about moving here on my own. The fact that the town has been rated as the worst place to live in UK, is not helping either. Guess I have to just get on with it. Will see how it goes. I am quite stressed now just having to look for a place to live!

Anyway, Happy Birthday to me. Here's wishing me the best of health and luck this year!
CHEERS!

Hello!

I haven't blogged for ages!

I've been ill....AGAIN! Then, busy with work and on-calls.

Now, I have recovered alot....but still have this tickly cough, which is worse at night, when I try to sleep. As a result, I don't get much sleep! =(

Anyway, work has been tiring...and I really HATE (maybe this word is too powerful), or rather, I DISLIKE CARDIOLOGY!

Help! I'm drowing in the sea of ECGs, ETTs, and echocardiograms! The clinics are just too outrageously overbooked for 2 person....the new patient clinics are total chaos....just because on the same day, I have to arrange various tests for the patients, and following these tests, they will see me again to get the results. So the coordination goes haywire ...and the waiting time stretches...patients become unhappy....and the vicious cycle carries on!

sigh. On a brighter note, I have managed to get all my paperwork sorted...and my educational supervisor has signed me off! yay!

have a good day everyone.

Immune System @ Its Lowest

I haven't been ill for a long time. Interestingly, the past 3 weeks or so, I've been a viral target. It first started off with me developing bodyaches, fever, and abdominal pain. This soon (no surprises) led on to the development of diarrhoea.

Having recovered from that, I developed a really bad sore throat 5 days later. The following morning, my throat was so painful that it was difficult to even swallow..... and then, my nose started to run.

Lucky for me that I am on my annual leave. So I could take the time to recuperate. However, I would also like to use my days off to enjoy the sun and do things I like! But, sadly, the weather has been miserable. And, my nose was completely blocked over the past 3 days. It is alot better now, thanks to the antihistamine and pseudoephidrine tablets. I literally could not taste or smell anything.

My kind housemate even made me an aromatherapy steam inhalation thingy....and I could not even smell the scent!!! But the inhalation was great....it did help to decongest my nose a wee bit.

Now that I am much better, guess what? Today, I had a really bad splitting headache. I thought it was because I was hungry...so I had some sugary stuff. But the headache persisted. I took some paracetamol to no effect. Dehydration? Probably not, as I have been at home all day, and definitely drinking plenty of fluids. Therefore, I decided that I needed to rest. I hid under my covers for a few minutes...but my head continued to ache..

Guess it must be some really bad viral illness I have been suffering from over the past weeks. I do hope I get better soon.... my immune system is absolutely rubbish at the moment. I better infuse myself with more Vit C.

Anywho, time to go to bed now. Hopefully my sleep will put an end to my headache. Shoooo schleeppy.....yyawwwnnn...... Nite nite.

The Best X-Men Ever!

I decided to share my germs (sore throat & cold) with the other cinema-goers yesterday.

I went to watch X-Men Origins: Wolverine!

This is the best X-Men movie so far! Loved it! Thumbs up!

The story was fantastic.....the casts were great...and for once, at least, I understood what they were fighting for...rather than the previous X-Men series. And, I didn't really like Jean Gray.

In this series, there were plenty hot casts. One of them was Gambit. I was just a little disappointed that he didn't perform much. Also, Wade was really cool. Hugh Jackman was being his usual charming self. His girlfriend (Lynn Collins) was gorgeous....and her sister, was superbly cool! I wished I have skin like hers!

hehe....so yes, please go watch it! I am so looking forward to Transformers and Terminator!

ps....my sincere apologies to those who heard me snuffling in the cinema!

I Hate Hospitals!

I know I have probably blogged about this more than 10 times. But, I hate hospitals when the atmosphere is so unpleasant.

Yeap. I am talking about dying patients. I know, I know, I have repeated myself so many times about how much I am saddened seeing patients die in front of my eyes. I am going to blog about the same thing again today....coz I AM gutted! I know hospitals are pretty unpleasant to be in anyway.

Sigh. There is a pleasant lady in the hospital who is only in her mid 50s. She suffered so many complications from this abnormal mass in her abdomen. It was only 4 months later that we finally got to the bottom of her problem. We found out that she has cancer. Unfortunately, I think her illness is rather extensive, ie, the mass is pretty big, and her general well being does not allow for a surgical operation. Chemo would not be much benefit either.

In simple words, she is dying. It is very upsetting. She is such a lovely lady. Her family are all so nice. I hate seeing them, crying away in another room, and then, to enter their mother's room, putting on a brave front. I highly respect them for being so supportive. My heart goes out to them.

I mean, looking at her today, she looked awful.....extremely pale and green. It is certainly not a good sign. I could just feel myself welling up when I saw her. She just went downhill so quickly. Sigh. I hate hospitals when it comes to things like this. =( Booo....

Highly Inappropriate

Can anybody please tell me whether or not parenterally feeding a terminally ill cancer patient is appropriate??

Hands down who agree that it is INAPPROPRIATE to do so.

hmmm......

Recently, I was treating a patient with widespread cancer to the lungs, liver and also, the bones. He was ill. We initially gave him a course of antibiotics to treat his sepsis. He did improve a little.... but after that, he never picked up again. He became increasingly dehydrated, lethargic and more unresponsive.

His swallowing was impaired, just because of his decreased consciousness. The SALT (Speech & Language Therapist) also asked to review, and she, too, was in agreement that he should not be allowed to swallow as he would be at a very high risk of aspiration.

Funnily enough, the nursing staff decided to refer this poor patient onto the dietitian. This dietitian, then, wrote in the notes the following:

" Note patient is unable to swallow. Patient would not be able to meet nutritional requirements. Consider parenteral feeding (such as via nasogastric tube or intravenously)."

I was appalled when I read that. Why would somebody attempt to force feed a dying patient? Should we not let the patient die peaceful, rather than, jamming a NG tube down his nose or poking him numerous times to gain IV access?? And, what benefit would he get by feeding him? I mean, honestly, why do you want to feed him and prolong his suffering??

I really did not get that at all.....and I felt that it was a highly inappropriate suggestion! Anyone beg to differ?

My Rotations are Out!

My rotations for the next 2 years are out!

And I am pleased to say that I am very glad to have been allocated my top rotations! =D

I will be based in JCH at Middlesbrough for 8 months, then, I will move to North Tees for another 8 months, and finally finishing my last 8 months back at JCH. My rotations include the usual core medical stuff, ie, cardiology, respiratory, gastroenterology, diabetes and endocrinology....but they also include infectious diseases and ITU! yay! I really wanted to do both of them..and I will be!

Now, the flat hunting begins!

The Best I've Felt for The Week!

I can't remember when was the last time I was ill. I think it was during Christmas last year. I was down with a cold. Since then, I've managed to build resistance against all the evil winter bacteria/virus......until last Saturday, that is.

I felt so miserable. I was acutally having a lovely dinner at this nice Italian restaurant, called Battlefield Rest, when it all started. My body started to ache all over. My beef lasagne tasted really good, but I was struggling to finish it. When I got back, I was so tired and sleepy....not long after that, my tummy started to hurt. It felt bloated and uncomfortable. I also felt feverish.

This lasted all day Saturday. On Sunday, I felt alittle better. But, again, could not master the appetite to eat anything! I dragged myself through 2 long days of calls on Monday and Tuesday....and by Wed, I was absolutely done in.

I slept really early that night....and guess what? I was feeling nearly 100% on Thursday morning...and now, I'm back to my usual self! My tummy is rumbling because of hunger...and I could actually finish my meals! Its certainly the best I've felt all week!

I'm really gonna take it slow and easy this weekend...but I have managed to sneak in a few little choc pieces today at work...keke... I know, I know, I should really keep off the chocolate...but, but, but, they were dark chocolate...and they are meant to be good for you! :o)


Have a good weekend!

Congratulations!

My heartiest congratulations to my photographer extraordinaire, Kevin, on obtaining his diploma in photography!! Not to forget that you were top 2 in the class! What can I say, you absolutely deserved it!!! After all that hardwork you have put in, the sleepless nights, the long hours of looking at the screen trying to get the pictures right....man, I am extremely proud of you my dear.

Lets go get some champagne!

Could I Have a G & T Please?

Medicine can be pretty boring, especially when all your patients are stable. No cardiac arrest calls, no sound of the emergency buzzer in the wards, no patients acutely deteriorating. I would review my patients, change management plans as neccessary, and hope that they will get better.

So at times like this...we, doctors, need to humour ourselves.


Cancer patients who receive chemotherapy are at risk of developing neutropaenic sepsis. For those without a medical background, neutropaenic means having a low white cell count (white cells are important to fight infection), while sepsis, means infection. So, when your body is low in white cells, you have low immunity, therefore, would be prone to develop different types of infections.

Different hospitals have different hospital protocols for treating neutropaenic sepsis. In my hospital, we like to give our patients G & T!

Yeah, G & T.....Gin & Tonic.

Gin is a spirit which is flavoured with juniper berries. Apparently, juniper berries have medicinal values. They act as a diuretic and also an appetite stimulant. The latter being extremely important in patients with cancer, as their appetite is normally quite poor. I mean, if you think about it, when your appetite is poor, your nutritional intake would be inadequate, and as a result, your body would not have the energy to resist infections....don't you agree??

Well, no, as much as I would like to think that Gin & Tonic could heal infections.....actually G & T stands for Gentamicin and Tazocin...which is a good combination of antibiotics to treat neutropaenic sepsis. =P

See...it is quite pathetic, I know...but at least it lifts the spirits of our patients up, when you joke with them about their antibiotics.

Having said that, I've heard that in certain special circumstances (ie, where conscious patients who are nearing their end of life or around christmas period), a small dose of alcohol has been prescribed on their drug chart, if it was requested by the patients, and if the doctors were given the green light by their boss. Being in hospital is pretty miserable...so we like to keep some of them happy! Cheers!

Unhelpful Surgeons

Surgeons - All they are interested in is to cut your body open and fix things. If nothing can be fixed, then, it would be a medical problem. This really frustrates me.

Yesterday, a cardiac arrest call was put out. We were directed to the acute surgical admission ward, where, an elderly man was extremely breathless....his face was blue....his heart rate went up to 160 beats per minute. He was admitted for problems with per rectal bleeding. I wondered whether he may have developed a pulmonary embolism (a blood clot in his lungs), or became very short of breath because of anaemia.

At the scene, the surgical reg was standing....asking for an anesthetist....who eventually arrived after a few minutes. Having examined the patient, I told him my thoughts and actions. He said "ok." While I was busy asking the nurses to give me a few medications, I soon realised that suddenly, no one from the surgical team was there with the patient. I didn't think much about it initially. The patient settled down alittle, but was still not well. I tried to look around for the surgical reg...and I later found out that he has left to go to A&E! I was like, WHAT?!

He left me to sort his patient out.....by myself?! I mean, honestly, I can understand that you have a sick patient down in A&E, but you should not just leave without even informing me! That is very unthoughtful and down right rude. The problem was I do not know what his plans were for this elderly gentleman from his surgical side. It became difficult for me to make up a plan too. I was appalled by his behaviour.

I dunno about other docs. But I have honestly admit that I do find surgeons extremely difficult to work with. I mean I can understand that they would lack experience in managing medical problems...and I would struggle to manage surgical problems. However, more often than not, we, medical people, do not hesitate to say, "yes we will take over the patient's care." Unfortunately, this is not the same for the surgeons. For example, I have found patients with Ischaemic bowels who is not fit for surgery, being left in the medical wards....or patients with acute pancreatitis. They are just very unhelpful. Imagine, if we leave a patient with fast AF in their surgical wards...they will be screaming at us to take the patient over. Anyway, think I have ranted enough.

There are a minority of surgeons who are really good....but as I said, MINORITY.

Marley & Me - John Grogan

If you haven't seen the book before, here it is! Please do read it...THUMBS UP!!!!

In the movie, they used 22 different labs to act! =)

I Love You Too, Marley

Marley. What can I say about this extremely naughty labrador?

I read the book "Marley & Me" by John Grogan a few years ago.....and I absolutely LOVED it! The book is about the life of the author, with his dog, wife and children. It potrayed the ups and downs of marriage, and the outrageous behaviour of Marley, the WORST dog in the world. I laughed alot when I read it, but also cried towards the end of it, when Marley left to go to doggie heaven.

I was really excited when I found out that the book was made into a movie. Both Jennifer Aniston and Owen Wilson did well. I felt that they had good chemistry on screen. And the dogs were so so cute. The movie had the same effect on me. I cried when I watched the movie. It was really sad seeing how Marley grew older and finally, put to sleep. In fact, most people in the cinema were sobbing too. I think, unless you have the heart of a stone, or you just do not like dogs, it is impossible to hold back the tears.

I highly recommend this movie, although, I know that most people would rather watch a feel good movie...but honestly, this movie did give me a nice warm feeling. Having said that, it made me miss my little wee Kiki at home (who is 9 human years old, but in dog age, she is 49 years old!).....and Pecan, my other little doggie who does not belong to me anymore...

Addisonian Crisis

It was an extremely interesting on-call yesterday.


At about 7 pm, I was called down to Resus in A&E. When I arrived, I saw this extremely drowsy but rousable girl. Her fingers were icy cold with mildly cyanosed fingers. Her blood pressure was in her boots; it was barely recordable! She was also tachycardic and tachypnoeic. Luckily her mother was around to provide us with some background information.


We soon found out that she was recently diagnosed with Addison's disease. She has been vomiting for nearly 1 week. She did not have any diarrhoea. Her mother insisted that the patient has been compliant with her daily steroid tablets. Addison's disease is a rare illness in which the adrenal gland fails to produce adequate steroid hormones. Steroid hormones are important to enable the body to function efficiently, especially at times of stress. Treatment for the illness would include replacing the steroid hormones by taking life long steroid tablets.


It was obvious that she was in Addisonian Crisis!! It is a potentially fatal illness. Immediately, she was given a dose of IV steroid, broad spectrum antibiotic to cover for possible sepsis (although I could not find a source of infection at that time), and fast fluids. Despite all the fluid challenges, her BP hardly responded.....at best, the reading was 40 systolic!!! I could hardly palpate her brachial or radial pulses. To make matters worse, she hardly passed any urine after 4L of fluid!! I understand that those with Addison's will have hypotension......but I was not sure whether her low BP was purely due to her Addison's, septic shock or simply dehydration.


At the end, I had to contact ITU for assistance, and subsequently, she was started on an infusion of noradrenaline to improve her BP. Fortunately, she responded well to this. Today, she was sitting up on her bed, happily chatting away, when I went to check on her. Her BP was 120/60 (obviously with help from noradrenaline).

The interesting thing about her was actually her chest x-ray. Her first chest x-ray when she was in resus was actually normal. There was no focal consolidation. However, after having a central inserted, another chest x-ray was requested in order to exclude a pneumothorax and check position of the central line. It was in this second x-ray that finally we saw the source of infection. She had severe bibasal consolidation! So, she definitely had a really bad pneumonia. Fortunately, she already received a dose of ceftriaxone, which is good in pneumonias.

However, I really do not understand why there was no consolidation in her first x-ray. I mean, it was only 2 hours difference between the 2 of them. One of the anaesthetics SHO believed that patients are too dehydrated and shock when they first arrive in the hospital. As fluids are provided, the body starts to fill up and as a result, the mucus pluggings in the chest start to loosen up, and hence, that's when the abnormality shows. I don't know how true this is....but it sounds a reasonable answer.

Anywho, she was a good case. She was my first Addisonian Crisis patient. The other interesting patient was an elderly gentleman who I believe presented with urinary sepsis. He was in acute renal failure, with a creatine of 786!! And he was profoundly metabolic acidotic with H+ of 80, bicarbonate of only 5! Also, he had amazing ECG changes due to his hyperkalaemia! There were wide QRS complexes and tall tented T waves. His potassium was 7.8. He must also be extremely septic. His urine looked like pus....it was thick, turbid and smelled horrible! urgh... never seen such a yucky looking urine ever!

It was a really busy on-call but surely exciting. On-call again tomorrow...hope it's a little better.

Brew...ha ha, anyone?

It was a lovely weekend. It hardly rained. The sun was shining brightly, but the wind was extremely icy. So, it was quite cold, to be honest.

I woke up very early on Saturday morning, and managed to catch the qualifying round for the Australian F1. I haven't been to the gym all week because I was busy at work, so I decided to head to the gym to do my usual 5k run. I felt refreshed after that. My endorphin levels were starting to rise.....and I felt like doing something in town, ie shopping or catching a movie.

Jaclyn, Kevin's sis, invited me to catch a movie at the cinema. Before the movie, we went to this cafe called "Brewhaha." Yes, funky name, eh? I do wonder why it is called Brewhaha. It is a specialised tea shop, that also sells yummy cakes and sandiwches. It must be that upon drinking the tea, you'll be happy.....therefore, the "ha ha" bit of the name.

I had "Calming Tea," which was a mix of honeybush, vanilla and some flower petals....the taste was a little bland...but it was nice. Jaclyn had "Feel Good Tea," to soothe her tummy. We also had a slice of Lemon Drizzle Cake and Ginger Loaf...oooohh....yum yum. Would certainly go back...and this shop in Glasgow is the first tearoom for Brewhaha. You can check the shop out at http://www.brewhahaltd.com/

After adding more endorphins to our system (ie indulging in tasty food), we watched Duplicity. Oh...I really am so in love in Clive Owen. He is really hot. And I love the collaboration with Julia Roberts. If I have not mistaken, this is the 2nd time both of them worked together. The first movie was "Closer." The movie wasn't great....but the witty lines were funny.....and just ogling at Clive Owen was enough for me!

ahhh.....guess the nice time spent has compensated for my 1 hour less Sunday.

Please Do Not Take Me for Granted!

I was talking about moving on to a new place for my next job...and also, how much I am looking forward to the change. I spoke about my housemate....who can be so irritating at times. I have decided that, if she doesn't care about how I feel, why should I? So I am going to b**tch about her now.

Honestly, I do not think I am being picky or difficult. Think the problem is with her.

First of all, she does her dishes probably 2 -3 times per week. I mean, ok, fair enough, you are busy (when she only works from 9-3 pm daily). But, leaving your dishes in the sink, with all the food stains still stuck on it....is pretty unhygienic, don't you think? I am happy if you wanna use the pots and pans, but I am also living in the same house. And when I come back from work at 7 pm or later, I would like to prepare my dinner too. How am I going to do that if you have used them all up and not even bother cleaning them up?? I have washed them myself many times...but you know what, there is a limit to do that. I know she feels guilty sometimes about that, but she doesnt care less. If you were THAT busy, how could you be lying down on the couch from 6 pm to midnight, watching the telly? yeah...exactly.

Secondly, she has taken me for granted. Her notebook broke down TWO years ago after she spilled water onto the keyboard. I told her to get it repaired, but she only took it to her friend, who doesn't really know much about computers. Silly I thought. Anywho, she decided that she could use my notebook from time to time until she gets one. I caught her using it a few times, before even asking my permission. She must have felt awkward when I saw her in my room, clicking away at Bebo or Facebook.

I still remember what she told me, "Ling, do you mind if I use your computer to check my emails and stuff? I don't do that often...just once or twice a week....while I get myself a new computer?" I just said ok. TWO years down the road, she uses my computer everyday, she even uses it to bid for things on eBay, and other internet shopping.....and WORST of all, she has decided that the computer also belongs to her, and she has allowed her friends INTO MY ROOM and USE MY NOTEBOOK!!!

NOw now now now now......that is SO CROSSING the line. I mean, that is MY ROOM, and that is MY NOTEBOOK, who gives you the right to allow your friends to use my things?? I do not even know your friends...i know their names...and thats pretty much it.

I was so pissed off. I told her I was not happy about that. She just said "Ok." No apologies whatsoever. I thought that maybe I over reacted....but having spoke to my fellow colleagues at work, who are Caucasians as well, they agreed that my housemate has stepped on my tail.

I am not a calculative person at all. I gave her half the amount for the TV licence because she said she doesn't have much money. I hardly watch the telly because she hogs it from 6 pm to midnight, and also the weekend, watching soaps and DVDs....which is fine. I am not going to push her away just because I wanna watch a few of my interesting series. Now, she uses my internet connection and she uses my notebook DAILY....shouldn't she give me some money then?? Oh oh oh....did I forget to mention that she also uses my printer from time to time, without even asking me? How do I know, simply because she never puts things back in the same order!

URGGHH.... more recently, while she was using my notebook in my room, she felt her empty tea cup and an empty chocolate bar wrapper on my table. This is again, not the first time. She has left tissues on my bed and on the table in the past. She laughs away when I told her about it. She must have found it funny....I dont know.

She boils me up sometimes. I could go on and on about her annoying habits. I sure have some silly habits too, but I never take her for granted. She is, otherwise, ok to get along with. I have lived with her for 3 years, and I think I have tolerated her very well.....but I am losing the plot already. Oh, can't wait to get away from this flat...... although, I will surely miss the convenience and comfort of this cosy little flat.

You're Hired

" Thank you for recently attending our assessment centre / interview. I am pleased to offer you a CMT CT1 commencing on Wednesday, 5th August 2009."

Yes, I'm finally hired!! I have managed to secure a job!! Yay!! I am so SO SO happy, and feel so glad. Yay for me!! hehe. Actually, the offer email was sitting in my inbox on Friday, but I only checked my inbox on Saturday evening!

After 3 painstaking and emotionally wrecking interviews, I finally get into the medical training system! The anxiety before the interview could literally give me a heart attack. The uncertainty of what clinical scenario you would be asked on, which ethical dilemma they will test you on, the preparation of my own personal portfolio; all of them made me really stressed! The whole interview process itself was equally stressful. And I mean you could be an absolutely great person on a daily basis, but when put under the spotlight, you just change completely.

So I am getting out of my comfort zone, and heading towards the Northern Deanery, which includes areas like Newcastle, Durham, Carlisle, Cumbria, etc. My job commences in August...so this will give me some time to find a new place to stay and move my things down. This time I would like to rent a place and stay alone. It would be easier for mummy and daddy when they come up to visit me.

I am so looking forward to this change...just because, I have been in Scotland for 5 yrs dy. And I am looking for a new environment. Also, this allows me to move out from my housemate.... Don't get me wrong, I love my room, and my flat, and the West of Glasgow is just so convenient. I do get along with her. But, she occasionally takes me for granted....and that is really doing my head in. Will write a whole blog about it later. haha.

Well, I was beaming and so excited yesterday that I decided to just go down to town to maybe buy something nice as a treat. But all the shops were closing in 30 minutes by the time I got there. Also, I told myself that I would get myself an iPhone if I get a job....and and and....my notebook is so cranky that I also wanna get a new MacBook!!! I have wanted to get a new notebook for a llooonngg time...probably about nearly 2 years now. My notebook keeps hanging despite me trying to reformat it. So its time to get a new one!!! woohoo!!!

Think for today I might either go watch a movie or something la. See how. Go visit the gym first.

=)
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=) =) =)

"Lovely" Neighbours I Have....Not!

It was a long day at work. I came back from my night shift and felt really sleepy, having not slept alot the day before.

However, I only managed a good 1 hour worth of sleep! I decided not to try to sleep anymore and kind of potter around the house watching the telly and drinking tea.

I was in my room, when the doorbell rang. My housemate, Helen, opened the door. I thought it was her friend. However, later she shouted, " Ling, the police is here for you!"

I was like, "HUH!"

The first few thoughts that rushed through my mind were, "Did I kill somebody?? Did someone decided to sue me and the police is here to get a statement from me? Was someone I know in trouble and needs my help? Did I even do anything wrong???"

I quickly rushed to the living room, and there, stood a policeman, and his partner, a policewoman. They looked at me and the policeman asked, "Hi. Are you the owner of the baby blue Peugeot 206 with the plate S**B** that is parked outside?" I said, "Yes." Then, I was thinking....oh no, I must have been caught speeding!

Then he said,"Your neighbour reported you. They said you have not changed your tax disc."

I replied,"OOOHhh.... (scurried back to my room to get my new tax disc for the year)....here it is. I actually renewed it last week, but it must be that I have been so busy at work, and disorientated to the time, that I forgot to change it. I'm really sorry."

He studied it and said,"Oh rite. That's fine. But please remember to put it up, otherwise, I'll have to fine you at least 60 quid!"

"Sure, no problem. I'll definitely put it up today."

And they left the house.

I don't know how to describe my feelings then...it was mixed feelings. I was glad that it was just a simple expired tax disc, and not something outrageously horrible! Also, I was a bit shocked that my "lovely" neighbours would report my car!! To be honest, I do not even know any of them. Not spoken to any neighbours. And everyone living on this road just parks their cars along the street...they don't own a particular car parking lot. So it was not like they could be angry that I "stole" their parking lot.

That night, before I left to start my night shift, I made sure I changed my tax disc.....still feeling really "funny" that my neighbours have so much time to look at tax discs and report to the police if they found one that is expired.

I mean I have spoken to the police before....but those were at hospital level, you know, giving statements about patients, getting their help to restrain violent patients, etc....but man, NEVER had I imagine that the police would come to my house to check on my tax disc!

*phew

ps. tax disc = road tax

Overwhelmed!

I feel so overwhelmed from work! I wonder, sometimes, whether I am cut out for this job. You know, it's been 2 and a half years that I've been doing this, but, I still get ovewhelmed, especially when I am doing night shifts.

We do 7 nights in a row. My first night has been the worse of all, so far. It was such a busy night. There were at least 3 sickies at that time, 2 of which died on me. I really hate the feeling when patients die within a few hours of hospital admission. It just gives me this feeling that I have not done anything to save the patient. It feels as though I must had missed something, or was not doing enough to prolong his/her life.

One of them was an elderly lady, while the other lady was in her 50s! She just went became unconcious. We managed to get her back after about 3 cycles of CPR. That gave me some time to discuss the case over with the consultant, and we felt that, she would not be a candidate for ITU, so therefore, we had to just let her go.

I still get goose bumps just thinking about what happened. It was horrible. She was vomited bloody fluid during CPR, her colour was blue, her eyes were rolling, she was cheyne-stoking! gosh...I really hate my job now.

Anyway, she is in a more comfortable place now. Just feel sorry for her family.......and I just could not stop thinking whether I have missed something.

The rest of the nights were better....however, again, last night, it was absolutely rubbish. There were quite a number of admissions. A patient was extremely unwell in HDU, and I kept getting pulled up, down, left and right, by fellow nurses, and my team of hospital at night specialist nurses.

Sometimes, I wonder whether I was being slow in reviewing my patients....I mean, I really did try to be quicker...but I really hate missing things. Because it was such a busy night, I had to leave the work I was doing, to complete another. So everything felt like it was all over the place.

The nurse was like, "Have you seen Mr. Y yet?? He came in earlier than Mr. X....and you went to see Mr. X first." I replied, "Well, it's because Mr. X is sicker than Mr. Y, so he get the priority." And I was thinking to myself, helllo?! This is not a queue in the supermarket....the sicker the patient, the earlier he gets seen, regardless of who comes in first! And you claim that you are a senior staff nurse?! She then replied, "Well, its just because I need to write up my bit...and I'm going home soon." I then said, "Look, there's only one of me here. I have alot of other things to deal with at the same time. So I will see him as soon as I get a chance."

I really do not like to bitch about nurses....but, sometimes I can't help it! So my apologies first to anyone who gets offended by this.

I think it was Tuesday today, but it was actually Wednesday......which means, I have only 2 more nights to go. I get so disorientated with time and days on these shifts, that it is not even funny.

The consultant who is on-call with me, is actually my immediate educational supervisor. And whether it is because he intimidates me or I am trying to prove myself to him, I do not how to describe this little ache in my heart......I left work this morning with a horrible feeling that I have missed something. I found it difficult to sleep...only managed 2 hours today. I pray deep down that no disaster was detected and everything I did was okie. Sigh, I should try to de-complicate my life.

Please, Just Listen to Me....for once....

It was a good day at work. I had my ward round finished by 12 pm. I made all my referrals, and wrote my letters. I managed to sit down for lunch! And I spent the afternoon trying to catch up with a few patients' family members.

Pretty chillaxing, isnt?

Until...I met the niece of one of my patients.

Boy, can she talk, and moan, and groan!

She kept yakking non stop....and she just didn't seem to get what I was trying to get across to her.

Her uncle was actually just discharged from the hospital one week ago. He was admitted because an irregular heart rhythm. Unfortunately, he was readmitted yesterday. This was, it was because his blood sugar level was too high. We screened him for any source of infection, and he was clear. So, it was felt that his high sugar level was purely because he needed an increased dose of insulin. There was no immediate issues with his heart. He was reviewed today, and his blood sugar levels were alot better! And, both the consultant and I discharged him.

The niece was an unhappy lady when she found out about this. She was dissatisfied with his SHORT hospital admission. She was unhappy that "nothing" was done for him.

Now, who in the world would be unhappy over a SHORT hospital admission??? Isn't good to discharge patient as soon as we can?? Why keep a patient in the hospital longer than they should?? And, what is this whole issue about us doing "nothing" for him. He was investigated for any infeciton, we increased his insulin....and you claimed that we did nothing??! Gimme a break!

Then, she asked me this question, "His blood sugar levels have been ok most of the time. Why suddenly it became erratic?? Why did he think he had a hypo, when his meter showed that his BM was high?? It must be his heart that is causing this."

I was like....whoooaaa.....hang on, hang on, too many questions at a time. The moment I tried to explain my thoughts about his problem...she just cut me short and was not listening. At the end, she became frustrated and just stormed out of the room. I gave my explanation as best as I could....I explained to her that his high sugar level is likely because his body is so used to his usual insulin, and therefore, needed more. A high sugar level can you feel quite unwell, and his heart has got nothing to his high BM.

It was such an exhausting conversation. I was trying to reassure her that nothing sinister was going on behind her uncle's back, and we can not guarantee whether or not he will have another episode of hyperglycaemia. I mean, how is that possible? How could you tell the patient or family member that, "yeap, I am 100 % sure that he will never have a hypo or hyperglycaemia again!"

Anyway, I just wished she kept her ears open and listened to what I have explained to her, rather than just storming out of the room. OR, maybe I was simply rubbish at giving her the explanation?

A Waste of Energy

Anger & bitterness eat away at your energy.
It actually takes alot of energy to hate someone.
You're punishing yourself.
If you hold a grudge, if you're walking around hating somebody & seeking revenge on someone, it eats you up.
Having the revenge might give you a split second of some kind of twisted satisfaction, but it won't last.


I came across the above short statement recently, and found it really true. There are many a times in life, where we feel so angry. Angry about something, angry about a person, angry about your own self. However, anger does not take you anywhere. Learning to forgive is a vital step towards moving forward.

Disappointed

I really wanna shoot myself.


I so really wanna hide somewhere in shame.

I dunno why, but I always seem to disappoint myself at times I needed to do well.

Urggh....why oh why???


SIIIGGGHHHH


All of you who are cursing and swearing and feeling so nervous before you attend a job interview....don't worry, I'm also a member of the club. I think the general public has this preconception that doctors will always get a job, no matter where they go. I shall politely ask you to think again. This is not the case in this country. We have to fight for limited training jobs, and attend painstaking interviews, which also depends on whether you were shortlisted.


How do we get shortlisted? Well, if you can fill in your form properly, ie, show that you're enthusiastic...then, who knows, you might be the lucky one, invited for the job interview.


I know I have chosen this pathway myself. But somehow, I feel that others seem to do so well under pressure...whereas I just seem to crumble.


I attended a job interview recently. I did not do well at all! There were 3 different stations. One was on my portfolio, the second one was about my commitment and the third one was a clinical scenario station. I was not too bad in the portfolio station, but the other two.....sigh....was where I fail to live up to my own expectations.


I was blown away by a few "funny" questions, such as, "how will you be different when you are a registrar?" or "what would you have done, if you were not a doctor?"


I found these questions funny....I know they don't sound hard, but somehow, finding a way to answer them seem difficult, at least for me, anyway. Because you have to relate them to your current situation or make it sound positive. Why are they asking me about being a registrar, when I'm not even started in the training programme, which will take me 2 years before I become a registrar?? All I know is, when you're a reg, you have more responsibility, and more junior colleagues working under you. And if I were not a doctor, I would do actuarial science. How I can relate that to medicine? I dunno.

Then, in the 3rd station, I was utterly disappointed with myself. It was a simple case of jaundice....and yet, I forgot to say that I would request a coagulation screen as part of the investigation!!! And, oh, I could not remember the cause of pre-hepatic jaundice....

I was like....HELLO??? What were you thinking, saw ling??!!! Alcoholic hepatitis is like your bread and butter!!! You deal with such cases almost every day....and yet, you forgot to mention the most important blood test!!!!! The moment I stepped out of the interview room, suddenly an influx of information entered my brain. Of course, the answer to the latter question was..... DUH!!! haemolytic anaemia. My memory failed me....my nerves got the better of me.


Anyway, I could go on and on to moan about how badly I did. I had only one chance...and I have failed myself miserably. I know it is all over now....but I can't help feeling this way.

Let It Snow! Let It Snow!

"Oh the weather outside is frightful

But the fire is so delightful

And since we've no place to go

Let it snow! Let it snow! Let it snow!"

yeap, the snow is here, finally! In some ways, I guess I'm lucky. The snow is not too bad in Glasgow. But certainly, places down south were hit by the weather badly.....to the extent that public transport ceased working, schools closed, and people took time off as they couldn't get to work!

This is my 3rd year in Glasgow. I can happily say that this is the first proper winter for Glasgow! haha. The previous winters were extremely rainy. At least it has been snowing intermittently over the past week, and temperature dipping below 0. It was -5 last night.

Anyway, I love the sight of white snow. I love the sight of snow covering everything on the ground....making everything look so pure, and clean! But this wouldn't last long, as the snow will melt soon, and people will start walking on the snow. The sight would be horrible. So that's why I decided to capture a few shots of the snow from my room....here they are.

The snow covering the common compound outside.

Cars covered with snow too!

Great Girly Weekend!

To top off my annual leave last week, my gal pals and I travelled to Dublin for a really short weekend break! woohoo!

Most of my weekends here are pretty unexciting. I would normally just hang out with a few friends and Kev. We would spend time savouring different food, shopping, chatting, coffee-ing, and going to the cinema. There would be the odd times where we visit a local attraction.

Last weekend was SUPER Girliciously FUN! hehe.

My gal pals were Georgina (or George as she is better known) and Laura. Laura has been my good friend in Glasgow. We met on the First day of our induction as junior house officers in Glasgow Royal Infirmary. We were both very early. She sat beside me. Later, we found out that we were both working in the same ward. We grew really close since then. George, on the other hand, was a colleague whom I met when I was also a junior house officer. However, she is not as close a friend as Laura.

Anywho, we flew to Dublin late Friday night. The weather in Dublin was pretty dull, to be honest. There was intermittent drizzle on Saturday, while on Sunday, it was SO chilly. But we kind of expected the weather to be like that.

We had tasty fried brunch to kick off our weekend. We wondered along the streets of Dublin, and popped into different shops to do some window shopping. As it was a chilled outing, we could not be bothered to visit the museums or galleries. We just wanted to look at buildings and take pics! Shopping was slightly pricey because of the current foreign exchange rates....but I still managed to grab a few bargains....like a new coat from Pull & Bear! hehe.

It was also an extremely sinful weekend. I had never eaten so much JUNK!! We munched on bags of Doritos, Mars Planets, M&Ms, chips.... and had a little too much alcohol. We had complete English brunch on both days. I ate 2 sunnyside ups on Sunday! Somehow, at the end of the weekend, my cholesterol level must have doubled!

oh well, the most important thing is I have enjoyed myself. I felt rejuvenated. I was ready to face being back at work, and facing all the nonsense that I have to deal with in the hospital. =D

Brunch @ Elephant & Castle - this is the first time I ate 2 eggs in a meal

I've Found My Golden Coin

It is very common to see coins or sometimes, notes, lying on the street. Some think that picking up money on the streets is not good, and some think that it brings the person good luck. Some think that it is too much a hassle to bend down to pick it up, and some think that every penny is worth it...even if it was only 1 pence.

I hardly ever bend down to pick up money found lying on the street. Don't ask me why. I really do not know....maybe I'm just trying to be too honest. However, having said that, I've found my golden coin a few days ago!

That evening, I was happily window shopping in Borders. I walked around shop looking at magazines, and was also actually trying to rest my feet, as they were very very painful because the heels of my shoes were killing me! Anyway, as I made my way out of the shop, I was something glittering on the floor. I looked towards that glitter, and hold and behold, I saw a big golden coin lying there.

Maybe it was Chinese New Year, or maybe the coin had some kind of magnetic pull, I instantly walked towards the coin and picked it up! Let me tell you, it is not any golden coin. It is pretty special! Here it is:

=D hehe....I know, I know, it is a fake chocolate gold coin.....and it is from Starbucks Coffee.....but what the heck! I found it on the 1st day of the OX year, and I will treasure it.

I found the whole thing pretty amusing! I mean, what a coincidence, dont ya think??

........ secretly, I hope it will bring me loads of luck and happiness this year! CHEERS! Hope everyone is enjoying CNY back home!