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...