What Have I Done Wrong?

The sarcasm continues today....in fact, it has been going on all week, and it has really killed me over, I think.

It was ward round day. My boss has not seen anyone all week because he has too many duties and chores to attend to. So this was his first time meeting all his beloved patients. We had alot of patients, and the ward round dragged on till 2 pm.

At the end of the ward round, I was physically tired, and more importanly, I was filled with shame, zero confidence and unhappiness.

Today, nothing I did was correct...somehow, he had something to pick on. Every patient we saw, I didn't seem to have done the right thing.

I told him that this particular patient (who was admitted via the renal unit) needed to be on IV antibiotics for 14 days as advised by the renal doctors. Ok, well this patient was admitted under his care, but the renal team has also been involved because they are quite particular about what antibiotics their patients get etc. Anyway, he asked me, "Why does this patient need such a long course of antibiotic?" I said, "Patient has a positive blood culture and the renal consultant wanted such a long course." Before I knew it, he said, "Oh come on, don't give me such crap"

I was like O K. Indirectly, he was implying that renal was being unreasonable and I was being stupid to listen to them.

The other situation was when one patient with progressive cancer and chronic leg oedema, developed acute renal failure. I told him that I had discontinued the patient's nephrotoxic meds, which included her diuretics, for a few days to allow her kidney function to improve. Now that it has stabilised I have restarted her diuretic at a lower dose. He told me later that, "You did the wrong thing. I don't give a shit about her kidney function. Her urea can be 50 and her creatinine can be 400. She's dying. You should have kept her comfortable by continuing the diuretic to allow her oedema to settle. Now, look at her legs, they are so swollen and puffy to the extent that they aretoo heavy to lift up." "Now, if it was your grandmother, would you like her legs to be so puffy?" I thought to myself, "well, of course not, but I do not want to accelerate her death by speeding up her kidney failure." I remained silent.

Sigh...We went on to another patient. This patient has newly diagnosed enlarged kidneys. I told him that I had spoken to the urologist and they were not going to decompress the kidneys and would not get involved in her care unless her kidney function deteriorates. Before I could even proceed, he went on to talk about the case and pointed out, "Why is the patient now on the list for a cystoscopy? That was not what you told me. You said they were not going to be involved."

I was thinking to myself that I haven't even finish my explanation earlier...and now you're telling me that I am contradicting myself? He didn't even let me complete my previous conversation.

Sigh...I totally gave up halfway during the ward round. I felt so vulnerable, and stupid. I started to wonder whether I'm made for this job...my confidence level went down to zero. I am still pretty upset about it all. I know I am learning, and I honestly do not mind being told I'm wrong. But somehow, I felt that this was unjustified. Oh, I know I should not be sour....it could be worse, I guess. I'll get over it after a cup of tea and a bottle of wine......

Whoa...sarcasm to the max!

Honestly, I am quite fed up with my boss at work.

First of all, I think he doesn't care about this patients. A consultant should review his patients twice a week...but heck no, not even once this week. He doesn't even enquire whether his patients are still alive?!

Secondly, he is pretty sarcastic. Give you an example.

Boss : what is the difference between prednisolone and budesonide?
Me : budesonide has less side effects.
Boss : why?
Me : I guess it gets digested quickly by the liver, therefore, it doesnt circulate at high levels.
Boss : You have no idea what you are talking about do you?
Me : Well, it was a guess. I haven't been reading up on this.
Boss : Hah! Thought so. It has high first pass metabolism.

wah...got slap right in the face.

Another example.

I was presenting a little case to him after clinic. Mind you, this was a GI clinic.

I said, "This is a 50 year old man with Crohn's colitis and sarcoidosis. He is currently on asacol, prednisolone - reducing regime, and alendronic acid." He stopped me abruptly.

"Hang on, is alendronic acid relevant? What does being on alendronic acid mean here? You have
to be more consise and relevant. What's the point in telling me he's on alendronic acid," he moaned.

" Well, he's on steroids for a long tem, and therefore, have developed osteoporosis secondary to steroids."

He then said, "Well, what does it have to do with his GI symptoms? Nothing."

I just kept quiet. No point trying to make a point...

I can take sarcasm very well...but I felt that this was unjustified, somehow.

Where Are You?

The cold days are back again. It has been raining EVERY single day. Mr Sunshine....where are you hiding?

Every morning, I wake up to embrace the rain, and on my way back from work, it rains again. The days are SO gloomy...temperature has not been any higher than 5 degrees so far. It was so bloody freezing that it actually rained sleet yesterday afternoon.

Having said that though, I see the rainbow almost every morning. I guess Mr Sunshine is actually trying really hard to show itself...but obviously, he is weak at present. Therefore, only a tiny wee bit of sun ray gets past the heavy dark clouds....and voila, you get a pretty rainbow. In fact, this morning, I saw DOUBLE RAINBOWS! yes... double, ie, one on top of the other. I could also literally see the end of the rainbows too...how wonderful is that?

Anywho, I hope for less rain and less wind....but I doubt that will happen.

The Script - The Man Who Can't Be Moved

This song is soo sooo sweet... if only there is a man like him...if only.

Going back to the corner where I first saw you,
Gonna camp in my sleeping bag I'm not gonna move,
Got some words on cardboard got your picture in my hand,
Saying if you see this girl can you tell her where I am,
Some try to hand me money they don't understand,
I'm not...broke I'm just a broken hearted man,
I know it makes no sense, but what else can I do,
How can I move on when I'm still in love with you...

Cos if one day you wake up and find that you're missing me,
And your heart starts to wonder where on this earth I can be,
Thinking maybe you'll come back here to the place that we'd meet,
And you'd see me waiting for you on the corner of the street.

So I'm not moving...
I'm not moving.

Policeman says son you can't stay here,
I said there's someone I'm waiting for if it's a day, a month, a year,
Gotta stand my ground even if it rains or snows,
If she changes her mind this is the first place she will go.

Cos if one day you wake up and find that you're missing me,
And your heart starts to wonder where on this earth I can be,
Thinking maybe you'll come back here to the place that we'd meet,
And you'd see me waiting for you on the corner of the street.

So I'm not moving...
I'm not moving.

I'm not moving...
I'm not moving.

People talk about the guy
Who's waiting on a girl...
Oohoohwoo
There are no holes in his shoes
But a big hole in his world...
Hmmmm

and maybe I'll get famous as man who can't be moved,
And maybe you won't mean to but you'll see me on the news,
And you'll come running to the corner...
Cos you'll know it's just for you

I'm the man who can't be moved
I'm the man who can't be moved...

Cos if one day you wake up and find that you're missing me,
And your heart starts to wonder where on this earth I can be,
Thinking maybe you'll come back here to the place that we'd meet,
And you'd see me waiting for you on the corner of the street.
[Repeat in background]

So I'm not moving...
I'm not moving.

I'm not moving...
I'm not moving.

Going back to the corner where I first saw you,
Gonna camp in my sleeping bag not I'm not gonna move.

A Little Too Much Alcohol

Vodka, whiskey, rum, gin, wine, cider, beer. What do they have in common? Yeap, they are all alcoholic drinks.

It is ok to drink alcohol within proper limits. Alcohol is a way of socialising, it is a way to de-stress, a way to soak your sorrows away, a way to help you sleep, a way to make you go off-limits and crazy, and lose all inhibitions! BUT, as fun as it may sound, alcohol is quite a deadly drink as well.

I was in utter shock when a saw a young girl, who shared the same birth year as me, dying in front of my eyes, due to alcohol related liver damage. Imagine, she was as old as I was. And yet, there she was lying in bed, slowly making her way into her own grave. It was due to excessive alcohol intake over a number of years that led to her liver damage.... Her liver was so scarred and inflammed that it could no longer function properly.....hence, she became sicker and sicker, and eventually died. The worse thing was I actually saw her a few weeks earlier when she came in with the DTs. I remembered emphasising the importance of stopping alcohol as her liver was quite damaged....but I guess it fell onto deaf ears.

Shocking, isnt?

I was pretty dumbfounded. How could someone so young self-destruct herself into such a state?? I mean we have tried to give her alot of advice, support and all the medications we could think of, to help her....however, she has lost her own battle to survive, purely due to her own irresponsibility.

sigh.

My Pic Diary

A picture diary about the food I had and the places I went when I was back home.

The tasty claypot loo shi fun @ Sri Petaling.

Maggots @ Singapore Biennale 2008

Aliens and a spacecraft, Singapore Biennale.

Funny phrases @ the Singapore Biennale 2008.

Funky bus stop in Singapore.

Tasty beef teriyaki wrapped around mushrooms @ Sushi Tei.

Amazing presentation for sushi @ Sushi Tei. Those are unagi pieces.

Extremely spicy Szechuan steamboat (the reddish soup) and ham choy soup by the side (to neutralise the spiciness!). Yummy!

Garlic Fried Rice @ Sakae Teppanyaki

Chawanmushi cooked in an onion @ Sakae Teppanyaki! Lovely!

Black Forrest Ice Blended @ The Coffee Club. It had tasty cherry pieces in it! Thumbs up!

My gal palies. Miss you guys!

SzeL & I @ her house, Ipoh.

Nasi Lemak @ Old Town Cafe

My 1st love with banana pie @ McD.

Kiki, Shopping and Tasty Food

My less than 2 weeks break at home went by SO quickly. I had a FABULOUS time.

When I first got home, Kiki was there to greet me at the gate. I have not seen her for 2 years, and the moment she saw me, her tail was wagging so fast, and she started to do her little dance for me...aww.... I really miss her. I gave her a biigg BBIIGG cuddle. I could see she was enjoying the attention as she relaxed into my arms and closed her eyes....

Malaysia is all about good food! And I was not going to waste my time eating Western food or bread. I had asam laksa and char kuay kak for dinner when I first arrived. The following days, my stomach felt so contented and happy, as I filled it with yau char kuai, ma kiok, chee cheong fun, nasi lemak, maggi mee goreng, roti canai and also, the best claypot loo shi fun ever. I was eating like there was no tomorrow. I even squeezed in a short trip to Ipoh to visit SzeL...and of course when I was in Ipoh, I had to try the taugeh chicken, dim sum and white coffee.... oohh... even thinking about them makes me so hungry!

Shopping was quite fun too, as I managed to catch the Raya sales...so in the end, I bought 2 pairs of lovely shoes, a couple of blouses, etc. However, I must admit that the prices are getting ridiculously higher compared to the last time I was home. Ohh...and I finally managed to visit the new malls, ie, Pavillion and The Gardens.

And now...I'm back at work, back to living in this cold refrigerator, better known as, Glasgow. It's back to the daily routine. Life has to go on. Surprisingly, my jetlag isn't too bad.

Crazy About Donuts

Dunkin Donuts.
Krispy Kreme.
And now...J Co?


I didn't know that there is a craze over donuts in Malaysia...that's until I came home. There is a new donut store in town, J Co.

My first encounter with this store was at The Pavillion. Bro said, "You've gotta try...its a craze here." I looked at the queue at this popular shop...and I would say it was pretty long for a weekday. Bro continued, "Oh....this is nothing. Once the queue was probably 1 km long!"

So bro went on to queue. To be honest, I am not a huge fan of fancy donuts... you know, like those sold by Dunkin or Krispy Kreme. They are just too sweet and not original. My kind of donut is the traditional sugar-coated ones.

Anyway, after a good 20 mins or so, bro returned with 3 different donuts... one was topped with choc hazelnut, the other was topped with alcarpone, and the third one had dates on it. I took a bite from each donut...hmmm...really not my kind of donut, and seriously, do not understand what the craze is all about. Having said that though, J Co's donuts are certainly not as sweet as Krispy Kreme.

We took our time to finish up the donuts...and more and more people started to queue up at the J Co counter to pack donuts home....some had like 10 boxes worth of donuts?! Crazy!

Less Than 1 Week Left

Ahhh.... it's a great feeling to be back home!

I arrived last Monday. The first thing I noticed was the humidity. I was sweating profusely the moment I stepped out of KLIA airport. It is so different being back home... suddenly, I see so many Malays, Chinese and Indians! haha.. I know that is what Malaysia consists of...but it is a bit strange for me, because I have spent nearly 2 years in Glasgow, not seeing THAT many asians around. Everywhere I go was Caucasians.

Home sweet home. Kiki, my lovely cute wee doggie, who is 8 years old now, still remembers me! How sweet! She wagged her tail and starting to dance around the floor. Aww...I really miss her VERY much. She was so "manja" with me... she started to turn her body upside down and rubbing her face on my feet.... =)

I have eaten alot too...in fact, maybe a little too much. The first day itself I savoured tasty, spicy asam laksa and char kuay kak. Then, the next day, I had pan mee.

My family and I made a short trip down to Spore. Bro was really kind to take us around Spore trying various different food...sushi, teppanyaki, SzeChuan Steamboat (which was SUPER spicy), coffee...etc... Boy, such an eating frenzy!

Being back home also gave me the opportunity to meet up with old pals, and my cousin sis who is getting married! Lucky me, I was the first to look at her wedding photo album....She was pretty... I still need to catch up with a couple people...but time is running short... =( There is less than 1 week before I need to go back to the human refrigerator in Glasgow. sigh.

okla...now need to sleep...and wake up for more yummy food tomorrow.

Harassed

It was a pretty exciting day for me at work today.

It started off with a gentleman with a NSTEMI and sepsis of unknown origin. He went into shock. I was not sure whether it was cardiogenic or just purely sepsis. To complicate matter, he went into fast atril fibrillation and his BP dropped even further. Never have I seen a patient as blue as he was. He was both peripherally and centrally cyanosed.

The second patient was a patient with active variceal bleed. By the time I saw him, he already vomited like 1L of blood! The surgeon inserted a Sengstaken blakemore tube to stop him from bleeding. I remember being a medical student and reading about variceal bleed. As far as I could recall, Sengstaken is used during clinical emergency where there are no other means to stop the bleeding.....and this is normally RARE.

Anyway, me being me, I was panicking. I have no idea how to manage this tube. The surgeon who inserted it started to give me instructions about how to inflate and deflate the balloon...how often I should do them, how long I should leave the tube in..etc...

As he was speaking, nothing was registering in my brain. Everything sounded Greek to me. It was too much information in an emergency situation. Then I went into a phase where I could see his lips moving, but I could not hear anything (i know this is very sad). All that came into my mind was this patient needs to go to HDU because no one in the receiving unit would know how to manage the tube.

The poor man was actively retching and bringing up fresh red froth. He was also actively losing blood from his rectum. The surgeon was busy trying to maintain the balloon of the Sengstaken tube inflated. The nurses were suctioning his mouth. I was trying to get a better IV access in him. It was all abit chaotic at the endoscopy unit.

He was nearly in shock. His BP went to about 109 systolic, he was tachycardic at 176! The nurses wanted to go home because it was 5.30pm already. But there was no way there were going to transfer him back to the normal ward. He has to go to HDU. But the nurses insisted on leaving and they just moved back to the ward against my advice! sigh. What can I do. But this really annoyed me.

Imagine this. Say for example, if I was in the middle of trying to resuscitate a patient (just like what we were doing to the bleeding man), and it was 5pm, which is the time for me to go home, should I just leave and say, "Oh look, its 5 pm. I am going to go home. You guys can carry on resuscitating him." But have we doctors ever do that? A big and loud NO. But why do nurses get away with that?? This remains a mystery. We stayed on to work on him..until he is stable enough and we are happy that he is in the appropriate unit and has a proper management plan in place. (my apologies to any nurses reading this).

Back at the ward, the other nurses were giving me the stares. I felt guilty...but really, it was out of my control. Anyway, he eventually went to HDU...... like 2 hours later.

I felt so harassed. In the midst of all these events, I have the consultant surgeon on the other end of the phone telling me how ridiculous of us medics to leave a man with hepatic encephalopathy in HDU. To be honest, this patient had a GCS of 7 to start with...he obviously had picked up when the surgeons were there to visit the HDU. The HDU nurses were also on my back telling me to step this patient down. But I just didnt have the chance to do that because I was occupied with other sickies.

Then, when I went back to the ward, everyone seems to be looking for me. Imagine this. When I walked out from a particular room, one nurse, one houseman, one DVT nurse specialist, all decided to call my name in unison. I was being attacked at all angles.

Oh man...it was a crazy day. And I'm absolutely drained.

That's Not My Name

Attended their gig at the Barrowlands, Glasgow Sunday night...and boy, they rock! As irritating as their songs can sound on the radio, but when you see them performing live...it was brilliant! =)

They sang a few of their popular songs such as Great DJ and of course, the super catchy "Shut up and Let Me Go!"

In A Difficult Position

I think many of us have been a difficult position before. It could be situations where you have to tell your mum that you broke her treasured vase, or situations where you have to tell dad that you drove his car into the back of another vehicle, or situations where you end your relationship with your boyfriend/girlfriend...etc...there are just so many situations that one could think of, that would place a person in a very difficult and uncomfortable position.

As a doctor, I think the most difficult situations I have faced so far is telling a patient that he or she is dying, or telling their loved ones that the patient is not going to pull through much longer. The other thing I find difficult is the decision making involved in the care of a dying patient. At what stage do you decide that you want to withdraw treatment and just keep the patient comfortable? And when you decide to take away all treatment, you are more or less "sending" the patient to his or her death. But then again, if you continue treatment, you are just prolonging the patient's suffering....and is that justified? Is that fair to the patient? This is tough.

A couple of days ago, I was left in another difficult position. A patient was terminally ill with cancer. To complicate matters, this patient was under police custody and have to stay in prison for a couple more weeks. Now, although I have never lived in the prison before (in fact, I sure hope I won't be at that stage one day), I am aware that it is not comfortable. The environment is gloomy and cold. It is certainly not the best place for a person who only has a couple more weeks to live. But at the same time, I can't allow him to stay any longer in the hospital given that we have treated what we could. It felt cruel sending the person back to prison. My colleague put this thought into my head, "It is unfortunate that the patient has cancer and is dying, but the patient commited a crime which led to imprisonment."

I guess she has a point. However, I couldn't help feeling sorry, but at the same time, I have to do my duty as a doctor, and discharge patients when necessary, to allow medical treatment for other patients.

I rest my case.

Foolish Me

I seem to be making an absolute fool out of myself more frequently these days. I wonder why.

The other day, when I was on call, I actually contacted the consultant who was at home having his dinner, to inform him of a patient whom I was pretty worried about. She was a young lady with funny movement in her left arm, power of about 2/5 in both legs, horizontal nystagmus and GCS 14. Although she was not hyperventilating, her arterial blood gases showed marked respiratory alkalosis. I thought about an urgent CT scan of her brain, therefore, I wanted to discuss this over with the consultant first.

This consultant of mine, is actually the consultant whom I have been attached with since I started working in this hospital. I told him about this patient, and I SWEAR, I heard that he thinks she may have a subdural haematoma. So I asked him, "So you wanna CT her tomorrow?" He said, "Yes."

Horror of all horror, when I went to work the next day, I met up with him to discuss about a few of his patients whom I have reviewed during the ward round. He revealed to me that, "I actually wanted the CT urgent, not the next day. She had it done at midnight yesterday."

I was like "oOpppsss." I asked how did he find out that she didnt get a CT scan in the first place. He told me he contacted the ward to find out whether this lady had been for the scan, and as soon as he knew she hadn't, he requested for one.

I couldn't feel any sillier (if there is such a word). I made a total fool of myself. I kept thinking over the telephone conversation I had with him...sigh...but what is the point eh?

Glad to find out that her CT brain was normal. *phew. Imagine if she actually did have something serious, I would probably just kill myself.

To make matters worse, I told him about a middle aged lady who was admitted with diarrhoea and vomiting, who I thought actually had aspiration pneumonia, because she has been vomiting persistently for like 10 days. He laughed. He said, "How could a young lady get aspiration pneumonia?"

I was abit dumbfounded. I thought aspiration pneumonia happens when your saliva or your vomit or when anything went down the wrong tract (like vomitus too). He laughed further. hmm... and then, I soon realised how foolish I was! How could a fit and healthy lady get aspiration pneumonia, especially when she has no problems with swallowing?! But then again, how do explain cases where healthy patients get admitted because of aspiration of foreign objects, which most often affect the right lung, just because the right bronchus is more vertical than the left?

tsk tsk tsk. i dunno.

sawling, sawling, you really need to stop being so silly and foolish. Silly mistakes you make when you're not thinking properly. hehe.

A Lovely Surprise

I got a little note from the postman to collect a parcel at my nearest post office a few days ago. I didn't have the chance to collect it until yesterday morning.

I do now know about you. But when I get a note saying that I have a parcel to collect, I actually am quite excited about it. I wanted to know who the sender is, and what is inside the parcel.

hehe...so on Saturday morning, I made my way to the post office. I was handed a big yellow envelope, which was very light, but pretty bulky. There was something inside the parcel which was quite big.

The moment I got home, this was what I received!

isn't so cute?? hehe... I absolutely loved it.

It was a gift from my buddy, SS. It was really sweet of her and not to mention, the hardwork put into creating it all. Everything was handicrafted by her!

SS, I am very impressed! Thank you so much!

HUGS! MUACKS!

And Let The Countdown Begin!

18 more days to go...

and guess what?

I'll be back to home sweet home. Yes, back to visit my mummy, daddy, koko, kiki, and my beloved friends. =)

ooh...I can't wait!

It has been a long time since I was last home....to be more exact, it would be 1 year and 10 months! This is indeed the longest length of time I have been away!

The Garden?? sorry, what did you just say? oh...where is The Pavillion? Is there even such a place in KL??

hehe...iIm very ulu, i know. But fear not, when I do get home...explore these places, I will!

right...now I just need to focus on my work...and without knowing it, I would soon be on the flight home!!

=) trust me, I am smiling from ear to ear even when I'm typing this. **tee hee hee

James Morrison - You Make It Real

Oh...I can't wait for his new album to come out!! Love his voice, love his music!

Come, sing with me.

Mmmmm
There's so much craziness, surrounding me
There's so much going on, it gets hard to breathe
When all my faith has gone, you bring it back to me
You make it real for me

When I'm not sure of, my priorities
When I've lost site of, where I'm ment to be
Like holy water, washing over me
You make it real for me

And I'm running to you baby
You are the only one who saved me
That's why I've been missing you lately
Cause you make it real for me

When my head is strong, but my heart is weak
I'm full of arrogance, and uncertainty
When I can find the words, you teach my heart to speak
You make it real for meee, yeaaa

And I'm running to you baby
Cause you are the only one who save me
That's whyyy I've been missing you lately
Cause you make it real for me

Ohhh
Everybodies talking in words
I don't understand
You got to be the only one
Who knows just who I am
Your shinin in the distance
I hope I can make it through
Cause the only place
That I want to be
Is right back home with you

I guess there's so much more
I have to learn
But if you're here with me
I know which way to turn
You always give me somewhere,
Somewhere I can learn
You make it real for me

And I'm running to you baby
Cause you are the only one who save me
That's why I've been missing you lately
Cause you make it real for me

You make it real for me

Bananas Make Me Yellow

I met a funny patient yesterday.

He was yellow, ie, jaundiced. But the problem was, he didn't realise it because he has dementia. To be fair, he was only mildly disorientated. This was what happened.

Me : Hello Mr. X. How are you?

Mr. X : Oh hello dear. I'm alright.

Me : So do you know what brought you into the hospital?

Mr. X : I dunno, doctor. I've got some tummy ache.

Me : Oh ok. I think your GP sent you up because we were abit jaundiced, you know, your
skin is all yellow.

Mr. X : Is that right? I didn't know that.

Me : Look, your skin is quite yellow. (me pointing to his skin)

Mr. X : Oh...I dunno. Sigh. No more bananas for me.


=D I broke into a big grin. Mr. X said that without even smiling or laughing. I guess he really meant what he was saying! kekeke.

Is That Inappropriate??

I have the "pleasure" of doing night shifts again. This is my first on call as the leader for the hospital at night team....which actually, scares me, ALOT.

Anyway, over the past 2 nights, I have been in contact with ITU.

Now, my understanding is, contact ITU if you think a patient may need ventilatory support.

And now, what would you do for the following:



Situation 1

A young middle aged lady, with severe COPD and morbid obesity, was admitted with exacerbation of her COPD. She took 2 of her sleeping tablets before coming to the hospital. She was mainitaining her own airway, but was very drowsy. When she falls asleep, her respiratory rate went up and she developed marked wheeze.



Situation 2


A young man with known asthma, was found with respiratory depression. He denied taking any illicit drugs on that day, but did admit that he is a drug abuser. He has a GCS of 14, and his respiratory rate was only 8. Oxygen saturation was 95% on 12L oxygen. He was also in respiratory acidosis.



Now, my impression of the above is they are both fairly sick...and may lose their ability to maintatin their own airway, if they drop their GCS. Therefore, I contacted ITU to keep them informed. However, I was told by the ITU doctor that these referrals were inappropriate?

She even told me off over the telephone. sigh. She was not interested. Well, at least, I have done my bit to provide medical care....

bye!

SzeLeng, my buddy, has left Glasgow for good this morning.

Good for her...going back home...home sweet home, to her family, bf, etc... sweet.

I felt really strange saying goodbye to her. It was also pretty weird in the way that every ticket she bought was only 1 way. It's not like I am not going to see her again.... but I think it was just very weird. I had mixed feelings. I was happy for her, but at the same time, I felt heavy hearted for her to go. We have been good friends for the past 4 years. She is my shopping buddy, coffee buddy, ranting buddy, movie buddy, etc... We have connected so much and became close friends.

Anyway, take care my dear friend.
Thank you for being there for me when I needed it the most. =)

HUGGIES!
Safe journey...and all the best!

What Can't Kill Me, Can Only Make Me Stronger

That is the motto I hope to carry with me throughout my life.

For the first time in my career, I actually broke down and cried at work! I seriously could not believe that happened.

I guess I have been having a rough time at this hospital. Last week, I had sick patients every day. Today, I had another person who was really sick, and had to be transferred to HDU.

To be really really honest, I do enjoy looking after the sick patients. It is interesting and rather exciting. You have to find out what the main problem is and also decide what is the action plan. And I think this is why I chose to go into medicine.

However, I think my consultant has not been very supportive. I told him that I have transferred the patient to HDU for closer monitoring, and his reply was, "what are you going to achieve from that?"

I was abit baffled. This poor man had a potassium of 7, which is potentially life threatening; his creatinine was 656 and was completely anuric. The bottomline is he has developed hepatorenal syndrome...and from that, he is going to die. He already has a "Do Not Resuscitate" order, but he would still be for active management.

So I really do not understand what the consultant meant when he asked me what was the point of moving into HDU. He said, "Well, if you want to do that, just do it, then." Now, how supportive is that? I went on to do it anyway. And, at the end of the conversation, he told me, "HAve fun with the sick patients!" WHAT!!?

I felt that he was not supportive of what I was doing. MaybeI should not have moved the patient to HDU, but if he is still for active management, why not?

I felt abit down because of that. And to make matters worse, my fellow colleague, came up to me and asked if I was feeling ok. She placed her hand on my shoulder. And that was it....I didn't know what happened, maybe it was a sensation of self-pity and what not that swept across me...and the tears just started to run down my cheeks. I think it must be all the stress that was cooking inside of me over the past few weeks, and to add on top of that, I was feeling very sorry for the wife of my sick patient..... If my colleague hadn't put her hand on my shoulder, I would have been fine!!!!

I don't know if any one of you were in that funny position ever. When a friend came up and asked if you were ok, and it just kicks you off....hehe.

It was so embarrassing!!! =(

Ah well, at the end of the day, I bumped into my consultant, and he enquired about our sick patient. And his final reply was, "It was not a bad idea after all." I was thinking to myself, if you had said that earlier, I would have felt better. Sigh.

The whole situation did not kill me, but I guess it could only make me stronger!

Here's to another day of adventure tomorrow!

Ya Man...This is Stressful

What a week!

Its been an extremely stressful week for me.

There was no consultant cover for 1 week. A couple of my patients became acutely unwell everyday, it was as though they were taking their turns.

Why the stress?

Simply because I do not like leaving the hospital without knowing whether my management plan is appropriate for the patient. Yes, I have made a few decisions about how to treat the patient, but at the end of it, when someone who is really sick, ie, peri arrest, I would really appreciate a senior review, either a consultant or a registrar (whom this hospital does not have).

So I start to build up this stress in me...the stress of not knowing whether my plans were good enough for the patient, the stress of whether I was missing something, the stress of having to pass on a sick patient to the night team, without a senior review on the patient, etc...

For the past few days, I was literally at the level of wanting to pull all my hair out and scream. Even my consultant, who returned in the middle of the week, said, "I think you're going to have a nervous breakdown by Friday."

huh?! thanks (with alot of sarcasm).

Luckily, when Friday finally arrived, I was back to my usual self. I was no longer stressed.

But man, I am not liking this hospital system very much!

WoW!

MICHAEL PHELPS is UNSTOPPABLE!!

He is THE GREATEST EVER!

Breaking a number of world records...and winning a total of 14 olympic GOLD medals!!

Where is he going to find space to display them all??

Wow....I'm totally amazed!

And also congratulations to Elena Dementieva...who took the women singles gold!
And, and...i'm happy for Roger Fed who won the gold in the mens double! NEver really seen him playing in a doubles match before...but good on him...he deserves it.

I hope Nadal wins the gold today! He is the official world number on Monday!


*keeping my fingers crossed for our malaysian hero, Lee Chong Wei, who will be bringing an Olympic medal home, hopefully it would be gold...

Rainbows!

Red and yellow and blue and green,
Purple and orange and pink,
I can sing a rainbow,
Sing a rainbow,
Sing a rainbow too!

Listen to your heart,
Listen to your heart,
And sing everything you feel,
I can sing a rainbow,
Sing a rainbow,
Sing a rainbow too....

Rainbow!

More rainbow! =D

Its amazing how the rainbow greets me in the morning, on my way to work, and also in the evening, on my way back to home. Its pretty.

30 roundabouts later...a pitta bread and 500 mls of water...i'm knackered...

the journey to my new workplace is really interesting.

now, instead of turning left into the highway, i have to turn right instead. the distance is approximately 27 miles...just 7 miles extra to travel, when compared to my previous workplace.

anyway, the thing i found most amusing was the fact that there were so many roundabouts to drive round. this is no exaggeration....i have to drive around 15 roundabouts!! so in a day, i would have driven around 30 roundabouts to and fro. i wonder why they need these many roundabouts? i think scotland, is by far, the country with the most number of roundabouts on their roads.

i couldn't be any more glad that my weekend on calls are over. i was really apprehensive about it. on the first day of work at this hospital, i freaked out when my bosses told me, "you are it. you are the most senior medical doctor for the whole hospital." I went into a panic. i always had at least a registrar on call with me....but now, i am THE registrar.

sigh. I was so scared and worried about it that the night before my weekend on call started, i dreamt that i killed a patient. in my dreams, this poor lady's face turned from pink to blue to purple and finally, white. i woke up with a jolt. it was so vivid! i looked around, and realised that i was still in my bed at 3 am! its amazing what stress can do to you.

so on friday nite (thats when i began my on call)....everything was chaos. it was a busy day. there were 5 patients that came in all at once, as though they took the bus together to the hospital. my junior residents were taking their own sweet time finishing their ward jobs (which i can totally understand, because it was only the 3rd day into the job as a doctor).

i tried my best to speed up...but by 9 pm, when the night team arrived, there were about 4 more patients who needed to be reviewed. i felt guilty. i mean, i really did try to speed up...but there were just a high influx of patients, and i was constantly bleeped by other junior residents, asking me really super basic questions like, "what should i do for this patient who has been diagnosed with bilateral PEs?" or "how much potassium you think i should prescribe, if his potassium level is 3.4?"

saturday was equally bad. i think i am normally a rather calm person, but on saturday, i felt i was losing the plot. i felt like i needed to scream. but i did not, of course. imagine if i had lost it, the whole hospital would be chaotic. i was anuric, hypoglycaemic, and dehydrated. i only had a pitta bread and 500 mls of water for the whole day....no wonder i felt like crap by the end of the day. i also stole some chocolates from the nurses, just to keep me going.

sunday was marginally better. i woke up quite early in the morning, and managed to catch abit of the olympic women's gymnastics on TV. the other thing that lifted my spirit was the beautiful rainbow that accompanied me during my drive to the hospital. it was so pretty that i actually stopped my car briefly to take this photo with my hp camera. gorgeous no?


am dreading my future weekend on calls. *yaawwnn....time to sleep.

i need to keep my cool

i need to keep my cool

i need to keep my cool and be strong

i need to keep my cool and smile

and i need to keep my cool.

SIGH.

i am so exhausted that i actually couldn't sleep...how bizzare is that?!

Its a Brand New Year!

One year has just flew by me. Can't believe that I have been a SHO for one year. The first day being at work as a SHO felt like ages ago. Its been an interesting but occasionally frustrating year.

Now, its the time to change over. Well, in fact, its time for all doctors to start new. Freshly graduated medical students, will start to be new JHOs. Current JHOs will become SHOs. Current SHOs will either become senior SHOs or registrars.

It feels really strange, leaving all the people at work whom I have bonded with. To be honest, I really do hate changeovers. I think it is even worse this year for me because I'm moving on to a new hospital all alone. No one I know is going there with me. And I have not heard anything good about this hospital so far, apart from the beautiful scenery I get while driving there. The response I have got from my fellow colleagues are " Oh. Good Luck!"

wtf?!

And the whole hospital organisation is bloody disorganised. I have contacted the hospital management a couple of times to find out what my rotations would be, and what are my working hours, etc. All I got was, " We will tell you on Wednesday during induction day." What is that all about?! How fair is it, going to work, not knowing which department you will be in, what time you're meant to finish, whether or not you'll be working over the weekend, and....I have not even seen my contract?!!

I do not even know how much I am getting paid!

Tell me, which job, is like this? It is only in medicine that we face all this kind of shite.

Anyway, thats just my thoughts.

Wish me luck tomorrow.... I am feeling very apprehensive about it. More senior, more responsibility. I do not think I am ready yet. Help!!!

All About The Medical Profession

Recently, I came across these little descriptions about doctors and medical students. They sound quite funny actually...and if you let your mind wander....you will realise that these statements are very true indeed.


The Medical Student

Runs into buildings
Recognises a train 2 out of 3 times
Hits himself with a water pistol
Don't stay afloat without life preserver
Mumbles to himself.



The JHO (junior house officer)

Makes more skidmarks on a wall when trying to leap buildings
Is run over by a train
Is not issued ammunition
Dog paddles
Talks to walls.



The SHO (senior house officer)

Barely clears a picket fence
Loses tug of war with a train
Can sometimes handle a gun without inflicting self injury
Swims well
Talks with animals.



The Registrar

Leaps short buildings in a single bound
More powerful than a switch engine
Faster than a speeding gun
Walks on water if the sea is calm
Talks with God if special agent is approved.

Celebrity Names

Do you feel that your brain seems to relate things together even if you were not thinking about it in the first place?? I think this is more pronounced when you're tired.

Now, what the hell am I talking about?!

Let me tell you.

Funny shifts do funny things to my thought process. Last week has been particularly strange. I have been looking after patients with the initials of MG, JL and NJ. And guess what I have been calling them, instead of their proper names?? Macy Gray, John Lennon and Norah Jones.

WHAT?

I do not know how that came up. But their names were so closely related to the names of these famous celebrities, that my brain subconsciously matches their names together...and I started to call them Macy Gray, John Lennon and Norah Jones, respectively. Now how peculiar is that?

My fellow nurses and colleagues were laughing at me. I couldn't help it too...it was rather amusing actually.

Horrible End

You know, at the end of 7 night shifts, all you want is a nice little ending to it. I mean busy is fine... but I do not like it to end horribly.

Guess this will never happen. So far, all my night shifts this year have ended horribly. But nothing has prepared for what happened yesterday.

I was extremely upset...was at the verge of crying, but I tried to keep my cool.

I have been looking after a very sick patient in the HDU overnight. He was such a lovely man. Although he was rather unstable, he managed to survive the night. But just before my shift ended, his condition deteriorated further. I was there to review him. I think, or at least, I hope, I have done what I could have done in order to prevent a cardiac arrest. However, he arrested.

At the end of CPR, we had to stop because he was not going to survive. I felt very very upset. Think my colleague could sensed it...and kept asking if I was alright.

To be honest, I am ok with deaths. But somehow, this was different. You know, its like you have put in so much effort to save him, and bonded very well with this patient. It was heart wrenching to see someone die. I know we should not be too emotionally involved with patients...but, doctors are human too.

oh well.

it was dark

The latest Batman movie is quite dark actually. But I loved it. It was just f**king brilliant!

Christian Bale, the current Batman, looked really cool. He never really smiled in the movie (guess that's what made him hot and sexy)...and I think he is one of the better Batmans....besides, Michael Keaton. I thought he looked thinner than his previous Batman movie... But I suppose nothing could beat his anorexic look in "The Machinist," which was an excellently disturbing movie.

It was not the typical Batman movie. The Dark Knight kind of concentrated more on the thought processes of the good guys and the villains. There were not many scenes where they introduced new gadgets. But, of course, the Batman's vehicle just got more advanced and gorgeous. There were not many love scenes too. It was just purely Batman, the Joker, Harvey "Two-face" and the detective. Wish I could drive a Lamborghini some day! (dream on....I know)

Heath Ledger was a legend. He played the role of The Joker very well. It was Heath Ledger like you have never seen before. I thought this was his best role so far. He was really wacky, psychotic, neurotic, crazy, funny....I dunno...he was just fantastic. If he were nominated for an Oscar, I bet he will win it. It is sad to lose such a young talent. In comparison to Jack Nicholson, who also played The Joker previously, I think they are both very different. Jack Nicholson was more crazily funny...whereas Heath Ledger was simply dark.

Please go and watch it, if you have not done so already! Don't miss out on the darkness of The Dark Knight!

sorry, what were you saying?

It is funny how many of us medics get ourselves enclosed in the world of medicine. We eat and sleep medicine.

I visited a pretty cool art gallery at the Tramway, Glasgow, recently. They were having a special exhibition by the artist, Kenny Hunter. For those of you who were not familiar, he is a famous Glaswegian sculptor. His work of art included The Citizen Firefighter, a famous landmark in Glasgow. He also creates interesting phrases as shown below.

Anyway, although I am very much interested in art and craft, I have never imagined myself sitting down in a small exhibition hall listening to an artist talk about his work on a nice Saturday afternoon. I do not enjoy art galleries...especially those with drawings and paintings...I find them boring and really a waste of time! (my apologies to those who do not agree with me). A normal weekend for me would be either eating brunch, resting at home, shopping or catching up with friends....not sitting down in an art gallery?!

Well, I actually did quite enjoy it. =P

To be truly frank, I did not really understand some of the things he were talking about. He used quite a few "art jargons." He also tried to explain why he made a particular sculpture and how it was related to objects in nature and life. Right, have I confused you already?

I began to feel silly...and to make matters worse, one of the students from the Glasgow School of Art, threw Mr Hunter a question. The question was created using simple words...and yet, I did not catch what the question was about. It was really complicated.

I think it was because art is such a subjective and abstract thing that words are, sometimes, not the best thing to use to explain it. Art should just be left by itself, and to allow it to provoke our own thoughts. That was what I found really interesting about this art exhibition by Kenny Hunter. His sculptures were very simple, yet unique. His phrases were strange, but were throwing out strong emotions.

It was a good experience, and thoroughly enjoyed it. I felt as though I was introduced to this new world that I have never seen before, a world outside the domains of medicine.....

The citizen firefighter outside Glasgow Central Station.
Note that you can't see the face of the firefighter and you can't even determine the gender. I thought it was cool.

Pic on the (L): You would remember that the word "everlasting" has always been used with nicer words, eg, "love," "memories" etc. Everlasting Agitation is so true in this world. We get stressed and agitated throughout our lives.

Pic on the (R): Imagine this; if you make your stand fast (eg, if you have determined that this is how you're going to be for the rest of your life), you will dissolve in the world. Why?? Because people need to change....people need to adapt to their surroundings, and change their lives according to the events occurring to themselves. If you don't, then you'll just fade away in this world and won't survive. (ie, dig your own grave).

Pics from Radiohead Gig

Finally...here is a glimpse of that fun gig that wet Friday night. The merchandise stall

Kevin

The stage!

My glaswegian fren.

check out the colourful tubes!

Blown Away

It was the start of what I hoped to be a lovely holiday....however, I thought I was going to lose my life yesterday.

I happily packed myself away to Gloucester this weekend. I boarded my flight to bristol in the afternoon. The weather in Glasgow was slightly cloudy with just minor drizzle. Halfway during my journey, the plane suddenly jolted backwards. Everyone gasped!

It felt as though the wind was blowing SO hard that it basically pushed the plane backwards. I thought we were going to crash. The captain informed us that there was a blizzard of wind ahead.... much to my horror, to be honest. We proceeded onto the journey.....until it was time for landing. The plane gradually lowered itself. Again, the plane appeared to be fighting hard against the wind. I could feel the plane swaying left and right....and I thought I could almost feel the resistance of the strong angry wind.

I was thinking, "OMG, this is not good at all. Do not crash....we should maybe not even try to land at the moment!" I looked around me and everyone appeared terrified. The plane continued its descent...and the moment we hit the ground, the plane kinda skidded slightly, and again, it swayed left and right.....and the captain must have slammed the brakes really hard because I was pushed forward as the result of the momentum.

I turned around to look at my fellow passenger on my left. She looked at me and said, "Boy, that was interesting." "It was scary" I replied. I think all of us on board could not be any happier to be safe and sound. Now, I know this might sound as though I am exaggerating, but it felt like a "near death" experience. *phew

I am glad I am still alive. Thank God.

Just Because

"You were good when you first started to work with me, but now, you're just like one of them."

*ouch

*ouch ouch

**sob sob sob

These are strong powerful words. So strong that it penetrated my skin, bones, bone marrow..etc.

oh my goodness...can't believe my boss said that about me. The thing is everyone in my workplace knows that he is a lousy boss...he comes up with the most ridiculous management plans, he can be rude to patients, and also to nursing staff....and of course, to his fellow colleagues too. Therefore, at the end of the day, he has created more foes than friends. "one of them" refers to the list of people who are already in his bad books for just trying to voice out an opinion.

Having said that though, that does not warrant him to make such a statement.

Just because....
1. When he asked me what happened to this particular person X over the weekend, and I replied, "I'm sorry I do not know because I was not working over the weekend, but I'll find out for you from the nurses." He, then, started to laugh sarcastically and said, "What is wrong with my junior colleagues...you do not have to answer me like this." HUH?! what was that all about? I don't think I was trying to be cheeky...unless those who are reading this, think I was??

2. I told my boss that this is not the proper antibiotic to prescribe for someone with aspiration pneumonia.

3. I told my boss that I think the abdominal x-ray looked like the patient has a dilated bowel loop....and my boss said that, " You do not have enough experience to say so." HUH?!

4. I asked him if he was happy to let a patient home although the patient developed acute renal failure..and he became angry with me....

there are so many "just because" BECAUSE the list is indeed endless!

It is pretty frustrating....and I sometimes wonder whether I am picking up the wrong things from my boss. Guess only time will tell...

Worse thing is, my boss no longer calls me by my name.... tsk tsk tsk. And now I have this thought that I am a useless doctor. sigh.

think it is time for some vino.

Joyous June

Where should I start? I have been wanting to blog for ages, but because of my silly old HP notebook, I can't. Half of the screen is gone...serious hardware problem. When I say gone, I mean the right half of the screen is black. However, the graphics on the screen are being cramped to the left side of the screen.....so everything is like super tiny (if you get what I mean).

Anyway, this month has been really eventful really. From growing that extra white hair and wrinkle, to becoming a rock chic.....June, has always been my favourite month of all time!

7th June
It was a dark cloudy day to start with, but my friends, my fellow participants and I ran 5k to raise funds for charity. It was the Cancer Research UK Race for Life event. Everyone's spirit was high and thank god it did not pour! Thank you everyone who has sponsored me. I am also proud with myself. hehe. I managed to run 5k without stopping to catch my breath and also, finished it in my own personal best. =) Think my next aim is to run 10k or maybe do the marathon for charity. I will definitely keep training!

13th June
This is when I grew an extra white hair and wrinkle. Yes, I am more than half a century old now....it is not good. Anywho, I actually spent my birthday at a mini gig with a few good friends, followed by pizza, garlic bread and wine. The band who played on that breezy Friday night was called "Orkestra del Sol." They were super fantabulous!! I loved their music. The whole band only consisted of just about 8 people. Each of them played various musical instruments, eg, trumpets, clarinet, double bass, violin, and the accordion. Now, the music had a slight Latin influence...and boy, was I dancing to the groove of the music! Great stuff!! I think you can even google them online if you wanna check them out.

You would imagine that birthdays are celebrated just on that 1 day. However, I was so lucky to have a 3 day birthday celebration! Yea, no kidding. I basically met up with different people for food and I have to admit, it was nice to be pampered by my friends, not to mention, all the lovely pressies I received! =D

15th June
It was Father's Day, and a day where I gained a brand new experience. If you like stand-up comedy, then, The Stand Comedy Club is the place for you!! I decided to watch of the comedy shows held at this club, and I was not disappointed. The show was called "Michael Redmond's Sunday Service." Now, Michael Redmond, is famous actor who starred in the hilarious series "Father Ted." He was one of the priests in the show, hence, the title "Sunday Service." The whole show lasted for about 2 and a half hours. The first few acts were by junior comedians who were not bad actually...then, came the professional ones... They were SO FUNNY that I really felt my facial muscles at the end of the show!

19th June
Screen partially black.
No windows XP loadable for 3 minutes.

I have now certified the death of compaq nx7010 at 8pm on 19th June 2008.

21st June
"Keep on rocking in the free world"
"Shot thru the heart, and you're to blame, you give love a bad name"
"wooahhh, we're halfway there...wooaahhh, livin on a prayer"

Any light bulbs switched on in your mind??

Oh well, these lyrics are taken from Bon Jovi's hit songs. hehe....and yes, I went to his gig at the big football stadium in Glasgow. I was glad that I bought the seating tickets, because it was pissing down quite heavily that day. The gig started off with The Feeling singing away their popular songs for an hour...and then, Bon Jovi, appeared and rocked all night long!! It was superb! He reminded me so much of my younger years...you know, with powerful cheesy love songs like "This romeo is bleeding, you cant see his blood, its nothing but some feelings, that this old dog kicked up. Its been raining since you left me, now I'm drowning in the flood. You see I've always been a fighter, but without you, I give up. Now, I cant sing a love song, like the way its meant to be...well I guess I'm not good anymore, but baby its just meeeee...." (oh dear, I can go on and on!)

27th June
Another great night, with the typical Glasgwegian weather (ie, rain). RADIOHEAD ROCKS! yes yes, I was at their open air concert at Glasgow Green ( a big park) on Friday night. The rain was pouring, but it did not hamper any of us fans...we braved the rain, with our hooded waterproof coats, to watch them LIVE in concert. It was worthed it. I have never been to a major rock concert and this is so different from any concerts I have ever been in Malaysia. The stage was so huge, and there were so many food stalls around selling hotdogs, chinese chow mein, nachos and of course, alcohol. Not to mention that I have finally met the TRUE Glaswegian crowd. Some of them threw beer around.

The stage was beautiful. There were about more than 20 tube like things hanging down from the roof of the stage. Throughout the entire gig, colourful lights were shone onto these tubes. It was so beautiful. Radiohead sang quite a few of their hit songs, such as Justp, Fake Plastic Trees, No Surprises, Paranoid Android and a lot of their new songs. Too bad they didn't perform "Creep." Anyway, it was really good and the rain, in fact, made it even more fun!!! haha.


Rite. So that was a little diary of events for the joyous month of June. =) I am happy that I have managed to remember all these events. But my pockets have now started to develop alot of holes, and my purse, is crying because it is not feed with money. And to make matters worse, I have to get a new notebook. I hope to get it soon though, so that I do not have to suffer like this!! I feel so disconnected from the world.... will blog again soon.

Duffy - Warwick Avenue

oohh....I so love this song....such amazing voice!

Top Class Duffy

Temporary deafness aside, Duffy's gig at the ABC in Glasgow was top class!

I love her beautiful soulful voice, I love her music.

She sang most of the songs from her first album, "Rockferry," which, of course, included the famous "Mercy" and "Warwick Avenue." It has been a long time since I have attended such events...and it was certainly a great way to end a horrible Monday at work.

I am sure there is more to come from this young artist!

Laptop on Sick Leave

My laptop has been officially sick. I can't load my internet browser, can't log onto my MSN or Yahoo messenger, and I can't even load my anti-virus software!

It is not a big deal, but I am just worried that I would lose my digital photos. These photos remind me of where I have travelled so far...I really cannot afford to lose any of them. Fortunately, I can still open my picture folder.

Unfortunately, as I tried to save them by burning these pictures into a CD, my CD burner application would not open for me!!! argghh... so I am at a dead end. I need to reformat my laptop, but I do not want to lose all these important valuable memories.... I have thought of transfering my pictures to my friend's external hard disk...but I was worried that I might transfer infection to his hard disk.

As a result, I have decided to buy a portable hard disk....I just bought a Western Digital portable hard disk from Amazon...it was the cheapest and best deal I could get. 250GB for 60 pounds... pretty reasonable I guess. Within 4-6 working days, I would receive this item.... and hopefully, after some "intravenous antibiotic," ie, formatting, my laptop would heal. Wish me luck.

I really hate it when I have to deal with all these techno stuff myself!!!

No More Hatred

The last time I played a full classical song on my piano was more than 10 years ago.

I never really touched the piano again since then. I seriously hated playing the piano. I hate practising the scales, the exam pieces, the aural tests and of course, the theory part as well. I was adamant that no matter what happens to my grade 8 examination, I would not touch the piano ever again, because I was really sick of it.

However, during my trip to Isle of Skye, one of the B & B s that we stayed in had a piano. The owner told us that we could play it if we wanted to. Somehow, regardless of what I had told myself previously, I sat down in front of the piano, looked at the music notes in front of me.... the music score was written by Beethoven, in fact, it was his famous Sonata. I started to play....although I struggled to play the notes spontaneously, I really enjoyed the sound of the piano!

Then, I started to play "Fur Elise." I recalled playing this song during one of my piano concerts... I tried to play a few songs from my memory, but nah, I failed. However, the bottomline is, I miss playing the piano. I really do. We stayed at that B&B for 2 nights...and every day, I would play a few songs from the book..and felt fantastic after that.

hehe...its amazing. So now, I take back whatever hatred I had previously. In fact, I am aiming to buy a baby grand in the future and place it right in the middle of my living room. =)

Tiring, but Well Worth It!

I haven't been blogging!

Honestly, there wasn't much to blog about. I could go on and on about my work life...but I decided that moaning would not really change anything. I just have to suck it up and shut up. Apart from work, I have been travelling! My friends and I visited the Isle of Skye, one of the famous island in Scotland. I volunteered to drive, as I do not see a point in renting a car, when I already have one. The drive was tiring, but extremely challenging. Imagine driving on a single track road, with a huge truck trying to drive pass you on the opposite direction....scary. But I survived, so did my car. =) I am proud of her (my peugeot).

The drive took nearly 6 hours....and I drove through country roads most of the time. If I have not mistaken, the whole journey, from my house to Isle of Skye, around the island, and back to my house, was approximately 800 to 900 miles. Anyway, the scenery was amazing. It was certainly a relaxing holiday. Check out the pics.

On The way to Isle of Skye.

Eileen Donan Castle















Plockton, a lovely village.















The Highland Coo (a hairy cattle)















That's me!



















Portree Harbour














The Black Cuillin Hills. (black coz the surface looks black).




















Dunvegan Castle
















Coral Beach, Moonen Bay
















Coral Beach, Moonen Bay
















Sunset @ Waternish
















Neist Point





















The lighthouse at Neist Point.

In One Ear, Out The Other

I am sure all of us have been in this situation before.

We get scolded by out teacher or parents, when we do not think we did anything wrong... so the words enter the right ear, and the same words leave the left ear almost immediately.

On Sunday morning, I went to work as usual. To be honest, I felt that the day would be ok... because I had a positive attitude when I woke up that morning.

However, things changed when I stepped into the hospital. The consultant whom I was working over the weekend with was in a grumpy mood....(well, apparently, he is ALWAYS in a bad mood). I have never really worked with him before.

Anyway, I was told off in front of everyone that I was trying to be clever. It was all about an elderly lady with diabetes, who was admitted the day before because of confusion. She is just slightly more confused than normal. She did not have a fever, her heart rate was normal, her breathing rate was normal, her oxygen levels were normal. The consultant thought that she probably has a chest infection or a urinary tract infection. He just said that this patient should be on an antibiotic. So I prescribed an oral antibiotic.

The next day, when he went back to review the patient, he went bonkers. He shouted, "I wanted this patient on IV antibiotic, and you prescribed her with an oral one?" I explained to him that I did not think the patient met the criteria for an IV antibiotic and she was otherwise clinically well. Her WCC was only slightly raised and her CRP was only 74. I thought to myself, you did not even write in the notes that you specifically wanted IV antibiotic...and now you are complaining that I did not follow your instructions?! wtf!

Today, I was informed by a fellow colleague that he was complaining about me to other consultants that he works with. "That Dr. Toh, whom I was on-call with over the weekend, really needs to know who is the boss. I told her to prescribe IV, she went on to prescribe oral!"

Great! What a way to begin the week eh?

in one ear.....out the other.... and smile! (that's what I told myself).

Absolutely Speechless!

I came back from a long day at work, feeling rather grumpy and tired. But I was immediately woken up by this TV programme on E4 tonight.

It was a performance by Derren Brown, a famous magician, psychological trickster, mentalist etc.. Oh my, oh my, I was left totally speechless after watching him.

He could read people's mind....he can really predict the future, he can make accurate calculations. I personally think he is more interesting than David Blaine. You have to watch it if you can...or even, try to You Tube him. You would be amazed at his tricks!

You could tell that he is so passionate about his work of art. He gets so excited when he explained the theory behind his tricks. He's just simply amazing!

Race For Life

I'm joining the 5K race for life. It is a charity run for Cancer Research UK, and I am looking for people to sponsor me.

So if anyone of you are feeling generous, please do not hesitate to visit the link below!

Thank you for your support! It is very much appreciated.

http://www.raceforlifesponsorme.org/sawlingtoh

This is Wrong!

I can't stand this anymore!

I have been asked to work with one of the consultants in my ward...and oh my, it is not going very well, I have to say. First of all, being the junior member of staff, I really have no right to choose which consultant I would like to work with. So I was pushed to work with this particular consultant because none of my senior colleagues want to work with him.

Why?

It is pretty obvious, isnt? Because he is absolutely SHITE! Let me tell you what these shitty things were:

1. A patient with newly diagnosed osteoporosis, was treated with subcutaneous injection of calcitonin for 2 weeks, and then, only start the patient on a calcium and vit D supplement.
When I asked him about his management, he replied, "Calcitonin works best for osteoporosis."
Yea, right...where is the evidence? He didn't even want to consider bisphosphonates.

2. A patient with severe sepsis and vomiting was changed from IV antibiotics to oral ones. Now, does the patient even satisfy the criteria for switching? No. But he wanted it changed anyway.

3. A patient who has been in the hospital for a chest infection, began to develop dysuria. He was otherwise, systemically well. He asked me to start this patient on IV vancomycin for his hospital acquired urinary tract infection. I was like, WHAT?! How about simple ciprofloxacin or even trimethoprim??

4. A patient was in atrial flutter at a rate of 150 beats per min. He wanted the patient to have only 250 micrograms of digoxin on that day, and daily after that. But hello, you would need to load that patient up first leh! The next day, patient was still in fast AF.

5. A male patient who developed urinary retention due to an enlarged prostate gland. I asked if it would be alright to start him on an alpha blocker, like tamsulosin. He replied, "There's no need to do that. His prostate gland is already big....what use would it be to start him on this medication." I was mortified.

I could go on and on about all his shitty plans....Now you would understand why my senior colleagues do not want to work with him. Because when they question his management plans, they will end up arguing. I, on the other hand, would be told that I have not much experience in my job.

I am tired. I am sick and tired of doing ward rounds with him...To make matters worse, he is always on-call. So I have loads of patient every week....and not to mention, the number of dictations I have to do for his hospital discharges!! URGGHH!!!