I just came back from Dunfermline. I haven't been home for 2 weeks already, and I certainly miss my bed and warm room alot! I am just extremely glad to be home this weekend..but have to go back to the cold accommodation next week.
Anyway, to summarise this week at the hospital: HECTIC!
I spent a week at the acute surgical admission ward. It was really busy. There were more than 10 admissions every day. Wednesday had a record of 22 admissions, most of them came in the morning...I think about 15 of them. The whole ward was loaded wif patients until there was no bed for them to come in....so the doctors had to see the patients in the A&E. Most days, I only get home just before 8pm...and feet were aching every single night because I stood and walked alot throughout the day.
Well, I didnt have a chance to speak to every patient...but I think, I managed to see 2 patients per day. There were plenty opportunity to practise practical procedures. Although I didnt receive a lot of teaching from the consultant surgeons, but I think, I did grasp the idea and role of a Junior House Officer (JHO), which is actually the objective of this rotation.....and all i can say is, the jobs that a JHO has to do is CRAP!
Friday, February 24, 2006
Saturday, February 18, 2006
Drink Drank Drunk
I am sorry if my posts are all about medicine...sorry...but my life is currently related to it..so most of the interesting things that are happening are associated with medicine.
Anyway, back to what I want to talk about. Drink Drank Drunk. It is a known culture for ppl over here to drink loads of alcohol, especially on Friday nites. Most of them ended up getting drunk and being involved in various accidents....
Today, I was doing my on-call with a junior house officer. The first 3 jobs when we both started working this morning were to speak to 3 patients who have injured themselves.
Patient 1: a lady in her forties, drank loads of vodka, tripped over the stairs on her way down from after going to the toilet..and just fell. she cant even remember what happened..because she lost her consciousness. She ended up with an injured face and aches in her arms and spine.
Patient 2: a 30 plus man, drank loads of lager, was found unconscious on the road. He doesnt even know who brought him to the hospital. He injured his face as well.
Patient 3: a 25 year old guy, drinking loads of alcohol, became drunk...and fell down as well while walking. He didnt injure his face...but he broke his left arm.
All these 3 patients were really wasting the bed spaces in the wards. Already there is not enough beds for patients who are in the waiting list to have their surgery. And all these patients, just get themselves drunk and injured....and then, the doctors have to admit them just to make sure that they are alright.
okok..i'm being kinda grumpy nowadays...dunno why...but yeah, stop drinking ppl!! or drink in sensible limits, PLEASE!
Anyway, back to what I want to talk about. Drink Drank Drunk. It is a known culture for ppl over here to drink loads of alcohol, especially on Friday nites. Most of them ended up getting drunk and being involved in various accidents....
Today, I was doing my on-call with a junior house officer. The first 3 jobs when we both started working this morning were to speak to 3 patients who have injured themselves.
Patient 1: a lady in her forties, drank loads of vodka, tripped over the stairs on her way down from after going to the toilet..and just fell. she cant even remember what happened..because she lost her consciousness. She ended up with an injured face and aches in her arms and spine.
Patient 2: a 30 plus man, drank loads of lager, was found unconscious on the road. He doesnt even know who brought him to the hospital. He injured his face as well.
Patient 3: a 25 year old guy, drinking loads of alcohol, became drunk...and fell down as well while walking. He didnt injure his face...but he broke his left arm.
All these 3 patients were really wasting the bed spaces in the wards. Already there is not enough beds for patients who are in the waiting list to have their surgery. And all these patients, just get themselves drunk and injured....and then, the doctors have to admit them just to make sure that they are alright.
okok..i'm being kinda grumpy nowadays...dunno why...but yeah, stop drinking ppl!! or drink in sensible limits, PLEASE!
Friday, February 17, 2006
Congratulations
Congratulations to all my IMU friends in Seremban, who has recently passed their finals. Their hard work has finally paid off. So it is just another 6 more months before you guys will be doctors!! All the best in Batu Pahat.
Thursday, February 16, 2006
Life Without A Bladder
There are so many organs in our body; all playing important roles to ensure that our body is functioning properly. Have you thought of life without a particular organ?
Well, just yesterday, I spoke to a 70 year old lady who was recently diagnosed with bladder cancer. She was to undergo a "cystectomy" this morning, in which she did. Cystectomy = removal of bladder. hmm..removing your bladder..it doesnt sound like a very nice thing to undergo. But I find it particularly interesting.
Therefore, I was at the theatre from 10am till 2.45pm today. The operation took so so long...now my feet is aching. But it was certainly an eye-opener. I was lucky to get a good view to observe the whole surgery. The surgeons were very kind to guide me through what they were doing, while pointing out the few organs in the abdomen.
I guess you must be wondering how the hell is this person goin to ever pass urine eh? Will that person ever feel the urge to pass urine ever again? The answer is NO. Without a bladder, there is no place to store urine.
Let me run you through the whole surgery. First, you have an incision in your abdomen. Then, your bladder will be taken out. If you're a female, then you'll most likely have both your ovaries and uterus removed together. The reason for this is because the surgery will usually cause some damage to these organs because they are closely connected. After that, a part of you intestines (terminal ileum) will be cut out, say about 7 cm in length. One end of this will be connected to your ureters (the tubes that carry urine from the kidneys to the bladder), while the other end will be connected to the side of your intestines (just so that it is fixed, and not moving about). Next, the opening of the cut-out intestine will be stitched to an opening in the abdominal skin, forming a "stoma". (hope you get the idea) So, once urine is produced, it will be carried by the ureters and move through the cut-out intestine, and through the stoma and finally, empty into a urine bag.
This urine bag will be attached to your body all the time..it serves as the new bladder. I have to say that carrying a bag of urine around is not fun at all. There is always a chance of urine leakage, the potential smell and the bag may protrude out from your clothes. Not to mention, your urine is warm and you'll always have this warm bag attached to your body...mmm...u know, it will be so weird. I really pity those who have to undergo such procedures. But this is the best option of getting rid of more extensive bladder cancer.
Well, just yesterday, I spoke to a 70 year old lady who was recently diagnosed with bladder cancer. She was to undergo a "cystectomy" this morning, in which she did. Cystectomy = removal of bladder. hmm..removing your bladder..it doesnt sound like a very nice thing to undergo. But I find it particularly interesting.
Therefore, I was at the theatre from 10am till 2.45pm today. The operation took so so long...now my feet is aching. But it was certainly an eye-opener. I was lucky to get a good view to observe the whole surgery. The surgeons were very kind to guide me through what they were doing, while pointing out the few organs in the abdomen.
I guess you must be wondering how the hell is this person goin to ever pass urine eh? Will that person ever feel the urge to pass urine ever again? The answer is NO. Without a bladder, there is no place to store urine.
Let me run you through the whole surgery. First, you have an incision in your abdomen. Then, your bladder will be taken out. If you're a female, then you'll most likely have both your ovaries and uterus removed together. The reason for this is because the surgery will usually cause some damage to these organs because they are closely connected. After that, a part of you intestines (terminal ileum) will be cut out, say about 7 cm in length. One end of this will be connected to your ureters (the tubes that carry urine from the kidneys to the bladder), while the other end will be connected to the side of your intestines (just so that it is fixed, and not moving about). Next, the opening of the cut-out intestine will be stitched to an opening in the abdominal skin, forming a "stoma". (hope you get the idea) So, once urine is produced, it will be carried by the ureters and move through the cut-out intestine, and through the stoma and finally, empty into a urine bag.
This urine bag will be attached to your body all the time..it serves as the new bladder. I have to say that carrying a bag of urine around is not fun at all. There is always a chance of urine leakage, the potential smell and the bag may protrude out from your clothes. Not to mention, your urine is warm and you'll always have this warm bag attached to your body...mmm...u know, it will be so weird. I really pity those who have to undergo such procedures. But this is the best option of getting rid of more extensive bladder cancer.
Saturday, February 11, 2006
An Afternoon at the Radiology Dept
As i have mentioned earlier, I am currently based at Queen Margaret Hospital. One afternoon, I've decided to follow 2 of the patients that I clerked in to their ERCP. (ERCP = Endoscopic Retrograde CholangioPancreatography, is a procedure done to investigate whether there are any stones in one of the ducts in our body). I have never seen one done before and was pretty much excited about it.
So, at 2pm, I made my way to the radiology dept. Asked the permission of both patients and also the consultant who was going to carry out the ERCP. Having given the green light, I waited for the procedure to start. And then, the horror started.
The consultant started bombarding me with questions regarding ERCP. Obviously, I didnt prepare myself for this, because, I've never been asked about anything whenever I follow a patient to all these procedures. I totally know nuts about it. So here is the short session I had with the consultant....which I found, sort of intimidating.
Consultant: Right, we're going to do an ERCP, I'm going to sedate the patient with pethidine and midazolam...what are the problems that can arise from this?
Me: The patient can be over sedated...hence leading to breathing problems.
Consultant: ok...what breathing problems are u talking about?
Me: ermm...(i dunno why i couldnt come out with the words "respiratory depression" at that time)..errmm...the patient's saturation will drop.
Consultant: ok....so the patient's respiration will be depressed...so ok, what if, the patient's sats drop to 94%, what will you do?
Me: hmm...give the patient oxygen?
Consultant: Correct. What if the sats keeps on going down despite the oxygen? What are you going to do?
Me: hmm...give oxygen...and..ermm...continue to monitor...do not give any more midazolam.
Consultant: ok...but is that ALL you're going to do?? the patient's sats is still going down and is about 80% now...
--at this point, most of the nurses in the room were listening to our conversation and were looking at us---
Me: ookkk, ermm...oh...i guess u can reverse it.
Consultant: what's wrong with you?? why are you being so diffident?
Me: (i didnt understand the word, "diffident", but nemind..i didnt respond to his comment, and my face was red and burning)
Consultant: ok..so how are you going to reverse it?
Me: hmm...mmm...oh..naloxone??
Consultant: NALOXONE? are you sure?? what is naloxone used for?
--Forgive me, i sort of lost of confidence at that time...and just couldnt think straight, so hence, blurted out anything that came immediately in my mind. i knew that i've dug my own grave---
Me: oh no...its for opiods...mm...ermm...yeah, flumazenil!
Consultant: Right, finally....ok...so wat are the complications of this procedure?
Me: hmm...I suppose patients are at risk of bleeding, infections...
Consultant: u know, bleeding, infections...these are so vague. You're not answering my questions like a final year med student. So, now, can u please start again. (spoken in an unfriendly manner)
Me: (I was abit taken aback...gulped down a lump of saliva) You can get infection from the bile duct...which is called...cholan...cholangio...cholangitis...
Consultant: Fine, to be more accurate, ascending cholangitis. What else?
Me: errmm...bleeding...from the pancreas??
Consultant: pancreas??? do u even know how an ERCP is done?? We do not even enter the pancreas...
Me: (I blushed...everyone in the room was looking at me) Sorry, I was a little confused. I'm not sure where is the source of bleeding.
Consultant: ok, bleeding is from the site of sphincterotomy. and what other complications can you think of?
Me: errmm...errmm...errmm.. (was really trying to squeeze all my brain juice)
Consultant: There is something called ERCP-induced pancreatitis, which is the most important complication...
Me: ok..
---silence...then he started the procedure---
so there you are...my short session at the radiology dept...I totally lost myself. I admit that i didnt know much about ERCP, but I do know the answers to the first few questions. It was just that I wasnt used to being questioned in this manner... and became nervous....sigh... Life is tough....
So, at 2pm, I made my way to the radiology dept. Asked the permission of both patients and also the consultant who was going to carry out the ERCP. Having given the green light, I waited for the procedure to start. And then, the horror started.
The consultant started bombarding me with questions regarding ERCP. Obviously, I didnt prepare myself for this, because, I've never been asked about anything whenever I follow a patient to all these procedures. I totally know nuts about it. So here is the short session I had with the consultant....which I found, sort of intimidating.
Consultant: Right, we're going to do an ERCP, I'm going to sedate the patient with pethidine and midazolam...what are the problems that can arise from this?
Me: The patient can be over sedated...hence leading to breathing problems.
Consultant: ok...what breathing problems are u talking about?
Me: ermm...(i dunno why i couldnt come out with the words "respiratory depression" at that time)..errmm...the patient's saturation will drop.
Consultant: ok....so the patient's respiration will be depressed...so ok, what if, the patient's sats drop to 94%, what will you do?
Me: hmm...give the patient oxygen?
Consultant: Correct. What if the sats keeps on going down despite the oxygen? What are you going to do?
Me: hmm...give oxygen...and..ermm...continue to monitor...do not give any more midazolam.
Consultant: ok...but is that ALL you're going to do?? the patient's sats is still going down and is about 80% now...
--at this point, most of the nurses in the room were listening to our conversation and were looking at us---
Me: ookkk, ermm...oh...i guess u can reverse it.
Consultant: what's wrong with you?? why are you being so diffident?
Me: (i didnt understand the word, "diffident", but nemind..i didnt respond to his comment, and my face was red and burning)
Consultant: ok..so how are you going to reverse it?
Me: hmm...mmm...oh..naloxone??
Consultant: NALOXONE? are you sure?? what is naloxone used for?
--Forgive me, i sort of lost of confidence at that time...and just couldnt think straight, so hence, blurted out anything that came immediately in my mind. i knew that i've dug my own grave---
Me: oh no...its for opiods...mm...ermm...yeah, flumazenil!
Consultant: Right, finally....ok...so wat are the complications of this procedure?
Me: hmm...I suppose patients are at risk of bleeding, infections...
Consultant: u know, bleeding, infections...these are so vague. You're not answering my questions like a final year med student. So, now, can u please start again. (spoken in an unfriendly manner)
Me: (I was abit taken aback...gulped down a lump of saliva) You can get infection from the bile duct...which is called...cholan...cholangio...cholangitis...
Consultant: Fine, to be more accurate, ascending cholangitis. What else?
Me: errmm...bleeding...from the pancreas??
Consultant: pancreas??? do u even know how an ERCP is done?? We do not even enter the pancreas...
Me: (I blushed...everyone in the room was looking at me) Sorry, I was a little confused. I'm not sure where is the source of bleeding.
Consultant: ok, bleeding is from the site of sphincterotomy. and what other complications can you think of?
Me: errmm...errmm...errmm.. (was really trying to squeeze all my brain juice)
Consultant: There is something called ERCP-induced pancreatitis, which is the most important complication...
Me: ok..
---silence...then he started the procedure---
so there you are...my short session at the radiology dept...I totally lost myself. I admit that i didnt know much about ERCP, but I do know the answers to the first few questions. It was just that I wasnt used to being questioned in this manner... and became nervous....sigh... Life is tough....
I'm scared...
Right, I've just returned from Queen Margaret Hospital in Dunfermline, which is about 1.30 hours away from Dundee by train. Spent one week there learning to be a house officer. How would I summarise my experience there? simple: SCARY!!
Fingers crossed, I hope to graduate in July and would start work in August. Well, I have to say, I am excited about starting to earn my own money....But yet, at the same time, I'm feeling very very scared. Shadowing the house officers who were working there has really made me face reality.
I have found out the following about myself:
1. I CAN'T formulate a management plan for the patients in the hospital. (although i do study from books, but when i'm faced with a patient right in front of me, my brain just stops working).
2. I CAN'T remember the doses of drugs that I need to prescribe to the patients, or even how frequent they need to take it and for how long. (its a wonder how the doctors working there can just write down prescriptions effortlessly).
3. I CAN'T catch what the consultants are saying...they give instructions in such a fast manner and watever that came out from their mouth, just sounded Greek to me. What if I heard them wrongly, then, I would be doing the wrong things to the patients...and then wat will happen???
4. I DUNNO how much fluids to prescribe to the patients..and yet, I'm expected to be doing that upon graduation...
gosh...I'm just so afraid...there are just so many responsibilities to carry with me when i become a doctor...I cant even imagine myself functioning as a doctor in August...would i be doing the right things?? can i give a correct diagnosis to the patient?? sigh..i may have the knowledge, but i just dunno how to use them....
i'm now just dreading the thought of finishing medical school...i just wanna remain as a student forever..no major responsibilities...i wont be blamed if something goes wrong..coz "I'm just a student."
Life is Tough
i have never thought that i would start a blog of my own. but, hey, Life is Tough, and people do change as a result of that. So here i am...with my brand new blog. Welcome!
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