My Fingers Are Too Short!

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!

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....

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

*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.