Confessions of An Idiosyncratic Mind

In The Spirit of The Lunar New Year

2012-01-22T21:26:00.005Z

Celebrating Chinese New Year (CNY) in a foreign country is pretty boring. There isn't any CNY atmosphere here. The day goes on as usual. There isn't any red lanterns hanging around, and there aren't any loud cheesy CNY songs playing in the background when you enter the shops. The only CNY-related event is the "Buy 1 Get 1 Free on Chinese Sauces" in Tesco and Morrisons, or the "10 pound meal deal" for Chinese food in M&S. Well, at least, they have us in mind.

CNY away from home also means missing the ang pows. And it would also be extremely difficult (or impossible) to savour the usual delicious goodies one can get back home.

I miss my grandmother's reunion dinner dishes. She would make a big pot of "ham choi" or preserved vegetable duck soup. Her "lo-bak" is to die for. "Lo-bak" is basically fried bean curd skin roll filled with pork. Then, her acar is so good....hmmm.... Thinking about them ismaking me hungry!

The other lovely thing about CNY is the traditional biscuits that we only eat during this festive period. Kuih kapit, peanut biscuit, kuih bangkit, spicy prawn roll, ribbon biscuits, pineapple tarts....I could really some right now!

So....because I'm missing home, and dreaming of all those goodies, I decided to usher in the Water Dragon New Year, by baking the famous Dragon biscuit. My mum managed to persuade my aunt to share her recipe. Her Dragon biscuit is, by far, the best I've ever tasted! She does make them to sell, and undoubtedly, they sell like hotcakes! Therefore, her recipe is super top-secret.

This is my first time baking the Dragon biscuit, and I was really enthusiastic. Halfway through mixing the dough, I realised that it is not as easy as it seems. It involved quite abit of mixing action with just a wooden spatula. My arms were aching, and I decided to use my fingers instead.

In order to get the dough to resemble a dragon, I have to put the dough into a piping bag and squeeze it out with a star-shaped nozzle. This is where I failed miserably! My dough was not soft enough to go through the nozzle! I decided to add a wee bit more of my leftover beaten egg to it....My dough became wetter, but I was still unable to squeeze it! I was frustrated. In the end, I used my fingers to try to create the "dragons." I also used red colouring to dot the eyes. And the result is ..........ttaa-daahhh.....

They look more like worms/snakes!! :(

I also made some squares, which definitely looked much better and pleasant! LOL.

Well, on a more positive note, they tasted quite yummy, but not as good as my aunt's. I think I will try a cookie press to squeeze the dough out next time!

I am pretty knackered now, having spent the whole afternoon baking these. The thought of going back to work tomorrow makes me even more tired!

Anywho, here's wishing everyone a very happy and prosperous new year!

Kong Hei Fatt Choy!

Wan Shi Ru Yi!

One Month Later...

2012-01-08T13:50:00.002Z

One month into the job,

1. I am definitely more confident in managing epilepsy, migraines, Gullain-Barre, and myasthenia gravis.

2. I can perform a slick neurological examination.

3. I have survived all the on-calls so far, but still feeling stressed at the thought of more to come!

4. I have invested in a neurology textbook written by Brazis.

5. I am still quite slow and need to pick up my pace.

6. I have seen 4 "functional" disorders.

7. I really need to learn how to interpret MRI brain and spine images.

8. I really need to pick up a copy of Practical Neurology, and start reading it.

Am I coping?

Yes, I am. I am slowly finding my way up my learning curve...I am just at the beginning of the curve. I hope my skills and knowledge will continue to grow exponentially.

It's The Last Day of The Year 2011

2011-12-31T20:35:00.004Z

Yes this is one of those entries where I reflect upon the year that is about to come to an end. So feel free to stop reading now as it may bore you.

I remember being really busy preparing for exams. In April, I sat Part 2 MRCP. This was quickly followed by a failed attempt at PACES in June. And as a result of my failure, I was unable to proceed to the next stage in my career. Fortunately, my 2nd attempt in October was successful, and because of that, I have completed my membership exams.

Should I say that obtaining full MRCP was somewhat life-changing for me? Well, I guess it was. I mean when I failed PACES, I felt really low. My confidence was down in the dumps, and I felt really embarrassed. The embarrassment was due to the fact that my junior colleagues passed theirs without much problem, and I seemed to be struggling with it. Yes, I have some ego in me. When I found out that I passed PACES, I was really super-duper overjoyed.

Then, it was time for me to choose which specialty I wanted to specialise in. I received 2 job offers; one in diabetes/endocrinology, and the other, in neurology. I chose the latter as I felt it was more interesting diagnosing the weird and wonderful neurological disorders. I am thoroughly enjoying the job at the moment, although I have alot to read up on.

Work aside, the only other exciting achievement for me was running and completing my first ever 10k. I was happy that I finished it in just over an hour. However, I regretted not training for it properly because I ended up with a very bad left knee injury, which left me inactive for a few months. I will definitely try to run it again this year, and aim for a better time!

My unhappiest moment in this year was when I was informed of my beloved doggie, Kiki's death in September. She suffered from septicaemia. I really do miss her alot, and think about her sometimes, especially, when I see other dogs walking in front of me with their owner.

This year saw me spending 2 holidays back home (which is unheard of since I came to the UK in 2004). =) Hopefully I would be able to repeat this next year. Nothing, absolutely nothing, beats spending holidays back home with my family and friends, whilst enjoying the comfort of being in the country where I grew up in!

2011 has been great. The 4 goals I set for myself in January have all been achieved; running 10k, travelling abroad (spent a week in Belgium in summer), passing exams, and going home. I am very grateful for what I have. I have also been very fortunate to have met new colleagues, who are now my friends, who have supported me while I prepared for my exams/job interviews.

What does 2012 hold for me??

I am looking forward to catching the London Olympics because I have tickets to watch badminton finals!! woohoo!!! Lee Chong Wei...dun disappoint me! I want to see you in the finals!! :P

I hope that 2012 will take me closer to my partner. I am seriously tired of the distance. I really just want us to be together everyday, that isn't too much to ask for, right??.... and deep down in me, I am hoping that we could settle down, get a house and slowly build a family.

I need to work hard and be geekier (is there even such a word?!) as I gradually build up my confidence, skill and knowledge in the field of neurology. It will be interesting to see how much I would have hopefully learned after 1 year.

Watch this space!

Happy 2012!!!

Cheers!!

It's Christmas!

2011-12-25T23:21:00.009Z

Christmas celebration started off with lunch at our favourite restaurant, The Waiting Room, in Eaglescliffe. It is a wholesome vegetarian restaurant that serves delicious vegetarian food! The menu was rather christmassy, and we decided to order the traditional Christmas dinner. The turkey has been substituted with a carrot, walnut and apple loaf, with roasted parsnip, carrots and beetroot! delicious!

This was quickly followed by dessert at the same restaurant. I ordered the chocolate and raspberry roulade, served with ice cream....Mmmmm

On Christmas day, I was feeling very festive, and in the need to do some baking! I spent the whole afternoon baking 2 things; Speculoos (traditional biscuit baked before St Nicholas' feast), and cherry + hazelnut biscotti!

Speculoos in the jar, and the biscotti is on the baking tray.

After all the baking, it was time to treat myself to a lovely dinner. It was a very non-british dinner.... which really reminded me of the times where I spent xmas back home. The main dish was chicken briyani. There were also cucumber with sesame oil + chili flakes as the appetiser, and a vegetable salad with lemon + olive oil dressing.

A closer look at the cucumber dish.

Merry Christmas!!

10 days & counting

2011-12-14T22:50:00.006Z

Christmas is not too far away!

I put up my christmas tree during the first weekend in December. Mum said that my tree was fairly bare, so I decided to buy new xmas decos. Here is a picture of the new decos on my tree:

(note the dog with a santa hat, russian toy soldier, snowflake, and an angel on top)

One of my colleagues at work was really trying to get us into the christmassy mood by bringing this in.

Yeah...a Gingerbread House!! 100% homemade!

I thought she did an amazing job. It was too beautiful to eat...but, in the end, we all couldn't resist it. I started to pick on the choc buttons on the roof. Her gingerbread walls tasted very gingery and yummy...

Now, I just need to complete my xmas shopping. I have yet to get a present for my ex-housemate. I have left it a little too last minute, as I am planning to see her this weekend. So I will have to do some xmas shopping over the next few days!

A Weekend in Neuro

2011-12-13T00:09:00.003Z

I survived the weekend.

Yes. It was my first 48 hour weekend on-call in neurology. I was rather worried about it. My fellow reg offered to swap the on-call with me, but I didn't want to. I would need to do the on-calls whether this weekend or later. Therefore, I might get it over and done with, and build up the confidence plus experience as I go along.

I did mini ward rounds in the ward on both Saturday and Sunday. I was finished by about 11 am. Then, I proceeded to review 2 patients in the high dependency unit. Both were in respiratory failure secondary to dermatomyositis and myasthenia gravis respectively.

So far so good, I thought to myself. No referrals yet. I decided to hang around in the hospital until about 3pm, just in case anything happens. But it was all under control. This would never be the case had I be doing general medical weekend on -calls!

The only phone call I received was early this morning at about 10 mins after midnight. Apparently, the medical registrar from this nearby hospital has been trying to contact me all evening. The switchboard dept in my hospital has got my name wrong, and they claimed that I was not on their on-call list this weekend; despite me ringing them on Saturday morning to confirm that I am on-call and even gave them my mobile number.

Anywho, the med reg was asking for advice on a patient whom they suspect might have Gullain Barre Sydrome (GBS). He was just wondering whether he needed to transfer the patient overnight to us. The patient was stable, and was not in any respiratory compromise. So I suggested that the patient remained in their hospital overnight, and be transferred in the morning. I ran that past the consultant and he agreed too.

The weekend was, otherwise, uneventful. I am glad that it was ok, but I was also hoping for a few more phone calls just so I get more experience etc. I look forward to more on-calls this week, and the months to come!

Day 3 Neurology

2011-12-08T07:27:00.006Z

It's my turn to be on-call.

Any problems or referrals from 5pm to 9am the next morning will be directed to me.

I have done so many on-calls before this. They were mainly medical on-calls, and I almost always have a senior (who is not a consultant) that I could contact easily. This on-call is different, as I am further up the pyramid, just under the consultant. So I have about 4 to 5 years of knowledge and experience to back me up. And also, I have to admit that I am a little intimidated to contact the consultant on-call with me.

I am not going to lie....I am really scared and worried about the on-call yesterday. I mean, if the ward rings me about how to manage medical issues, you know, such as pneumonia, tachycardia, sepsis, etc, it wouldn't be a problem. What I am concerned about is managing the hard core neurology things....for eg, advice on changing anti-epileptic medications, or reviewing patients with weird neurological presentations.

I know I am still very green in this field. But I can't help but worry. And also, I will no longer need to be doing the on-call on site. I will be contacted from home. Yes, it is nice not to be running around the hospital in the middle of the night. But it is also a challenge for me to be able to provide advice/opinions over the telephone. I have to learn to trust the person on the other end of the telephone. I am not saying that they will be providing me with wrong information, but you know, it is different being in the hospital (where I could easily review the patient), and listening to the condition over the telephone. I really need to get used to this.

Interestingly, I didn't get any call until 10 something at night. It was a call from A&E.

"Hello, its the neurology registrar," I mumbled.

(mind you, I struggled to say the word "registrar," which shows how much confidence I'm lacking).

"Yeah, it's A&E here. Do you remember that lady with gallstones?" asked the doctor over the telephone.

"Errm...gallstones? Who are you talking about?"

"You know, the lady with gallstones whom the urology SHO reviewed earlier?" replied the doc.

"I'm sorry. But you are speaking to the wrong person...I am from NEURO, not UROLOGY," I told her.

"Oh...haha...I'm sorry to trouble you. Thank you!"

"ok bye" I said and put down the phone, somewhat relieved it was not a neuro call.

I couldn't really sleep for the rest of the night. It was probably because I was worried that I might not hear the pager, and also, worried that if were half asleep, I would not be able to provide good advice/suggestions, and speak with a clear mind.

The rest of my on-call turned out to be a quiet one. There were no further phone calls.

Honestly, I really need to take a chill pill, and stop worrying so much!

Day 1 Neurology

2011-12-05T20:18:00.000Z

I have been building up myself towards this new role of mine....you know, from being the Senior House Officer (SHO) to a Specialist Registrar (SPR).

Today marks my first day as a SPR, in neurology, a field which is very much new to me. My knowledge and experience in neurology is pretty limited. I mean, I have a bit of stroke in the past, and also had a month's attachment in neurology. However, those experiences are certainly not enough to prepare me for what is to come!

I am the allocated ward registrar for the month of December. The day started off with a handover between me, the nurses and the SPRs who have been in the dept already. The handover took at least an hour, as they had to tell me important details about every patient (we have 15 patients). I know it is not many, but it took quite awhile for us to get around them.

By the end of the handover, my head was spinning. Alot of questions were running in my mind... What is this about limbic encephalitis? And what is ventriculitis? How do you treat it? What is TBM? (I soon found out that TBM = TB meningitis).

After that, I started my first ward round as a SPR. It was not an easy task, just because most of the patients have been there for a number of weeks. So it took quite awhile for me to grasp what was wrong with them in the first place. By the time I completed the round, it was already 1pm!

We all went for a quick lunch. Upon returning, the nurses were looking for me. They wanted me to review a few patients in the day room, there were 2 difficult lumbar punctures to do, and a few other bits and bobs. It really didnt occur to me that there were so many decision making tasks as a SPR. I also had to attend to a few phone calls from patients who needed some advice.

When I was a SHO, all I had to do was to ensure that the ward runs smoothly, get all the requests done and do as the registrar tells me to. But now, I am on the other end of the stick...it is me who gives advice, it is me who makes some of those decisions that SHOs can't make, it is me who have to take on more responsibility than before....

The only positive thing I found today was that I am starting my new role in a familiar environment. I know the nurses in the ward from my previous attachment. I am working in the same hospital, therefore, I know how to get my way around things. I couldn't imagine starting work in a completely new hospital...it would be even worse.

It was a wee bit overwhelming for me today. Thankfully, my senior registrars have been pretty helpful, in giving me some very much needed support and advice.

I hope for a slightly better day tomorrow.

ps. one last problem is that i need to constantly remind myself to write down my correct grade when i write in the notes. So far, i have been calling myself a "CT2," whereas it should have been "spr."

Can't Stop Beaming!

2011-10-28T22:38:00.004+01:00

YESSS!!!! YEEESSS!!!! YYYYEEEESSSSSS!!!!!!!

Hooorayyy....yipppeeee!!!

Words cannot describe how happy I am feeling right now!
I finally passed all my membership exams!! :D
Finally I have earned MRCP (UK).
I know it is only a small step towards a long career in medicine...but heck, it is by no means an easy exam.

I can't stop telling everyone about it...even the nurses, and the ward clerk!

I knew that results would be out today. I've been checking my online account like 3-4 times already all day. Finally at about 5pm, I saw the word "pass" ....and oh my goodness, I felt such huge relief...it was like a heavy weight has been lifted off my shoulders. It means even more to me as I failed by 2 points previously.

Anywho, as much as I would like to celebrate, I am on-call over the weekend. But its ok!!! I don't mind, and I surely won't be complaining!

:D

congratulations to me!!

oh...ps. did I mention that I have finally decided to take up the neurology training job!

so double happiness for me:

MRCP +ve + neuro job = happy me!!!

Post Exam Stress

2011-10-15T22:47:00.009+01:00

I took my clinical examination (PACES) today. It was my 2nd attempt...I failed it by 2 points previously. I arrived early at the hospital. It certainly didn't do anything to calm my nerves.... The other candidates and I waited anxiously for the exam to start. And with a blink of an eye, the exam ended, just over 2 hours later. It's amazing how quickly the time flew by.

How did it go??

To be honest, I was definitely more confident. I presented fluently, and was not hesitating much. I started with station 4 again, similar to my first attempt. I can't stop thinking of all the stations that I went through...therefore, I need to let it all out!

Station 1 (respiratory/abdo)

The chest station was a case of pulmonary fibrosis, which was pretty straightforward I thought, and lucky of me. I finished the clinical examination well before the time limit ended. The abdomen station was a patient with only splenomegaly. I gave a few differential diagnosis for splenomegaly, however, none of them relate to the patient. The examiner then asked me, "Have you not heard of hairy cell leukaemia?" "No." *krrriiinnng (the bell indicating that the station has ended ). I dunno if I were sort of "saved by the bell" so to speak...

Station 2 (History)

The history was on a patient presenting with bilateral ankle joints swelling and a dry cough. It was not too bad a station. The patient was pleasant and I was able to build rapport quite quickly. I gave my differential as inflammatory arthropathy with pulmonary fibrosis or sarcoidosis.

Station 3 (CVS/Neuro)

This went ok. The patient I examined had a metallic AVR. I don't know why, but somehow, I found consultants who wear bow ties pretty old school. He didnt help to ease my anxiety.

I was glad that I could hear the metallic click at the end of the bed. However, he tried to make me doubt myself by saying, "Are you sure it is his heart sounds? Don't you think the sound is coming from this clock above?"

Why is he making my life difficult?!

Neuro, on the other hand, was not straight forward. I did not have time to complete my neurological examination, as I had to also perform full sensory examination. The patient's signs were not classic. On hindsight, I think it was either a case of spastic paraparesis or brown sequard syndrome. arrghh... my brain failed to perform adequately during this particular station!! I felt really awful.. hope i didn't fail it!

Station 4 (communication/ethics)

I've been asked to speak to the daughter of a patient who is comatose following a major stroke. She was not responding to any stimuli, but was still able to breathe on her own. She also has mild dementia. As her daughter does not live locally, she has been placed in a nursing home for some support. We, doctors, have thought of feeding her through a nasogastric tube, but felt that it would be futile. My role was to break this news to her daughter and also tell her that we are going to withdraw treatment.

I guess this is the type of scenario that I have and will continue to face throughout my career. The conversation went ok. I introduced her to the end of life care pathway. But, I didn't manage to answer all of the patient's daughter's questions, as she began to fire them to me towards the end.

After the conversation ended, it was the examiners' turn to ask me questions. One of them asked, "So, if this patient presents to you in A&E, what would you do? Is she someone whom you consider thrombolysable? " I replied, " If she turns up in the hospital within 4 hours of presentation, I would assess her against the criteria to see if she is suitable." The examiner then said, "Well, would you? She has dementia, and dementia itself is a contraindication for thrombolysis."

I really disagreed with him. The patient only has mild dementia, but she is still able to conduct her daily living with just minimal assistance. I kept my thoughts to myself. It is never a good step to disagree with examiners!

Station 5

This is the most dreaded station! In this station, you are expected to review 2 patients in 8 minutes (which includes a brief history and quick targeted clinical examination). I was really nervous as I sat outside the room while reading my 2 scenarios. The examiner didn't help to ease me either by saying, " You have 2 cases, 10 minutes each. You have 8 minutes to examine the patient, while the other 2 minutes is for you to shine!" Shit. I dislike it when he said the word "shine." I felt like there was alot more pressure on me now!

My first case was a review of a lady with unilateral leg swelling. The second case was on chronic diarrhoea. Looking back, I felt I could have done better in the latter case. I think the patient probably has inflammatory bowel disease, so therefore, apart from examining her abdomen, I should have also looked for other signs of IBD, you know, like skin rashes, anaemia etc. Oh well, can't do anything about it now!

hhhuuhhh.....

I am feeling SO STRESSED that my heart is aching and I could still feel intermittent palpitations until now. All I can say is I have given it my best shot...but is my best shot enough for me to pass it this time?? Fingers-crossed! I will find out 2 weeks later!

Mid Autumn Festival!

2011-09-03T14:07:00.003+01:00

It is the time of the year where the chinese amongst us welcome the Mid Autumn Festival (Zhong-qiu Jie).

From my point of view, this festival is all about playing with lanterns, and eating mooncakes! I shall not go into the various versions of the legend that lead to this festival.

I'm sure everyone is familiar with mooncakes. A mooncake is typically round or square in shape, and is filled with a thick filling, and also with the yolk from salted duck eggs. When I was younger, mooncakes where either filled with the traditional filling of lotus paste or red bean. However, things have changed now. The modern mooncakes come in variety of flavours; chocolate, green tea, yam, pandan, and even durian! There are even mooncake ice-creams around! And to make those health conscious people less guilty, there are reduced sugar and reduced fat ones as well!

Being so far away from home, I really miss this festival. If anything, I enjoy this festival more than chinese new year!

Weird huh?

I don't know. Its probably because I like the idea of lighting up funky shaped or traditional paper lanterns. I like the idea of exchanging mooncakes with my friends/families. And of course, I enjoy eating them too. My personal favourite is lotus paste mooncake, without any yolk! Many people will disagree with me, but I think the yolk just ruins the natural taste of the mooncake.

I haven't savoured a mooncake in 2 years! :( The mooncakes being sold in the local chinese stores here are not as yummy as the ones back home. Therefore, I stopped buying them. Maybe I should hunt for a chinese paper lantern, just to humour myself. Or maybe, I should plan a visit back home during the festival period next year!

A Parting Prayer for Kiki

2011-08-07T00:11:00.001+01:00

Dear Lord,

Please open your gates
and call St. Francis
to come escort this beloved companion
across the Rainbow Bridge.

Assign her to a place of honor,
for she has been a faithful servant
and has always done her best to please us.

Bless the hands that send her to you,
for they are doing so in love and compassion,
freeing her from pain and suffering.

Grant us the strength not to dwell on our loss.
Help us remember the details of her life
with the love she has shown us.
And grant us the courage to honor her
by sharing those memories with others.

Let her remember us as well
and let her know that we will always love her.
And when it's our time to pass over into your paradise,
please allow her to accompany those
who will bring us home.

Thank you, Lord,
for the gift of her companionship
and for the time we've had together.

And thank you, Lord,
for granting us the strength
to give her to you now.

Amen.

I Love You Kiki

2011-08-05T21:13:00.006+01:00

Kiki, my beloved doggie, has gone to doggie heaven.

I love you so much Kiki, and I want you to know that I will miss you loads!

You have been my lovely companion, friend, and family.

I hope that the last few days of your life has been comfortable, and that you didn't suffer too much.

My life without you is going to be very difficult....

I will miss the way you smile when you see me

I will miss the way your whole body "wriggles" in happiness when you see me

I will miss your lil antics, your bark, and will miss playing with you

I will miss hugging you, patting you, and tickling you...

I will miss everything about you.......

I LOVE YOU KIKI.

May you rest in peace.

God bless you.

HUGS!!!!

Left: Puppy Kiki Right: Elegant grown-up Kiki

The Great North 10k

2011-07-18T09:10:00.007+01:00

Yes! Finally I have ran my first ever 10k. The event was held at Gateshead on a very wet Sunday morning.

I was really dreading it, to be honest. I haven't been able to train much as been pretty busy with exams and work....so I only squeezed in 4 x 1 hour sessions of running 2 weeks before the actual event. I was starting to think twice about running the 10k, as I wasn't able to run 5k without stopping for a short rest. And to make matters worse, my left knee began to hurt during the last training session. I probably had a lateral ligament sprain. So I gave myself a 4 day rest before the event. The pain in my left knee also disappeared...phew!

I looked up the weather forecast a few days before the 10k. "Heavy thundery showers" was forecasted....*shit I thought. How am I going to run in the rain? My shoes would be soaked wet...and it would be uncomfortable. Anyhow, I reset my mind, and made myself ready for the day.

Sunday morning has pouring rain, just as it was forecasted. I got myself to Gateshead by 9.30 am. The rain was still present, but not that heavy. Thank you Berghaus for keeping my body dry.

I began the run. I felt good, my mind was ready....unfortunately, 10-15mins into the run, my left knee began to give me trouble. It was beginning to hurt, but I continued to push on...it somehow felt slightly better after more exertion, which was slightly odd, I thought.

I got to the 5k mark in just less than 30 mins. I was happy with that. Surprisingly, I was not too breathless, and my legs still felt strong.....

6k....7k...then, I had to run up a rather steep slope...that killed my pace. I stopped just for about 5 secs at the top of the slope to catch my breath, and continued to run.

*ouch....I felt a sharp pain in my left knee, and lack of energy... I told myself, there's just 2 k left...come on...just get it over and done with! I persisted. The rain had stopped, and the sun was starting to shine!

8k...yet another killer slope....9k...and finally yes! I crossed the finishing line!

I stretched out my legs...and oh dear...my left knee wasn't feeling good at all. I was aiming to complete the race within an hour, but I was still pleased with my official time of 01:02:56. Guess I could have been faster if it wasn't because of my knee problem.

This morning, I woke up feeling stiff all over...the muscles in my thighs are aching...and left knee still hurts, especially on flexion. I am kind of walking with a limp at the moment. I am really concerned over my knee....There are two possibilities: iliotibial band irritation or lateral collateral ligament sprain/tear. Whatever it is, I think I deserve a rest for the rest of the week, and probably next week too.

Here are a few pics!

A wet day!

The finishing line in the background...the sunshine appeared in the end!

My complimentary T-shirt & medal!

My List

2011-07-11T20:07:00.005+01:00

I remember making a list of things I wanted to do before I turn 30. I know there's no need to make such lists...but somehow a list makes life somewhat more interesting! So here is the list I've created when I was quarter of a century old. Next to some of the statements are my comments/thoughts on them.

1. run a marathon or 10k (yeah....doing a 10k this weekend)

2. skiing/sledging (making too many excuses for this; "no time")

3. go sky diving (know for a fact that wont happen coz i'm a chicken)

4. own a pair of manolo blahnik/christian louboutins (i can only dream, with my horrible bunions, i cant even fit into these lovely shoes, or walk on them!)

5. fall in love again (yeap, in love now)

6. married with a at least one child (this thought is down the drain)

7. learn hip hop dancing (probably getting too old for this now - so unflexible/stiff/uncoordinated)

8. go to wimbledon to watch fedex/nadal play live (tickets way to pricey)

9. get horribly drunk (yeap...done dat, not a good feeling)

10. wall climbing (yeah, went to learn this on my own...havent been back coz I need a partner)

11. see the world (still haven't visited my countries yet)

12. take up a new hobby ( i did, which is beading)

13. not to grow up (aha...still dun plan to)

14. cycling trip in an EU country (still planning)

15. own a convertible (dream on)

16. dancing like an idiot, and no one watching (well, did dance like an idiot at a night out...and i'm sure loads of my colleagues were laughing at me!)

17. do some sexy dancing with a hot guy (ermm...haha...yes, i will say, yes. i sexy danced with a hot guy from work 3 years ago!)

18. own a beautiful house/apartment (been moving around too much to be able to buy a place permanently)

19. learn to play the drums (hmm...bila ada masa?)

20. have a one night stand (why not?)

Why Do I Crumble At Times of Anxiety?!

2011-06-21T13:55:00.005+01:00

"Mind over matter."

"All too frequently, anxiety crushes not only your spirit and your potential, but your ability to take care of your mind and body." ~ Jonathan Davidson and Henry Dreher, The Anxiety Book: Developing Strength in the Face of Fear.

"Nerves and butterflies are fine - they're a physical sign that you're mentally ready and eager. You have to get the butterflies to fly in formation, that's the trick." ~Steve Bull

Have you ever wish that you could just behave abit more normally when you are anxious/nervous?

Have you ever looked back and think, "Oh man, I can't believe I just said that?"

Have you told yourself that everything will be fine, and yet it doesn't turn out that way?

Have you ever wish that you have never ever have to go through this whole frightening situation again?

I guess most of us would probably have said "yes" to at least one of the questions above. The second quote certainly applies to me. I just sat for one of final medical exam, called "PACES." It is a clinical skills examination, where the exam candidate rotates through 5 different stations, and if you pass it, you will gain membership into the royal college of physicians, which then, allows that person to further specialise into the medical field.

I took the exam only yesterday. I have been building myself up to the exam over the past few weeks. When the examination day arrived finally, I told myself, "Just be calm, and you'll be alright."

Guess what?

I was really really really nervous. I tried to take a few deep breaths, but still felt much the same. I started off with a communications/ethics station. I was asked to discuss whether ventilation is appropriate for a lady with end stage COPD. I thought that invasive ventilation is probably not appropriate, but non invasive one, would be her ceiling of care. However, the feedback I got from the consultant was not good at all. From his point of view, ventilation would still be appropriate in her case. hmmm...

Then, I moved on to the dreaded Station 5. There were 2 cases in the station. The first one was a guy with vision loss....I was only given 6 mins to talk to him, and explain what I thought was the problem. I didn't have much time to explain to him what I thought was the problem....so I guess I lose marks for that. I did better in the 2nd case.

I moved on to examinations skills stations. I had to examine 4 different patients. I think I did worst in the respiratory one...purely because I totally missed the 1cm scar at the side of his chest! yeah...it was 1 cm long!! my eyes really have failed me. And I didn't get the diagnosis right in his case. :( A few questions were directed at me...and honestly, I really don't believe the answers that came out of my mouth!

I finished the exam at the history taking station. This didnt go well either because I couldn't finish on time....the patient was so long winded, and I think he didn't know his history properly. So I faltered there.... sigh.

Is this all just nervousness? If it is, I really need to know how to overcome this. I personally don't think that the cases were too difficult...but my brain has just decided to work separately from my body...and everything just seemed to have gone wrong on the examination day!

I am very disappointed with my performance. I can only blame my ownself for this. I am most likely going to fail it. The only consolation I have is that it will not be the end of the world if I do fail. I can try again in December...

Guess I probably have to do more locum shifts to get some money back to pay for this very expensive examination. Results won't be out till next month, I better enjoy the time off I have, before I start preparing for the examination again!

A Pool of Blood!

2011-06-15T21:48:00.005+01:00

For the first time in my life, I have felt alot....I mean, seriously, ALOT, of blood pouring through my fingers.

So far, I have dealt with minor bleeding in patients after venepuncture, or angiograms. But, today, patient X, fell onto the floor after having a seizure. Patient X cracked the back of X's head, and subsequently, bled from the wound.

When I arrived at the scene, patient X was already lying in a puddle of blood....One of my colleagues applied pressure on the wound with his bare hands as he wanted to stop the bleeding quickly. I offered to take over from him, as I had gloves on.

I used some gauze to help seal the wound. However, blood kept pouring out of the wound...I could actually feel the warmth of the blood through my fingers. The nurses kindly got me a surgical pad, which I applied with good force on the scalp. I had to place the entire surface of both of my hands on his scalp, and also at the same time, trying to stabilise his head, as he was very agitated. It was quite a difficult task I must say! Finally, after about 10mins or so, the bleeding stopped.....thankfully!

After that, my arms ached. The muscles in my forearms were twitching. The shaking was definitely not due to nervousness. I have no problems looking at blood. I think it was probably due to the way was trying to put pressure on the wound, and also, the amount of persistent pressure I had to apply to patient X's scalp. Imagine having your fingers spread out on a person's scalp to hold and stabilise it as well. I have to admit I have pretty small hands, which made it a bit more difficult.

It was quite an experience for me, as so far, I have never been involved in any moderate-major trauma. I would never ever forget the sight of pouring blood and that warm sensation of blood when is just seeps through my fingers.

Take That Rocks!

2011-06-12T20:44:00.013+01:00

TAKE THAT is FANTABULOUS!

Yeap....their Progress tour has began. They started off in Sunderland as usual. And I was one of those lucky fans who managed to get tickets to watch them live in their next stop, which was Manchester, where they all came from.

I am a mega fan of Take That. I loved them since I heard their song "Babe" and "Back for Good." I was very excited when the boys (or maybe I should call them men) decided to reunite a few years back! I was slightly sceptical when Robbie joined them last year...but I have to say, it was really nice to see them all together on the stage.

The show kicked off with The Pet Shop Boys....unfortunately, I didn't manage to watch their entire performance, as I was running late.....and....ermm....coz I was too busy choosing which t-shirt(s) to buy from the stall outside. hehehe...

...............75 pounds less later (yes i know!), I eventually went in and saw about 15 mins of The Pet Shop Boys. They were entertaining, and certainly, got the crowd going.

Take That (minus Robbie) began their gig with "Rule the world," one of my favourite songs. The interesting thing to note was that this particular song was the closing tune for their Circus tour. It was like they were continuing their gig from where they last toured in 2009. A few songs later, the 4 of them went behind the stage....and Robbie appeared on the stage, on his own.

I never was a huge fan of Robbie (the person)....but I do like his solo music. He started off his own mini gig by singing Rock DJ! I loved the fact that Robbie sang a few of his own solo songs on stage...and at the end of it, he was joined by the other 4, singing tunes from their new album, and popular songs when they were a team back then.

I really enjoyed myself! There were fireworks, confetti, human chess board, amazing dancing troupe....wow...the gig was brilliant!

The Circus vs Progress tour?

I personally think that The Circus tour is the better of the two. I thought that The Circus tour was more extravagant and playful, which made it special. The Progress tour was more serious & grown-up. It really showed how much the guys have "progressed" and moved on.

Having said that, the stages were set with similar ideas. For example, in the Circus, there was one main stage, and another that tracked into the middle of the concert venue. This concept was maintained in The Progress tour. The other similarity was the use of robotics. It was a robotic human in the Progress tour, while in the Circus, they created a robotic elephant.

For those of you who are unable to catch the gig, I would highly recommend that you buy the DVD when it is out later this year, you will not regret it!

Let the show begin!

Yellow confetti!

The grand finale (the robotic human is in white)

Interesting yet controversial

2011-05-28T09:59:00.002+01:00

Here are a few interesting statements that I came across this week in the the hospital. Some of them were overheard, some of them were directed right at me.

In order to maintain confidentiality, I will not mention who said it, but will just label them as Staff A, B, C etc... (my thoughts on the statement will be written in Italics)

"Oh, I hope he hasn't gone away to google the solution to the problem here!" said staff A, on a cardiologist registrar. (how rude and unprofessional, and its not like staff A knows much about cardiology anyway)

"That surgeon has no idea....she is so stupid!" said staff B. (other specialty commenting on other specialities is a very common thing in the hospital)

"Out of these few names, who will you choose to put the CPAP hood on? Chantelle, Fred, Tiffany, Kieran?" asked staff C to the team members. "Of course you will choose Fred, coz he sounds more like someone who will cooperate....Chantelle/Tiffany will be too worried over their looks." (judging people even before meeting that person)

"Most haematologists think that all their patients have an excellent prognosis." (hmm..i dunno, I am no haematologist. if the specialists think so, i would believe them)

"Are the registrar here?" asked staff D to me, after reviewing his patient. "No, I am the SHO here," I replied. (Staff D looked at me up and down, and turned away. He did not want to tell me his plan for the patient...prob coz I am the SHO)

"I don't expect you to know anything." said a fellow registrar to me. (hmm....i might not know alot about advanced ITU things, but I do have medical knowlegde, you know?)

Any thoughts about these statements?

Freaking Out!

2011-05-19T00:11:00.002+01:00

Now that I'm back in the UK, reality has started to sink in, once again.

There are 4 weeks left to my PACES exam in June....and honestly, I am shitting myself.

The last time I had a proper OSCE style examination was during medical school years, which was many moons ago! I recalled sitting outside the examination rooms extremely nervous. My heart was thumping hard, fingers icy cold, palms sweaty, and I had a churning/crampy feeling in my tummy. Gosh...I really hated that feeling. It was worse than taking my UK driving test or Grade 8 piano exams or presenting at a regional meeting. I also remembered saying to myself," I don't ever want to have these feelings ever again."

Well, come 20th June, I know that these feelings will come back to haunt me. Ok, I know that I have no choice. I have to take the exam in order to make a step closer towards specialisation. If I pass, then I will be over the moon! But if I were to fail, which is a very high probability, then, I will have to face the exam again...

Life is so unfair! :(

Today, I attended my first PACES teaching session. I really thought that cardiovascular examination is probably the only examination skill that I have mastered properly.

Huh! dream on!

I forgot to test for a collapsing pulse, missed palpation for the apex beat and got my special murmur manoeurve all mixed up! Its amazing how being put on the"hot seat" made me fall deep into a hole.... sigh.

Bearing this in mind, I don't even want to think how I would perform a good and sleek neurological examination!!!

I seriously need to put my arse into gear...practise! practise! and more practise!!

Monkeys Caught in The Act

2011-05-05T05:31:00.009+01:00

I visited the Botanical Garden in Penang on Monday. I haven't been to this garden for yonks! And I have to say, I am pretty impressed with the garden. The landscaping was beautiful, and there were some information written about specific trees/plants in the garden.

Dad suggested that we take a tram ride around the gardens first, and so we did. Sitting on the slow tram reminded me of my childhood days....hmmm

One of the things that haven't changed is the presence of monkeys. These monkeys are pretty wild, and they could potential bite you if you are not careful. There are many signs in the garden asking visitors not to feed them, but as usual, Malaysians being Malaysians will naturally ignore them. And as a result, the monkeys can be seen fighting for the food given to them. Check these pics out:

The battle to see who gets the food first!

The winner, enjoying an ice cream.

I know that history has linked us to apes in the past. Just look at the way the above monkey held the ice-cream. It kinda looked like a little boy enjoying an ice-cream on a sunny day. Recently, The Star newspaper published a picture of a orang utan smoking a cigarette! hmm....bit disturbing, no?

Anyway, while strolling in the garden, I also saw a few monkeys shading themselves under the trees.....and this was what they were doing.... (look at the pic)

This is what we call "kutu searching." Too bad the pic is abit tiny, otherwise, the monkey on the left actually had its eyes closed during the kutu hunt. haha.

We spent about 2 hours at the garden. Although the weather was burningly hot, I thoroughly enjoyed myself, soaking up the tropical breeze, and letting my skin tan a little!

Here are more pics (not of monkeys) taken at the botanical garden.

Big Cactus at the cactus gallery

Interesting plant coz its new leaves are white in colour

Cannonball Tree (named so coz of the shape of the fruits)

At the entrance of the botanical garden

Home Sweet Home

2011-04-25T16:40:00.005+01:00

6 months later, here I am again, back at home, and absolutely loving it!

It was a last min decision to come back here, coz I only found out that I have been given 2 weeks off work 2 weeks ago. Managed to get my air tickets from Emirates, although, they were definitely more expensive compared to my previous trip back here. But it doesn't matter, spending time at home with family is well worth it!

On the day of arrival, I guess I was lucky to not have to embrace the burning sun. It was pouring heavily. I have to admit that it has been a long time since I last experienced such heavy rain. It was rather humid, and visibility was very poor. Luckily my dad was the one behind the wheels. The only poor visibility I get in the UK is with fog, and heavy snow!

Anywho, once I got back, I had a quick shower, and before I knew it, we were out for dinner!

And.......right after dinner, mum, dad and I put our feet up, and enjoyed a 2 hour performance by MLTR at the convention centre!

yes...i know...MLTR!! haha...yes, they still exist, but I have not heard much of their newer songs. I kind of grew up listening to their music, and I will admit, that I can still sing their oldies word for word! oh yes!

Just in case you're wondering who MLTR is, they are a danish band, called "Michael Learns to Rock." They are more famous in Asian countries...and they are known for catchy tunes like, "25 minutes," "Paint my love," "Actor" etc...

So it was a pretty nice start to my 13 day break back home!

I plan to just chill, eat, shop and catch up with old mates when i'm here! I know that time will pass really quickly, and before I know it, it will be time to fly back home. I should enjoy it as much as I can right now!

DECISION TIME!

2011-03-10T08:16:00.002Z

The time that most of us doctors at my level dislike has arrived.

Yeap, it is decision making time. The much dreaded job application has began. Now, I have to decide what I want to specialise in.

hmm.....is it respiratory? diabetes/endocrinology? gastro?

well, definitely not cardiology...neurology... renal...

or, is medicine what i really want to do for the rest of my career as a doctor??

or, should I switch to something that doesnt involved so much medicine, ie, psychiatry?

or, should I switch to something less frustrating, and more lifestyle-friendly job of GP?

or, should I go to a specialty where I do abit of everything...like acute medicine?

I really hate filling in forms...I hate deciding on things like this. The thought of choosing one specialty and the thought that I might not like it in the end is rather frightening. And, even if I want to do that particular specialty, I might not get the job at all....

Imagine, each deanery only has about a maximum of 3 available spaces for each specialty...

competition is tough.

arrghh....

R-U-B-B-I-S-H

2011-03-08T21:32:00.003Z

The week has panned out to be pretty rubbish.

This is Day 9 of my 12 day working week. As the week progresses, things seem to be getting more out of control, crazy and frustrating.

On Sunday, I spent at least 6 hours in one of the wards sorting out a very ill patient. The thing that frustrated me the most was the fact that there was no proper plans created for the patient. The diagnosis made by the patient's usual team was of X, however, when the patient was seen by another team, the diagnosis was Y. The interesting about this was the team that diagnosed the illness X, is a specialist in the illness Y. So the diagnoses were sort of going against each other.

I was stuck in the middle, and I was asked by one of the teams to get ITU to review the patient....Unfortunately, they gave me a big mouthful because the diagnosis was unclear. So I resorted to telling them what I personally think it was. I am sure many junior doctors out there have been in the same position as me. It is just so difficult and uncomfortable being in the middle of an argument between 2 teams.

To add to the misery,

I really wanted to "aou huit" today.... that is a chinese phrase, which literally means "vomit blood." A patient was extremely agitated in the ward because of a severe infection. The patient has no capacity whatsoever to make decisions. A few doses of sedation was given earlier, but they had no effect on the patient at all. The interesting thing was again, there was no clear plan from the ward round about addressing the agitation.

So there I was, holding a syringe filled with diazepam, gently sedating the patient intravenously to allow us to provide treatment. I dislike doing that....but had no choice because I was doing it in his best interest.

The joys of being a doctor.....NOT!

If Wagamama Can Make Teriyaki Sauce, So Can I

2011-02-27T21:42:00.004Z

I finally made teriyaki sauce from scratch!

Yay! I am very proud of myself. I am a huge Japanese food lover....I love sushi, teppanyaki, teriyaki, green tea, miso, bento...etc...etc.. Wagamama is a popular Japanese restaurant that can be found around the UK. I love going there to savour all the delicious chicken katsu, ramen, and gyoza. Unfortunately, living about an hour's away from the city, I haven't been able to frequent it as much as I would like to.

Feeling all miserable, and in order to satisfy my cravings for Jap food, I challenged myself to make teriyaki sauce. It is NOT difficult! All you need is a small saucepan, sugar, light soya sauce, dark soya sauce and sake. Mix them all together...and VOILA....

TERIYAKI SAUCE!

The sauce tasted exactly like the ones you buy off the shelves...but at least I know, there isn't any preservative or msg or anything like that. I decided to use the teriyaki sauce to marinate a piece of salmon. I grilled the salmon for awhile.

While waiting for it to be ready, I stir-fried some mix vege - using pak choi, button mushrooms, carrots, broccoli, sugarsnap peas and garlic. I also added a touch of teriyaki sauce and a bit of lemon juice into the stir-fry......just to give it a sweet tanginess.

And the final result:

Grilled Teriyaki Salmon served with a bed of vegetables!

I munched it down with a bowl of white rice...and I can happily say, my dinner was absolutely delicious!

Inspired by MasterChef!

2011-02-22T13:03:00.006Z

The brand new masterchef series has started! And remember that one of my new year resolutions is to prepare more homecooked food?

Yes...both Kevin and I were very inspired to prepare our own fine dining in the comfort of your own home! =D I have to admit that it does take quite abit of an effort, but the end result is well worth it. And it is definitely nicer to cook for two!

So...here they are!

Stuffed apple with ice cream
(pardon the apple, it kinda exploded in the oven...hence it had lost its shape)

Brown Rice Kedegree with side salad

Pan Fried Seabass, topped with tomatoes and olives salsa, and grilled courgettes on the side.

We attempted to present the dish well! Guess we didnt do too badly.

I wish I could take credit for creating such lovely food...the recipes are taken from Sophie Dahl's Cookbook, "Miss Dahl's voluptous delights!"

I highly recommend this cookbook if you're looking for nice homely healthy food!

Today is The Day

2011-02-09T22:18:00.002Z

Today is the day that I felt I have failed to be a doctor.

It hasn't been a good week so far. Things were disorganised, consultants were being difficult, nurses were being pushy, and patients were very ill.

There is a death in the ward for the past 2 consecutive mornings.

However, the death this morning has made me feel like a complete failure. This poor patient has metastatic cancer...lets call this patient B. B came in with increasing abdominal/chest pain, with episodes of diarrhoea. We have thought it was gastroenteritis, and attempted to get on top of B's pain with opioid based analgesia. B was very settled before we all left for home yesterday.

Unfortunately, when I came to work this morning, B was in severe pain overnight. I went to review B. B was screaming in pain and was writhing around the bed. B apparently had a shot of diamorphine, which seemed to work for a few mins, before B was in severe pain again. The tricky thing about B's pain control was B was quite sensitive to morphine, and had an episode of presumed opioid toxicity, which he responded quite well to naloxone (an antidote for morphine).

I didn't know why B had such bad pain. But my initial plan was to give B some intravenous morphine to get him comfy. However, just as we going to get some IV access in him, B just suddenly deteriorated. B's breathing became very laboured, the colour on B's face disappeared very quickly, and just less than 1 minute, B just stopped breathing, and died.

I was shocked that B deteriorated so quickly. The worse thing was B died in pain! How could I possibly allow a terminal cancer patient die in so much pain...B was screaming in pain seconds and minutes before B's death.

I was very disappointed with myself for not doing anything sooner. One can only imagine how much pain B was in, and that B's death was so uncomfortable for B. I seriously felt I failed to be a doctor today. I also could not understand why B's pain relief was not addressed properly overnight, when B was in so much agony. Who knows! B's death was certainly inevitable, but we as doctors should have made sure that the journey towards B's death was as painless as it can be.

I was very disturbed after that death. My deepest sympathy goes to B's family.

* sigh.

How Unthoughtful!

2011-02-01T19:56:00.004Z

This is no laughing matter.

And, this is NOT the first time that I have encountered this problem.

Yet, I still DO NOT understand why there is a lack of modern technology in this era!

Now, what am I talking about?

Well, simply the fact that there are quite a number of obese patients in the country that could not fit into MRI, or CT scanners.

One of the patients in the hospital needed an urgent MRI scan to investigate for spinal cord compression. Unfortunately, although he is not obese, he still could not fit into the MRI scanner. The radiographers have blamed it on his big tummy! There are no larger MRI scanners in this region....and I heard someone mentioned that there might be a specialised MRI scanner for obese patient in Sheffield, or the patient could use the scanners build for the use of animals.

What I do not understand is, why aren't there many larger scanners available in this country? I mean, surely, the government realise that obesity is a problem in the UK. And surely, this problem occurs quite frequently. Ok, I admit I do not much about the physics and mechanics of these scanners...but one would have thought that if there are scanners available for large animals, why can't there be ones build for larger patients?

MRI scans are more helpful in identifying spinal cord problems compare to CT scans. Are we depriving larger patients more accurate diagnostic investigations? If building larger machines is not the answer, then what is?

I guess you can ask these patients to try to lose weight...but that would take quite awhile. Moreover, the scans are needed to be done on an asap basis. I guess health professionals just have to treat empirically and use their best clinical judgement for such cases. Or, utilise other investigative methods to investigate an illness by the process of elimination.

Do Not Miss The Black Swan!

2011-01-31T19:00:00.003Z

I am a big big fan of Natalie Portman. I simply love the way she carries herself, her intellectualness, beauty, and her acting skills. I last seen her in the movie "Closer," which I really enjoyed. So when I first saw the thriller for Black Swan back in December, I told myself, I NEED to watch it.

Yes, I watched it about a week ago. Oh my, Natalie was A-M-A-Z-I-N-G. She was so graceful as a ballet, yet extremely mentally disturbed. Thumbs up to her for being able to portray the character Nina so well. I know this whole movie is fictional...but heck, it was brilliant!

It was rather intense. I cringed when I saw "Beth" stabbing her own face with a knife, and also the scene where Nina slammed the door against her mother's hand. There were scenes where I was just not sure whether she had made it up in her mind, or were they for real? The lesbian sex scene was also really sexy and steamy. Well down to Natalie and Mila. Imagine being good friends, and having to kiss each other, and pretend to have sex?! that must be SO UNCOMFORTABLE!

So, if you haven't heard of the Black Swan, you are definitely OUT OF DATE!

If you have heard of it, then I would highly recommend it. =)

Harmless Flirting

2011-01-18T18:40:00.004Z

FLIRTING.

According to Wikipedia, "Flirting" is non-physical sexual communication between two people to negotiate mutual attraction through body language and verbal tactic.

Flirting can happen anywhere really, whether at a shopping mall, dinner, parties, or work.

In the hospital setting, a lot of flirting takes place, particularly, between young female nurses, and male junior doctors.

It is really quite interesting to see it happening in front of your eyes. I had the luxury of observing one the other day.

The junior doc working in my ward at present is a young male, who is very much into gymming. Let's call him X. He is bald, and has a muscular V-shaped body.

You get the pic?

It was a busy day at work yesterday. We were all rushed off our feet. Later in the morning, I returned to the ward after reviewing a few patients in a different ward. As I approached the doctor's table, I saw a group of female nurses crowding around the table, where X was sitting. They were all giggling in a very flirtatious way. I was wondering what was going on, and I found out that they were flirting with him.

"Aww...X, would you mind prescribing this for me, please? I will stare at you until you prescribe it....hehehe (giggling)....." said one nurse.

Another said, "Hey X, you not been for your lunch yet? Aww...would you like a cup of coffee or tea? I will make one for you."

"Hey X, I will send that off for you, just pass it to me..." offered another young nurse.

The nurses hardly ever offer to make any one cups of tea/coffee, unless we are on our night shifts, or you are a consultant. I wanted to laugh when I saw X blushing. He suddenly received a surge of attention and TLC from the nurses.

After all that, I heard one of the nurses whispering to another, "Oh...he is so cool and hot...look at his body."

I have nothing against all these harmless flirting. But it could make the person in the hot seat quite uncomfortable sometimes.

Cook, Cook and Cook!

2011-01-16T17:37:00.003Z

I havent mentioned this before, but one of my other resolution for the new year is to cook. Yes, I seriously need to spend some time cooking a meal for my ownself.

Over the past year, I have to admit that I have been cooking more than I used to, but it is still not good enough. Many a times after coming back from work, the tiredness and laziness just overcome my whole body, to the extent that I simply could not be bothered to stand in kitchen to cook a simple meal, like pasta or fried noodles/rice. But, is boiling some instant noodles for 3 minutes considered as cooking? Probably not.

This is even worse after a long day at work, or pre-night shifts. I keep telling myself, "Come on, how difficult can it be to chop up some vege/meat....put some oil in the pan, and cook yourself something edible?!"

Well, I think it is difficult, and requires alot of inspiration and effort. haha. The only time that I feel the urge to cook is when I have a friend over.

When I don't cook, I would eat loads of junk, just to keep me tummy filled. The junk includes sweets, chocolates, biscuits, crisps, breakfast cereal (even for dinner!!!!)..and ice-cream!! (I hide my face in shame just admitting to all these....) How am I meant to set a good example to my patients?!

So this is why it is very important for me to stick to this resolution of mine. Therefore, I have recently bought a few new recipe books...just so that I can get some ideas and make cooking bit more exciting/less hassle.

One of my new recipe books is called "Miss Dahl's voluptuous delights," written by Sophie Dahl, of course. I bought it because this book is written in a seasonal manner. So, they are different recipes for the 4 seasons of the year, and each recipe uses certain ingredients that are of more abundance in that particular season. Her instructions are easy to follow. Now, isn't that a good recipe book?

I shall update this blog now and again, whenever I attempt any of her recipes.

Also, since the start of this new year, I have followed a few of Nigella Lawson's recipes, which were taken from the internet. I love the way Nigella cooks her food. It is so different from other chefs, like Gordon Ramsay/Rick Stein.

Before I end, here's a treat for all you chocolate lovers/snack lovers out there. I strongly recommend Nigella's very easy to follow, and sinfully delicious "Churros with a chocolate dipping sauce" recipe. Yummmm....

Here is the link, so do go check it out:

http://www.bbc.co.uk/food/recipes/churros_with_chocolate_84833

New Year ... New Look!

2011-01-06T22:04:00.002Z

Welcome 2011!

I must admit that I have been struggling to write the dates in the case notes!

I keep writing too many number 1's. LOL.

Anyway, to celebrate this new decade, I have decided to change the look of the blog! I have chosen the wintery background because it is winter here in the UK. More snow has been forecasted over the next few days! *sigh

I should not really make any resolutions as I never keep up with them....but I feel the need to aim for a few things this year...and they are:

1. to run a 10k

2. to pass all my exams

3. to go home for a holiday

4. to travel abroad...somewhere!

Just 4 things to aim for this year....should not be THAT difficult!

wish me luck!

A lil note to end the year...

2010-12-31T23:24:00.002Z

another year has came and gone.

what can i say about 2010?

it has not been a bad year for me.

i managed to pass my exam after a few attempts, which was a great milestone for me.

i had a wonderful spring break visiting Paris...such a lovely place. i would go back there anytime.

i had a fun summer....this time, i travelled to Lake District, and visited the little towns at that place.

Autumn was the main highlight of the year...because I got to go home! yes....it was lovely. i managed to attend my best friend's wedding, and was even more surprised when she asked me to give a speech at her wedding. i also attended my cousin sis' wedding...which was lovely. i met up with most of my old frens, savoured all the tasty local cuisines...

then, came winter....which was BITTERLY cold. it snowed, snowed and snowed. my arms were getting very good daily workout, by just simply scraping the ice off the car! driving conditions were horrible....i feel so lucky that my car has been brilliant, apart from the signal light wiring problem.

it was soon christmas....where i spent the weekend working. it was busy and tiring. i received a few lovely pressies....got lovely purple gloves, 2 DVDs from the studio gibli company to add to my collection, a head massager, a box of chocolates, 2 tins of biscuits....However, i also received a rather odd xmas present, in the form of a luggage tag?!

anywho, it is new year's eve now...and i am happy that i am sitting down on my couch, in front of the telly, and typing this, with kylie minogue's music playing in the background. life has been very kind to me. i am blessed to have a lovely supportive family back home, a boyfriend that is so patient with me, a few good friends here that are there when i need them, a nice and cosy flat, a good job, enough funds to support my occasional crazy shopping spree...

so goodbye 2010....and welcome 2011!!! =)

Night Shifts.....again

2010-11-07T08:52:00.004Z

My night shifts ended on Friday morning. The whole week was horribly busier than normal, most probably because people are catching various kind of illness during these few months as we approach winter.

The nights were made more pleasant by being on call with a hot Spanish registrar. *hee heeee

Yes, he is new in our hospital. He has lovely wavy dark brown hair, tanned, and I love his Spanglish. He is also tall and well built. (hopefully you could picture him in your mind). He is also extremely approachable, helpful and down to earth. The funny thing was actually watching how a few of the nurses with him in the ward! yes!

The nurses will come up to him to ask him to prescribe simple things like paracetamol or an anti-sickness medication...which is what I usually do for them. But rather than asking me, they approached the reg. While waiting for him to prescribe them, they just start to chat him up!

haha.

I bet the reg was enjoying all the attention. Some of them even sat down and had a little conversation with him...which was pretty unusual on a busy night shift.

Oh well, that aside, he is a great reg to work with, and I was glad to be on call with him.

errm.....yes ok, I probably did giggle a little too much whenever he cracked a joke! =P

Yay!

2010-10-28T07:07:00.003+01:00

Finally got my MRCP 1 performance details yesterday. Yes, I passed, finally!

I really wanted to know which field I did best....After the exam, I felt I didn't do well in the clinical sciences, clinical pharmacology, infectious diseases (ID), neurology, dermatology, nephrology and respiratory.

Surprisingly, I did very well in ID, pharmacolgy, neuro and nephro. And even more surprising, I scored full marks in dermatology! I also did very well in geriatric medicine...maybe I should think about becoming a COTE specialist.

But I was right, my scores were quite low for the clinical sciences. I didn't do as bad as I thought in ophthalmology and respiratory.

Overall, I'm pretty pleased with the outcome.

Now, to prepare for Part 2.

The pressure is on...coz a lot of people at my stage has already gotten full MRCP.

Delicious Malaysian Food

2010-10-27T07:02:00.006+01:00

My trip back home was all about catching up with friends, family and enjoying local food. And that was exactly what I did. Due to our multi-cultural society, we get to enjoy food from a vast variety of food, including chinese, malay, indian, western, japanese, korean etc.

I will not write much...but all I can say is MALAYSIAN DELICACIES ARE DELICIOUS! There are so tasty, bursting with flavours...yumm... I hope the following pics will make you hungry! =D

Ipoh white coffee, with kaya toast

Tasty and crunchy bean sprouts (or taugeh)

Ipoh Hor Fun

Char Kueh Kak

Nasi Goreng Peranakan

Asam Laksa

These food looked good rite?

Well, they were EXCELLENT!

If you haven't been to Malaysia, pls do plan a trip there...its well worth it! =P

6 more days and counting!

2010-09-30T22:52:00.002+01:00

The only thing that is keeping me through the crap at work is the thought that I'll be home in less than 7 days!

woo hoo!!

I really can't wait. I am really excited coz I haven't been home for the past 2 years. But at the same time, I am rather stressed with it too. Well, should I say that the stress is actually GOOD stress. I mean it is NOT like exam stress at all, which I must say is BAD stress.

Now you may ask why am I stressed out?

The stress is because I have not much time left for packing.....I dislike the fact that I am on-call this weekend. If only I were off, I could take the time to pack my stuff, and also maybe do abit of last minute shopping.

The other stress is having to prepare a speech for my good friend who is getting married in exactly 10 days. Don't get me wrong, I am extremely honoured to be asked to speak at her wedding reception.....but the only problem is I have never done this before. I have never been to a wedding reception before! So I really do not know where to start! Anyone has any good ideas? Or anyone has spoken at a wedding reception before???? Please share your ideas and experience with me.

I am thinking of starting it with a lil LOVE quote, and then, proceed to talking about what I think of my friend as a person, and how she met her hubby and managed to keep the relationship strong for the past for more than 5 years.

hmm...it is easy to think of what to say...but it is putting those thoughts into words I find difficult. I still haven't started to write anything yet....and time is running short!! help!!

Those stress aside, I am starting to count down to the moment I step into my flight back home to destination: KL.

Physiological Changes to the Body During Stress

2010-09-22T06:49:00.003+01:00

Gosh...its amazing what stress can do to one's body. I have been very stressed lately, with exams, portfolios and work.

Stress was at its peak yesterday because it was exam day! My body was behaving oddly.

I could not sleep...(waking up every hour from my sleep is NO sleep at all.

I struggled to eat any of my meals (but forced myself to otherwise my brain cannot function).

I have million butterflies in my stomach (highest number yesterday compared to the rest of the week).

I felt so nauseated that I nearly vomited in the train!

My heart rate was averaging from 90 to 100 bpm for most of the day.

I was having pleuritic chest pain for a few hours.

My fingers and toes were freezing.....and the palms were sweaty.

........... This morning, I slept bit better, still having some flashbacks about the exam yesterday....I just need to stop thinking of the questions and the answers..... Coz when you think about it, you want to know whether you have put down the right answers by looking it up in the book. If the answer was right, that's good....if not, I will feel very upset. So I'm really trying not to think about it.

It is time to get ready to work.... I am not hungry, but probably should have my breakfast otherwise I would be hungry later.

I am hoping for a stress-free day at work today....can't physically manage another stressful day again today.

Grim

2010-09-02T21:01:00.003+01:00

Dying from cancer seems like the most dreadful thing. It is a slow and painful death. There will be numerous hospital admissions either for chemotherapy, radiotherapy or surgery. And let's not forget that these patients have to endure endless complications either secondary to the side effect of their treatment or because of countless infections.

It has been a grim day at work today. 1 out of 4 patients in the ward is suffering from terminal cancer. None of them are curable. Majority of them have a severe infection, while the others have new spread of their cancer.

I really can't imagine how much pain these poor patients are experiencing. It must be excruciating. We are trying to manage these pain issues with strong doses of opiates, and also putting them on a syringe driver. But we never seem to be able to keep their pain score at ZERO.

And it also makes my heartache when I saw a lovely man in the ward who was talking to me about 2 hours ago, and just as I left the hospital, he was unconscious, agitated and taking the last few breaths of his life. I know I shouldn't be surprised to see how quickly a cancer can kill you, as I have seen many of them in such situations, but still, I can't help it.

To top it all off, it upsets me even more when people drink far too much alcohol for their own good, and end up having liver damage because of it. Why do you self mutilate your body?! And once we have treated you and get you back on your feet....what do you do??? Of course! You go back to your old drinking habits. Within a few months, they bounce back into the hospital again, and the whole cycle repeats itself.

Have they ever thought of how previous their life is??? Why do they want to end their life so quickly??? Have they even thought of those patients suffering from terminal diseases that would prefer to live on for a little longer, but can't because they isn't any other way to cure them?

I dunno. I guess this is medicine and the reality of life for me.

The Big Changeover

2010-08-13T21:41:00.002+01:00

The biggest day in hospital diary is the day where all junior/senior doctors changeover in August. Outpatient clinics are reduced or cancelled to allow for a less chaotic changeover. Team leaders from different departments in the hospital will be asked to do a short presentation to the new group of doctors, as part of the hospital induction.

On this day, fresh junior house officers begin their career as doctors, learning to apply everything learned in medical school into clinical practice.

On this day, ex-juniors become senior doctors, embarking on new challenges and bigger responsibilities.

On this day, most doctors will start work in a different ward or hospital, whereas a few others will remain in the same place.

This particular day is said to be the worst day to be admitted into the hospital, as errors do happen, and most things will be disorganised.

My changeover day was not bad at all. I started off doing night shifts, which is absolutely fine, because I get to escape the morning chaos in the wards. However, on my night shift, there was a junior doc who was absolutely terrified of doing anything! *Bless her!

She was terrified of writing up a patient's drug chart.

She was terrified of taking a blood sample from a patient.

She was even terrified of waking a patient up at 3 am for a physical examination!

Poor gal....I have honestly never seen anyone as scared as before!

Anyway, with a little push, she plucked up the courage to do a few basic things during the night shifts.

Apart from being terrified, she appeared absolutely clueless as well. The one thing that I remembered the most from that night shift was she didn't know how to prescribe paracetamol!

In my very humble opinion, I think that is the simplest prescribing task ever! How could she not know how to prescribe that? hmm...Maybe I am expecting abit too much from a junior house office.

The big changeover day has passed, and work resumes as usual for everyone.

Live or Die?

2010-08-11T08:15:00.002+01:00

Wow....the season 6 finale for Grey's Anatomy is the best yet!

In fact, the storyline from season 4 onwards have been really good. I see each characters growing... most of the episodes were very meaningful. Somehow, I can feel what the patients and surgeons were experiencing. I feel my emotions floating into the scenes....I couldn't help but cry too!

Season 5 ended with George dead.....then, Izzie had skin cancer... and then, the unexpected happened. Dr McDreamy was shot!

Gosh....I was crying so badly when I watched the final two episodes....

I know it is only a drama...but heck, the creators have done a good job.

What Grey's Anatomy said was right. We all have choices. Life is full of choices...

Do we want to be a hero or a coward?

Do we want to fight or give in?

And do we want to live or die?

I know that these choices are not always given to us...but if we were given them, which will we choose?

Would you fight on to live.....or do you give in to your illness and die?

Do you become a hero, and try to save the day....or do you become a coward, and hide from all responsibilities??

hmm....decisions......

The Writer - Ellie Goulding

2010-08-09T20:43:00.002+01:00

My favourite song at the moment: The Writer by Ellie Goulding

Love the the lyrics... here is part of it.

But I've got a plan

Why don't you be the artist

And make me out of clay?

Why don't you be the writer

And decide the words I say?

Cause I'd rather pretend

I'll still be there at the end

Only its too hard to ask

Won't you try to help me?

Such meaningful words....

Conversations in the Hospital

2010-07-27T22:29:00.004+01:00

Thought I would share a few entertaining conversations I had in the hospital this month.

Conversation 1

This lovely elderly man was admitted with urinary retention, and subsequently developed a urinary tract infection. While examining him, I proceeded to ask him the routine 10 AMTS (Abbreviated Mental Test Score) questions.

One of the questions was, "What do you think my occupation is, if you look at me?"

Bear in mine that I was wearing a simple blouse and trousers, with my stethoscope hanging around my neck, and my pager stuck to my pocket.

He gave me a good look, and said, "Well, you're a beauty queen."

hmmm.....I wish I was. He scored 5/10....so guess he was pretty confused eh?

Conversation 2

A locum orthopaedic doctor came to my ward to review a patient of mine who possibly has a broken pubic rami. He examined the patient thoroughly as you would. Then, he started to write his findings down in the notes. While doing so, he looked up and asked, "Is it better to write; there is good moving of the right leg, OR there is good movement in the right leg?"

I know I really shouldn't be laughing at others, whom English is not their first language. I tried really hard to stifle my giggles. My colleague told him that the latter sentence was a better of describing the patient's range of movement. It was amazing that he could keep a straight face while doing so.

Conversation 3

There was a pleasant elderly lady in the ward. Unfortunately, most of us, when we grow older, we will lose our hearing. This lady was nearly 90 years old, and she looked alot younger than that. I asked her whether she smokes. She replied, "Well, yes I do...you know, its really hard to get rid of this habit."

"How many do you smoke in a day?" I asked.

"hmm...about 4 to 5 a day."

"Oh ok...so about 4-5 a day...."I repeated as I make a note of it on my records.

She said," No....not 45 a day....it is 4 TO 5 a day."

I laughed...and told her that I know she said 4 to 5, and not 45.

Treasure What You Have

2010-07-15T10:34:00.003+01:00

It is such a common humanly mistake that we never seem to REALLY treasure what we have until it is taken away from us.

I thought the latest Shrek movie was excellent. It was funny, good animation and not to mention, the moral value the movie was trying to teach everyone. Shrek had almost everything he could dream off....a lovely ogre wife, Fiona, 3 cute kids, good friends (Donkey and Puss), and a nice place to live..... BUT (there is always a but), he felt that he has become a tame ogre, not fearsome no more. So he decided to exchange one day in his life, and that day, was back to a day he didn't have any friends, no family, and Fiona did not recognise him as his wife. He regretted his actions, and felt miserable. He misses Fiona and his family. He did everything he could to go back to his present life, and succeeded in the end. And like most animation, the story ended happily ever after.

I felt good after watching it. I realised that sometimes, I may have taken some things for granted...and I need to change my actions, change my attitude, to become a better person, less grumpy, and really appreciate the lil things in life that makes my life meaningful.

ahh....how's that for a new resolution?

That aside, I highly recommend Shrek Forever After to everyone! It is definitely way better than the previous one. Watch out for catchy words like, "Cat-tastrophic!" and "Ri-don-culous!"

McDreamy or McSteamy?

2010-06-09T20:23:00.007+01:00

Grey's Anatomy rocks!! Yes it so does. I love this drama to bits! I wish there is a real McDreamy and McSteamy in the hospital that I am working in at the moment. haha.

I know alot of people will disagree with me. The storyline might be cheesy to some, or unexciting. They might think that some of the medical bits in the drama unreal. But who cares! Grey's Anatomy catches the essence of life as a doctor. Although I have to admit that the love life might not relate to everybody, but the happiness, disappointments, competitiveness, difficult decisions, life-saving measures....they are so real.

Many a times, while watching Grey's Anatomy, I found myself thinking about my own personal experiences. For example, I could feel the disappointment in Dr O'Malley when he found out that he had failed his internship. I could feel the joy in Meredith and Derek, when the finally managed to treat a patient's brain tumour successfully in their clinical trial. I could sense their tiredness at the end of the day....their need to just not talk about things at times.

I guess that is what attracted me so much to Grey's Anatomy....of course, not to mention, the existence of McDreamy and McSteamy makes the drama that even more exciting and hilarious....what more can you ask for?

If you don't watch Grey's Anatomy, then, you wouldn't know who they are. McDreamy is Dr Derek Shepperd...a talented Neurosurgeon...at least he isn't as grumpy and as arrogant as some of the Neurosurgeons I have spoke to. He is McDreamy, because I suppose he has that dreamy look in his eyes....Then a few seasons later, McSteamy arrived! He is a hunky plastic surgeon. The 2 of them are good mates. And I feel the complement each other in the drama very well.

If given a choice, I would pick McDreamy anytime....keke.

Anyway, I just completed watching Season 4 of Grey's anatomy. I finished the entire series in less than 7 days!! I have to admit that I have an addictive personality. Once I start watching a drama series, I want to watch the next episode immediately. That is why I NEVER EVER buy DVD box sets. I simply have no self-control.

I will need to get season 5 stat!

Welcome to The North East of England

2010-05-27T01:07:00.002+01:00

It was a wonderful sunny weekend.

It is time to get rid of the heavy thick coats, time to put on a summer dress, and time to take those lovely sandals out from the store.

Yes....why hide in the house, when such hot weather is hard to come by.

So I decided to pay a visit to The Angel of The North.

I am not sure if you are aware of this wonderful creation of Antony Gormley. It is a big sculptor located in Tyneside at the North East of England. It is probably one of the most popular work of public modern art in England.

The wings of the angel is about 54 m in length. It stands on top of a very small hill, and it sort of welcomes you to the North East of England. The body is about 100 tonnes in weight, while the wings are weighing approximately 50 tonnes each.

As you can see, it looks simply amazing. I would highly recommend a visit to this place in order to truly appreciate and soak in the majesty of this sculpture.

Thanatophobia

2010-05-13T22:11:00.005+01:00

Anyone heard of this word "thanatophobia?"

Thanatophobia = fear of death

I am sure many of us are afraid of death. No one knows how it feels like until the day actually arrives. It may come so quickly that you don't even feel it.....or, it may be a slow, painful, and gradual process. Who knows which kind of death we will suffer from.....

I have to admit that I can't help but think about death too. Death is inevitable in the hospital. Patients die, and we, doctors, certify the death. Within a few hours, the patient's body will be moved to the mortuary. Then, a new patient will arrive in the ward to take up that empty bed in the ward.

Yes, the turnover is fast. Yes, I have encountered many expected and unexpected deaths in the hospital. I should have been used to dealing with death by now.

But no.

Today, I felt really upset when I spoke to one of my patients. He has 2 failing organs...and that is a bad sign. Death is quite near. It is horrible seeing how someone could deteriorate quickly just within a few days. I explained to him what was going on. I told him that his kidneys are not functioning very well anymore, and that there is a limit to what we could offer him due to his other co-morbidites.

He said, " Doctor, I don't want my kidneys to fail...."

There it was.....the look in his eyes.....just broke my heart and soul.

I guess it would be even scarier for them to see the reflection of his fear in my eyes. I could only keep my cool, and tried my best to give him my honest opinion, with a lil encouragement. Its difficult. Once 2 organs are failing, the body will slowly shut down and fail completely.

I can't imagine how it feels like when you know death is inevitable. I can only hope that the person is as comfortable as he/she can be.

..................................

Unfortunately, he died peacefully a few days later. I was not surprised, but felt rather upset.

RIP. You are now in peace with your body and soul.

Is It Trust or.....is it just plain laziness?

2010-04-29T20:44:00.005+01:00

hmm.....I kept asking myself these questions over the past 3 nights.

Yeap, I am doing the night shifts these week. Someone has got to do it...and it so happened to be my turn this time.

I am not complaining about it...

But I somehoe dread going into the shifts.

I mean, no one can predict how busy it is going to be....what sort of disaster is going to happen.... or whether it is going to be a quiet night (oh no, I said the dreaded Q-word!).

But, but, what really bothers me is my senior colleague I am working with.

Senior Colleague's name is J.

J is a medical registrar. So J has to oversee everything in the hospital. He is the boss at night, second to the consultant who is on-call from home. Yes, so J's responsibility is HUGE.

So I really wonder, how come J goes to bed every single night of these shifts from about 1 am to 6 am?? J has left me with all the acute admissions during that time. If it is a ok night, I really do not mind at all. But when there are 10 people on the board waiting to be seen, and more to come...surely, J should help out, no?

J is the registrar, yes, I know that.

But, this is the first time I'm working with J. So, J doesn't know whether I know what to do, whether I am careless or careful...etc.

So the question is.....Does J really trust me so much that he has left me with all the admissions? Or, is J just plain lazy? When J wakes up later, he will just say," Oh there were more admissions this morning, eh? Everything ok?"

Hmm...I don't know. I want to say that he trusts me. But deep down, I think there is a tiny bit of laziness there.

Unexpected Visitor

2010-04-24T14:36:00.003+01:00

I seem to attract the authorities. This is my 4th encounter with the police.

This week, I came back from work as usual. I was really hungry that day, and quickly heated up my leftovers in my microwave. While enjoying my dinner, I suddenly heard a loud knock on the door.

I was like....hmm...who could that possibly be? I thought it was a delivery man, sending a parcel.

So, I peeped through the hole in my door.

Oh-uh, there was a police officer standing at the front of my door. Immediately, I could feel the adrenaline rush....my heart started to thump really fast and hard. A few thoughts came to my mind.

Did I commit a crime? Did somebody sue me? I dunno.

I opened the door to greet the police officer.

"Hello," he said.

"Ermm...hi," I replied.

"Just wanted to ask you if you knew your neighbour living over there?" he said, while pointing to my neighbour across the corridor.

"No, I don't know him. I don't know my neighbours at all," I said. (and this is true)

"You not seen him moving furniture or anything like that?"

"No I haven't. I've seen those girls living opposite him, but not see him."

"Oh ok then. Thank you very much," he said.

After I closed the door, I still felt weak in my legs. My heart was still thumping.

Don't get me wrong. I was glad that he wasn't looking for me.....glad that I wasn't in trouble. But I can't help feeling intimidated when I meet a police officer.

I speak to police officers occasionally in the hospital environment, and even prison officers. But I do not feel scared when doing so. It is probably because I was in a hospital, where there are other colleagues around me. While being at home, there is no one else.

I am so Stiff!

2010-04-18T08:50:00.002+01:00

It was a lovely bright sunny day yesterday. I have been working for the past 2 weeks without any break.....therefore, I decided that it was time to soak up some lovely sunshine, and fresh air.

So what did I decide to do?

Go for a jog around the park.

It wasn't a bad idea to start with. I used to run 9 miles a week (6 months ago!). I stopped running because the weather was becoming colder, and I moved down here to M'bro. I had to quit my old gym....and was TOO lazy to get myself registered in a new one locally.

I got changed into my exercise gear. Did bit of warm up...and started to jog at a slow pace. After one round, I was panting like I have just completed a marathon run. My heart was thumping so hard. I could not continue running. So I stopped to catch my breath. After a few mins, I started to run again....but found myself stopping another time just before the second round was completed.

Yes, clearly I have lost my fitness level...how upsetting!

I remembered being able to run around the park 3 times without stopping....and now, only just one round?! Gosh...how bad is that?!

Luckily there was the happy sunshine and fresh air to cheer me up a little.

This morning, I got up with stiffness all over. My quadriceps are stiff and achy....my lower back is just the same too.....sigh, these are the consequences of not exercising regularly.

I shall now attempt to run bit more regularly.....i hope! no more excuses, now that the weather is so much warmer!

If Only I Can Split Myself into Two

2010-04-14T18:57:00.002+01:00

Exactly....it is impossible....well, not entirely, it can be done, only that I have to lose my life.... *yikes (that's not ideal!)

I really do love my job. I really do...trust me. The only thing I struggle with is trying to be in 2 different places at the same time. I am sure many other doctors out there will agree with me. This situation is made worse when you're in an on-call shift, where you are IT. You are THE ONLY doctor on-call for the wards...in charge of looking after more than 100 patients during that shift.

I found myself caught in a dilemma over the weekend. The situation was:

a patient was scoring a EWS of 12?!
a patient complaining of chest pain
a man who had more than 1 litre of ascitic fluid drained from him, and now hypotensive
a patient with pyrexia
a patient who has disseminated malignancy in severe pain (despite being on really high doses of opioids)

Now, I received these many calls within 10 minutes. HELP!

I told myself...prioritise....prioritise.....breathe....breathe....dun panic.

So off I went to see this patient with a EWS of 12. He was really really sick. After performing a few resuscitative measure, I quickly walked across to the opposite ward to check on the ECG for the patient with chest pain.

Great! Now he is in uncontrolled AF! A quick assessment was done followed by giving him a rate limiting medication.

Then, I rushed back to that sick patient....still very ill.... did a few more things for him....but he was too ill to be left alone. So I called the ward to ask about the hypotensive patient...who apparently looked "washed out" according to the nurses. I told the nurses to give him a fluid challenge to see if it would help.

The patient I was with was now scoring a 14. !!!!!!

I actually did contact my SPR for some advice...which he did provide...but clearly none of them was working. He needed HDU/ITU support. I called my SPR again...it took him such a long time to come review this ill patient (it wasn't like he was busy in the MAU!).

Anyhow, in between all these chaos, the poor cancer patient has been left in pain....I felt so guilty. I told the nurses to give him some IV morphine...but none of them could cannulate him... so I told them to give it s/c instead.

Finally the ill patient went to HDU. I was now able to leave him to carry on with my other tasks....

*sigh.... it was certainly a challenging day. I was so exhausted in the end. To add to that tiredness, was plenty of guilt. I felt that I was not doing a good job. The poor cancer patient was left in so much pain....in fact, he was in pain for nearly 9 hours, before I could sit down and calculate how much morphine he requires in a syringe pump.

Imagine if one of my family members were left in so much pain.....that would be horrible...I would not be happy to leave them in pain for so such a long time! Luckily the cancer patient and his wife were so understanding.

SIGH. Another sigh.

Glad I am not on call for the rest of this week.

Holidays!

2010-03-29T20:45:00.004+01:00

Its so nice to have a great holiday.

I got back from Paris more than 1 week ago, feeling rather refreshed, rejuvenated and rested. =)

We were blessed with great weather there. It was sunny everyday, except on the day we left. As a result, we managed to do alot of walking and sitting around on the pavements, enjoying the beautiful view in front of us.

Paris is a great city. Everyone is so well-dressed. Every woman carries a beautiful handbag (well, almost everyone of them). The buildings look old, but are well maintained. The only criticism I have is that things are very pricey. A simple sandwich with cheese and pickles was priced at 4 euros! I found that really dear, as I could possibly get a sandwich similar to that for 2 pounds or less in Tesco. A small cup of cappuccino costs about 2 to 2.50 euros...and I could get decent coffee at the train station in the UK for 1.50 pounds.

Anywho, that aside, I thoroughly enjoyed myself. We went to visit most of the usual attractions, including the Eiffel Tower and Versailles. Eiffel Tower is stunning. It looks even more elegant at night.... The orange lights on the tower make it glows beautifully, and did you know that the tower twinkles (with blue lights) for 5 minutes in every hour? I sat down in front of the tower for at least 3o minutes just enjoying the wonderful sight!

Oh did I also mention that I forgot to pick up my luggage from the conveyor belt at the arrival hall in Paris airport? YES....silly me. I was too busy thinking about where to catch the bus to get to Paris city centre, and thus, just walked out of the hall without even getting my luggage first. I laughed at myself for being so careless....and quickly walked back into the arrival to get me luggage. Thank God it was still there.

=) ahh...holidays.....what will we do without them? Where will me next destination be? should probably start planning soon. Now that summer is near too, there is even more reasons to plan ahead! Remember, it doesn't matter where you go, as long as it is with good company!

Short Getaway

2010-03-21T10:25:00.004Z

yay!!!!

In just a few hours, I'll be flying away to the capital of France! I'll be there for a few days.

I haven't been there since I was a little girl.....to be honest, I don't remember anything of that trip made when I was about 5.

Mum keeps telling me that I was a real grumpy girl then...My dad had to carry me because I was unwilling to walk. haha. Having looked back at those pics, I would agree with mum...I didn't smile in the pictures at all!

Oh well, I am sure I will enjoy it now. =) I am keeping my fingers crossed for good weather.

Till then...au revoir everyone!

In No Hurry...

2010-03-20T10:20:00.002Z

Its been more than 1 week since I left my car at the garage.....and I have yet to hear anything from them. I mean how long does it take to just change the bumper??

I became very curious....which led me to pick up the telephone to call the repair centre. She struggled to locate my car at first (which kind of worried me a little). Then, she said, "Ahh....I found it. The parts of your car only just arrived yesterday. So they are going to strip your car next.....looks like we are looking into next week."

Right. Cool.

I was bit disappointed that it took quite awhile to repair....but then, secretly, inside me was a little sense of joy? ermm...yes, remember that I am driving a cool white sporty Fiat 500. And I am getting the hang of it. So, as much as I want my car back asap....I am also in no hurry to get it back because this replacement car is great! haha.

Talking about being loyal to my wee Peugeot.....tsk tsk tsk

Small Funky Car

2010-03-13T19:20:00.003Z

I have to admit that I am enjoying my temporary replacement car. I know my poor Peugeot is in the garage being fixed at the moment....I am missing it....honestly, yes, I am. However, this replacement car is quite cool.

It has been voted the "Car of the year 2008", and also the "Best Small Car" award.

I am talking about the new diesel Fiat 500. It is a really sporty 3 door car. It is very easy to drive. The interior is funky and the seats are comfy. The engine runs smoothly, and I like the sound the engine makes when I start it....it ROARRSS! haha.

My only complaint is the colour. White is nice for a dress, but for a car, dirt can be seen easily. And....I am worried that I might just fill in unleaded petrol instead of diesel! I have been having a few nightmares about that........=( Well, I know I still have at least quarter of a tank left...so that should keep me going until the end of the week, before I start worrying about it.

So, if anyone is thinking of getting a small sporty car, give the Fiat 500 a thought! (ps. it does come in a beautiful fiery red colour!)

Hanging Loose

2010-03-09T20:36:00.004Z

The mechanic came to estimate the damage to my car this morning. I was really glad that he came because I was kind of anxious just waiting to find out how badly the car was hit.

After taking a couple of photos of the car, he asked, "Hey, you still driving the car?"

"Errmm...yeah, I am," I replied.

"Right ok. Do you know that it is fairly dangerous to do so?"

"Oh is it? How come?"

"Well, as the result of the impact, your exhaust pipe is actually hanging down quite loosely...so it could fall off very easily. Secondly, even if it doesn't do that, because the exhaust is loose, it leads to an increase in tension at the front part of your car....leading to even more damage to your car. So be really careful when you drive up the humps on the road," Mr Mechanic explained to me.

To be honest, all I had in my mind was how unsightly the bumper was....It never occurred to me that the exhaust was also involved in the minor accident. How ignorant of me!

I was curious to find out how much the repair would cost (although, I know the money was not coming out from my pocket...).

"Hmm....probably at least 1000 pounds minimum, and the repair may take up to 2 weeks,"he said.

Wow....that is very dear....and 2 weeks in the garage???!! man...that is long. Oh well, I guess they have to adjust the bodywork, re-spray the paint, etc.

He will be picking my car up tomorrow to get it into the garage. My courtesy car will be arriving around the same time too. I really just want my wee car sorted asap.

It Just Happens...

2010-03-07T21:39:00.004Z

So it was 9 o-clock Saturday morning. I just completed my set of night shifts. When I do night shifts, I run out of food from my house very quickly....because I have no initiative to buy food during the week. Therefore, on this particular Saturday morning, I thought of all the different type of food I wanted to get from the shops. I was already formulating recipes in my head for the week!

I left the hospital and thought to myself. "Hmm....maybe I should do food shopping after getting some sleep first." But, I was actually quite awake after the adrenaline rush I had throughout the busy night. I decided against that idea...and drove myself to get some food from Morrisons and M&S. yumm....

After paying nearly 20 pounds for food, I drove myself home, quite happy and contented.

Unfortunately, this feeling did not last long. As I was heading towards a roundabout, I noticed that a car had stalled just at the entrance into the roundabout. I, therefore, pressed my brakes to slow down. All of a sudden, I saw a fast car heading towards me from the rear. I thought it would have stopped before me....however, to my horror, the car moved closer to me...and at the very last second, the driver realised that he could not stop in time, and swerved to the left...........

BANG!

My heart sank.

My car slided forward. (thank goodness the car that stalled had managed to get his engine started and drove away, otherwise, I would have bumped into it).

All blood supply drained from me.....I felt weak.

Yes, I was knocked from the back. That idiot driver was kind enough to stop his car at the side of the motorway.

We got down from the car. He apologised for his mistake. I was still in shock. We exchanged details, ie car registration number, address and contact details.

My rear bumper was cracked and dented. I think my Peugeot is a tough car. The impact was quite hard....but the bumper was still intact.....well, maybe only just hanging down slightly. Luckily none of the lights broke. Obviously, part of the car paint was scraped off....it wasn't a very nice sight.

His car was damaged even more...probably coz his car was the driving force for the accident.

Sigh...I was like, "GREAT!!! This is just what I need after a long week of night shifts!"

I drove home...still alittle shaken. I was very glad that I was safe and unhurt. To be honest, it was a very minor accident....but MINOR enough to make me scared, shocked and traumatised. I really couldn't imagine being in a major accident.....it would even be worse!

When I got home, I contacted my insurance company immediately. I was really impressed by the efficiency of the system. Come Mon/Tues, I would be able to get my car to the garage for repair...and I get a courtesy car at the same time....all on the expense of the other driver.

I am alot better now. Just wished it hadn't happened. But things like that was probably going to happen anyway. I mean, if I didn't go food shopping in the morning, I wouldn't have been in this position, no? It just happens....I was at the "right" place, at the "right" time...

Sigh.

My Fingers Are Too Short!

2010-02-25T00:55:00.002Z

I've learnt one very important fact in my life as a doctor yesterday.

MY FINGERS ARE TOO SHORT!

And I thought my fingers are quite long for my size because of my piano playing background. In fact, I recalled measuring my fingers with my classmates last time, and they were surely longer than theirs!

So I was quite surprised to find that my fingers are too short for a simple manual evacuation yesterday.

hehe.

For those naive to medicine, let me tell you the satisfaction of a manual evacuation. (no not really...not so much satisfaction....more of a disgusted feeling!)

Right. The situation was this elderly lady was in the post-operative period. She has been constipated for a good few days. She has tried various laxatives to help with it, but unfortunately, none was working. I suggested a trial of a phosphate enema (you know, those things that you stick up your bum to activate a bowel motion).

To my horror, the nurse returned to tell me that she was so impacted (ie, her anus was so stuffed with faeces), to the extent that she could not even use the phosphate enema!

The nurse asked me, "So what are we going to do?"

I dreaded the thought I had in my mind.....and I reluctantly said, "Guess, the next step would be manual evacuation."

A manual evacuation of faeces is when a person inserts his/her fingers in a rectum to digitally remove faeces inside it. It is helpful in people who are rather constipated....and just need to unblock the hard faeces that is blocking the rectum. Once evacuated, it makes it alot easier for the person to open the bowels again.

I couldn't have found a better time to perform this procedure......which was after my lunch! Perfect! (I was crossing my fingers that I will keep my food down).

I explained to the patient what I was going to do....and she told me that she did not care how uncomfortable the procedure was going to be, as long as she could get rid of the discomfort she was having as a result of the constipation. She was more concerned that it would be unpleasant for me! How thoughtful!

I said, "Don't you worry about me, my dear....that's my job...to make you more comfortable!"

Prepped with double layered gloves and lots of lubricating jelly, I started the manual evacuation by inserting 2 fingers into the rectum. And............my fingers could not really reach the hard faeces stuck inside. I could feel it with my fingertips. So I just thrusted my fingers deeper into her rectum, and at the same time, wishing if only I had longer fingers. The poor patient was looking quite uncomfortable. She told me not to worry about it. *Bless her! And eventually after a few minutes, I managed to dig out at least 4-5 blobs of really hard stools.

I have to admit that this was probably the most disgusting thing I have ever done! I really wanted to vomit...due to the smell of the faeces...and just the thought of me, digging out faeces from a rectum. (I salute you fellow nurses/HCAs/cleaners)

The lovely patient was feeling so much more comfortable after all of that. She was able to sit comfortably on a chair as she didnt feel too impacted. All the nurses in the ward was laughing at me for having to do this manual evacuation...and the wise registrar said, "Well done. The only time you won't do a manual evacuation, is when you're a consultant! This is probably one of the MUST-DO when you're a junior doctor."

It was quite an experience....and I am glad that I've helped to make someone's life better!

hmm.....if only me fingers are bit longer.......

I don't have a straw!

2010-02-18T17:35:00.002Z

I couldn't stop myself laughing today. I know, I know, it is not very professional and nice of me to laugh at my work colleague....but what he told me today was hilarious!

He will be working this weekend on-call. So I said, "You have the short straw eh?"

He replied," What straw? I don't have a straw."

I was like huh?!

"I meant you are the unfortunate one that has to work this weekend," I told him.

He, then burst out laughing, and so did I. haha.

He said, "I didn't understand what you mean by straw. Guess it is just the way you say things here."

I wonder....

2010-02-10T21:51:00.004Z

I wonder sometimes whether I am being ignorant, or, the nurses just don't pay any attention.

hmm...

An elderly lady has been admitted with severe heart failure. She has longstanding bilateral leg oedema for the past 5 years, and as a result she has suffered from a degree of venous eczema. Both her lower legs have looked red for years. She has been a patient of that ward for 2 to 3 weeks now, and the same nurse has been looking after her for the past 7 days.

Now, this evening, I got a worried phone call from her. She was concerned about these red legs which she has never seen before. So I went on to review it. The legs were as red as they were when we looked at it many weeks ago. There are not hot or tender. There are unchanged. The patient herself did not notice any change the in the condition of her legs either.

So I reassured the nurse that there isn't anything to worry about at the moment. I've also explained to her that she has venous eczema. The nurse said, "oh really? I've never seen her legs like this before....it is new." I replied, "well, I have been looking after her, and I am 100% sure that her legs have been like that for many weeks now."

I can only conclude that she hasn't seen those legs while looking after the patient. Or, she was just not paying attention during the ward round, because, we examine her every day, and expose her legs every day....so how could you not have noticed that?

I dunno.

GGGggrrrr

2010-02-09T18:48:00.002Z

*GGRRrrr

The year of the tiger should start with a bang. The tiger is a fierce and ferocious animal. So I believe that I should begin it with something grand. Unfortunately, there isn't anything exciting in my life at present.

1st of January 2010 went on like any other day. In fact, it was strange having to countdown in the hospital. I had to do the night on call then, and the nurses, and my fellow colleagues, turned on the telly for awhile just to catch the live telecast of the fireworks display in London.

And look at how first time flew by. It is February already.

Well, if I can't start the year like the way the tiger pounces on its prey, then, I should end the Ox year with a few resolutions.

My new year resolution is to pass all the exams I am attempting. I really need to, if I am thinking of entering into the specialty of my choice in a year and a half. I seriously can't afford to fail any.....moreover, these silly exams are so bloody $$$ anyway.

My second resolution is to plan and go on a cycling holiday break during Summer. I have always wanted to visit a place in Europe that would allow me to do cycle around the streets, and doing some tourisy things at the same time. I've heard that Amsterdam and Italy are good places for this activity. So hopefully, if all go as planned, I might be able to do that this year!

And finally, I would like to save enough money to get me-self an iphone! haha. yes...what a treat eh? I have 10 reasons for wanting one, but one reason not to....and that is because I find the current package deals wee bit pricey. So, if I save enough, I won't feel the pinch, no?

So listen, I will try to update my blog more often (I know I have neglected it for quite a few months now). And, I will give myself a huge pat on the back if I do fulfil these resolutions. Till then, Happy Tiger Year everyone.

Too early?

2009-11-25T19:20:00.003Z

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

2009-11-07T08:43:00.010Z

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?

2009-11-04T17:03:00.002Z

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!

2009-10-23T21:47:00.003+01:00

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!

2009-10-12T20:33:00.003+01:00

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?

2009-10-06T21:48:00.002+01:00

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!

?

2009-09-27T19:31:00.025+01:00

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!

2009-09-26T10:56:00.002+01:00

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!

2009-09-14T22:24:00.002+01:00

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....

2009-09-07T22:30:00.003+01:00

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...

2009-09-06T17:25:00.007+01:00

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

2009-08-30T00:25:00.003+01:00

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

2009-08-18T21:37:00.003+01:00

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?

2009-07-14T22:21:00.003+01:00

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

2009-07-09T00:17:00.002+01:00

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?

2009-06-30T00:23:00.003+01:00

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!

2009-06-21T12:01:00.001+01:00

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!

2009-06-21T11:32:00.012+01:00

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

2009-06-16T22:38:00.004+01:00

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

2009-06-13T06:48:00.003+01:00

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!

2009-06-03T07:56:00.002+01:00

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

2009-05-06T00:09:00.004+01:00

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!

2009-05-03T11:49:00.003+01:00

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!

2009-04-29T20:52:00.003+01:00

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

2009-04-28T21:45:00.002+01:00

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!

2009-04-27T20:33:00.003+01:00

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!

2009-04-23T21:30:00.003+01:00

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!

2009-04-18T00:14:00.003+01:00

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?

2009-04-16T22:05:00.003+01:00

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

2009-04-13T11:53:00.002+01:00

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

2009-04-05T23:24:00.002+01:00

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

2009-04-05T23:08:00.004+01:00

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

2009-03-31T23:11:00.003+01:00

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?

2009-03-29T21:43:00.002+01:00

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!

2009-03-28T08:33:00.002Z

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

2009-03-22T08:31:00.004Z

" 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!

2009-03-07T09:11:00.003Z

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!

2009-03-04T15:14:00.002Z

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....

2009-02-24T19:52:00.002Z

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?