Nothing works better as an alarm clock than having colicky pain, incredibly loud bowel sounds, a reflexive clamping of the anal sphincter and the alarming instinct that one must sit the ass down on the toilet bowl the very next second before the shit literally hits the fan.
I swear i have never gotten myself awake, tumble out of bed and scramble the 3 metres to the bathroom this quickly in any other circumstances.
The disbelief and relief is almost palpable when one actually makes it in time... again... for the xth time in the middle of the night.
Brilliant.
If dehydration doesn't incapacitate the person, then exhaustion and anxiety will. With the body in high alert mode 24/7 for massive explosions, it's not a wonder the fight or flight response has run the system haggard.
I've noticed another interesting fact over the years of experience with gastroenteritis. Normally, faeces just smells repugnant, but when one has the bowel runs, the smell actually induces nausea and sometimes vomiting as well.
Another miraculous way our body has designed for us to purge all toxins from the body, be it from the top or bottom end.
Enchanting.
So Lai, if anyone asks how i dealt with your departure, you can say that my body became to wrecked with grief that i had to take 3 days off to recuperate. ;)
Showing posts with label medical stuff. Show all posts
Showing posts with label medical stuff. Show all posts
21 Nov 2010
11 Nov 2010
Humour me
As i'm currently trying to get back into night mode for ED, i unintentionally began to recall the times when i would stalk the dark hallways of the hospital, file in hand, humming a tune.
During daylight hours, there are at least a couple of hundred medical staff around the hospital, but once it hits night time, the numbers dwindle down to a handful. 3 in emergency, 2 in ICU and 4 on the wards.
It is isolating, lonely, somewhat unsupported and it can get scary very quickly. When a patient is crashing, there is only so much help available.
Lady Antebellum's Need You Now never sounded more appropriate:
That was the theme of many of my conversations to my registrar during those 8 weeks.
Enjoy the song :)
During daylight hours, there are at least a couple of hundred medical staff around the hospital, but once it hits night time, the numbers dwindle down to a handful. 3 in emergency, 2 in ICU and 4 on the wards.
It is isolating, lonely, somewhat unsupported and it can get scary very quickly. When a patient is crashing, there is only so much help available.
Lady Antebellum's Need You Now never sounded more appropriate:
It's a quarter after one
I'm all alone and I need you now.
I said I wouldn't call but I lost all control and I need you now.
And I don't know how I can do without
I just need you now.
That was the theme of many of my conversations to my registrar during those 8 weeks.
Enjoy the song :)
5 Nov 2010
Farewell
As i was saying my goodbyes to all the good people on the orthopaedic ward, i stumbled upon bits of 3rd hand information about a few of the patients i've dealt with during my respiratory term.
A 16 year old CF kid passed away last week and another is comatose secondary to respiratory failure. Both of them were/are beautiful children with awesome personalities.
From warm, breathing, talking, smiling, dancing, surfing the net, fussing over homework, socialising to pale, cold, never to open their eyes, never to respond, never to experience graduations, proms, falling in love, getting married or having children. The brilliance of life rapidly and abruptly snuffed in a flash and at such tender ages.
It was hard to reconcile the fact that one week i was bumping into them around the hospital and the next week they were 6 feet under or on their way out.
Rationally, it's always been known that people with CF have shortened life expectancies, but with the advancement of medical treatment, most are able to live into adulthood. The news about the death and another impending demise is a rude awakening to the fragility of life.
As an insightful singer put into words and song:
A 16 year old CF kid passed away last week and another is comatose secondary to respiratory failure. Both of them were/are beautiful children with awesome personalities.
From warm, breathing, talking, smiling, dancing, surfing the net, fussing over homework, socialising to pale, cold, never to open their eyes, never to respond, never to experience graduations, proms, falling in love, getting married or having children. The brilliance of life rapidly and abruptly snuffed in a flash and at such tender ages.
It was hard to reconcile the fact that one week i was bumping into them around the hospital and the next week they were 6 feet under or on their way out.
Rationally, it's always been known that people with CF have shortened life expectancies, but with the advancement of medical treatment, most are able to live into adulthood. The news about the death and another impending demise is a rude awakening to the fragility of life.
As an insightful singer put into words and song:
If someone said three years from now you'd be long gone
I'd stand up and punch them out because they're all wrong
I know better 'cause you said forever and ever
Who knew
...
When someone said count your blessings now before they're long gone
I guess i didn't know how i was all wrong
They knew better, still you said forever and ever
Who knew
-Pink-
MH and SB, this is for you.
5 Jul 2010
The shadow...
I am the shadow that stalks the hospital, creeping up to unsuspecting babies, pulling off their blankets and sticking them with my stethoscope!
I flash them with my torch, i poke and pinch them with my fingers and rattle in a raspy voice secrets in the dark.
I float between 5 storeys for 12 hours each night and turn into a zombie with the first rays of the sun. After which i return home to my dark room and attempt to go into an abbreviated form of mummification under the layers of blankets.
On days when my mummification is insufficient, i turn into a snarling werewolf. Beware all ringing devices and their owners, which i will have a violent urge to smash into the wall. Should i be deprived of food or expected to labour for more than an hour on it, i snap my powerful jaws and bite off the head of the nearest animate object.
Consider this a warning to stay away from me unless otherwise invited.
I flash them with my torch, i poke and pinch them with my fingers and rattle in a raspy voice secrets in the dark.
I float between 5 storeys for 12 hours each night and turn into a zombie with the first rays of the sun. After which i return home to my dark room and attempt to go into an abbreviated form of mummification under the layers of blankets.
On days when my mummification is insufficient, i turn into a snarling werewolf. Beware all ringing devices and their owners, which i will have a violent urge to smash into the wall. Should i be deprived of food or expected to labour for more than an hour on it, i snap my powerful jaws and bite off the head of the nearest animate object.
Consider this a warning to stay away from me unless otherwise invited.
9 May 2010
Totally freaking genius!
On the last day of my rotation, i became the first person in the history of the Children's respiratory department to insert a PICC on the wards, without assistance. I think i absolutely deserve bragging rights.
The story has its beginnings in the prolonged hospital stay for CF tune ups. In an adult hospital, a 2 week tune up means 5 IV resites, which is unacceptable for children in general, not to mention those with chronic diseases needing frequent admissions.
Hence, the long lines which if properly cared for lasts for weeks. The advantage of a long line being that it can be done on the wards, no fussing and begging for theatre time, and only a short 2 hour period of fasting required if sedation was necessary.
As for the cons, the list goes on and on, starting from it's procedural difficulty. This 2 French finicky line is so soft that when met with any minute resistance from the vein, even extravasation of blood, it will not thread.
Once successfully inserted, the problems do not end.
There are only a handful of people in hospital that know how to insert one, and many ignorant nursing staff who either don't lock it with heparin (hence allowing it to be clotted with blood), put too much pressure while flushing it (hence bursting the line), or mistakenly think that it's not working hence removing it altogether (which drives me utterly insane each time it happens).
There are only a handful of people in hospital that know how to insert one, and many ignorant nursing staff who either don't lock it with heparin (hence allowing it to be clotted with blood), put too much pressure while flushing it (hence bursting the line), or mistakenly think that it's not working hence removing it altogether (which drives me utterly insane each time it happens).
The idiocy of it all resulting in increasingly difficult veins, multiple stabs for the patients, and if unsuccessful at reinsertion, a general anaesthetic for a PICC insertion, wasting of precious theatre time and unwelcomed solicitation of the ire of all anaesthetists.
Due to all these problems, a clinical survey was made, cases collected, and a push for change commenced. That was when we found out that most of the consultants have never laid eyes on one let alone the "pleasure" of inserting a long line.
The audacity! It was absolutely preposterous to ask us to employ long lines when they are not aware of what it even looks like.
Which brings us to the PICC.
I've assisted once in the insertion of a PICC more than a year ago in SCH and since then have not remotely glimpsed or touched the packaging of a PICC.
After opening said packet, playing with the equipment and trying to match it with the instructions that didn't make sense (even to my reg), i finally got it figured out by pure intuition.
Hands trembling with the adrenaline rush, the brain whirred with impromptu solutions to the obstacles of inserting the introducer and attaching the connector bits, while explaining the step by step process to my patient and trying to sound like i've done it a million times before.
Finally, the PICC was in the vein, connected up, taped down with absolutely all sticky things i can find and patient in no pain whatsoever throughout the procedure.
Hallelujah!
*Queue applause*
Thank you! Thank you! *Waves hand in air Miss Congeniality style*
MOAO and my other friend will tell you how i described to them in detail the process, bored them shitless and amazed them with the thickness of my skin and copious flow of saliva.
I've assisted once in the insertion of a PICC more than a year ago in SCH and since then have not remotely glimpsed or touched the packaging of a PICC.
After opening said packet, playing with the equipment and trying to match it with the instructions that didn't make sense (even to my reg), i finally got it figured out by pure intuition.
Hands trembling with the adrenaline rush, the brain whirred with impromptu solutions to the obstacles of inserting the introducer and attaching the connector bits, while explaining the step by step process to my patient and trying to sound like i've done it a million times before.
Finally, the PICC was in the vein, connected up, taped down with absolutely all sticky things i can find and patient in no pain whatsoever throughout the procedure.
Hallelujah!
*Queue applause*
Thank you! Thank you! *Waves hand in air Miss Congeniality style*
MOAO and my other friend will tell you how i described to them in detail the process, bored them shitless and amazed them with the thickness of my skin and copious flow of saliva.
14 Apr 2010
Hand me the crown would you?
So i've returned once again to brag about my procedural prowess. My technique with long lines is down pat and i've managed to maintain a 90% success rate of first stab success.
*massive undeflatable ego expanding exponentially*
So while i'm not at work and dying for procedures or surgeries to preoccupy my hands with because i haven't stepped foot into the OR for a year, i made these:
Listening to Adam Lambert's album, his voice has versatility abound and the star power to evoke emotions. Pam's lewd graphic spiel about his "soul sucking" national tv pash which spawned legions of PWP aside, i find his songs addictive.
I guess another reason why i find him endearing is because he reminds me of a good friend/colleague/uni mate who is also tall, broad shouldered, hilariously witty and perhaps somewhat gay. Oh S, you make my life more colourful. :D
*massive undeflatable ego expanding exponentially*
So while i'm not at work and dying for procedures or surgeries to preoccupy my hands with because i haven't stepped foot into the OR for a year, i made these:
Got to channel all that digital dexterity somewhere!
Hopefully there will be more completed works arriving soon. I've got a design sketched out on paper for a necklace but can't seem to pin down the best material and technique for it so it's still on the drawing board.
On other inane random musings, i realised that i work in a hospital that peddles hope. The irony of having a cynic such as yours truly work in a children's hospital does not escape me. Perhaps deep down in the dark untouchable recesses of my sub-sub-sub-consciousness i'm an optimist afterall.
No matter how annoyed i get with nurses, parents, sometimes patients, at the end of the day if i see a cute baby who smiles at me, i feel that it's all worth it. Now i can say to my sis, "I can cuddle my patients too!"
Listening to Adam Lambert's album, his voice has versatility abound and the star power to evoke emotions. Pam's lewd graphic spiel about his "soul sucking" national tv pash which spawned legions of PWP aside, i find his songs addictive.
I guess another reason why i find him endearing is because he reminds me of a good friend/colleague/uni mate who is also tall, broad shouldered, hilariously witty and perhaps somewhat gay. Oh S, you make my life more colourful. :D
4 Jan 2010
Killing me softly...
Another day, another palliative patient to discharge back to a nursing home. As per my usual conduct, i sneak into the room in search of the medication charts to write a discharge script, hoping that being palliative, the patient would be so out of it that i wouldn't have to talk to them.
I enter Mrs M's single room in my usual haste and spy her lying quietly in bed awake. Mrs M is a 93, stick thin, bed bound and no longer communicative granny who had stayed with us for 2 weeks, almost dying in 2 separate occasions despite our heroic attempts to dissuade her.
On her first attempt at death, she became unrousable and unresponsive. We gave up, ceased all medications and the next day she sat up asking for steak and meat pies.
With our hopes buoyed, we recommenced medications slowly and in her defiance, she made her second attempt at crossing over to the unknown. Quelled by her unyielding determination to pass on, we withdrew medications again and now her eyes are focused on me and following me with her gaze as i drift by the foot of her bed.
Having lost my chances of darting in and out without being rude, i walked up to her, gave her a smile and said hello as i rubbed her shoulder.
She looked back at me, smiled, gave me a cheeky wink and ripped a part of me asunder.
I can't withdraw treatment and let a patient who winked at me die!
Yet it was our meddlesome methods that were killing her.
I enter Mrs M's single room in my usual haste and spy her lying quietly in bed awake. Mrs M is a 93, stick thin, bed bound and no longer communicative granny who had stayed with us for 2 weeks, almost dying in 2 separate occasions despite our heroic attempts to dissuade her.
On her first attempt at death, she became unrousable and unresponsive. We gave up, ceased all medications and the next day she sat up asking for steak and meat pies.
With our hopes buoyed, we recommenced medications slowly and in her defiance, she made her second attempt at crossing over to the unknown. Quelled by her unyielding determination to pass on, we withdrew medications again and now her eyes are focused on me and following me with her gaze as i drift by the foot of her bed.
Having lost my chances of darting in and out without being rude, i walked up to her, gave her a smile and said hello as i rubbed her shoulder.
She looked back at me, smiled, gave me a cheeky wink and ripped a part of me asunder.
I can't withdraw treatment and let a patient who winked at me die!
Yet it was our meddlesome methods that were killing her.
24 Dec 2009
My Christmas Wish
It's Christmas and as a diabolical (and erhem! conspicuous) plan by HR to pay me back for working unrostered overtime, i'm scheduled to work the long weekend.
I don't celebrate Christmas. It doesn't hold any particular significance for me except for boxing day sales, which, much to my chagrin, i will miss this year just as i, finally, have sufficient financial capacity to splurge.
However, even the importance of that pales in comparison to the wish of having a good weekend at work.
The week began with being the admitting team and accumulating patients at an insane rate. As the week slowly ticked away, the medical ward pushed and laboured towards getting patients home for the festive season. As the days went by, so my desperation and desolation grew when come Christmas Eve, the ward hardly had any empty beds.
Tonight as i go to sleep i will be wishing that the stress of Christmas not precipitate the influx of these particular demographics on my ward:
1. Freeloaders: homeless, poor people who come into hospital for free food.
2. The desperate lonelies: people with no friends or family who want to have an excuse to be around other people.
3. Malingerers: Druggies who forgot to stock up on happy pills while their regular opiod/benzo-prescribing GP is off to the Caribbeans.
4. Accidental overdosers: Druggies who figured that hey, it's Christmas, perfect reason to get higher than normal and end up with a GCS of 3.
5. Neurotics: People who are so disagreeable that even their own family shuns them, and in their morose disappointment, develop psychogenic chest pain in order to bring family rushing to their "death beds" in guilt.
6. Alcoholics: Alcohol induced DKA, HONK, Hepatic encephalopathy, self asphyxiation... anything!
7. That god-forsaken, ungrateful, intellectually disabled, obnoxious, self righteous, borderline, bogan son of a bitch whom we just discharged yesterday. I swear i will feed him panadol to tip him over the edge of his liver cirrhosis if he decides to represent for the 4th time due to non compliance with medications.
So, as long as these people stay the hell away from my ward... it will be a pleasant weekend.
Merry Christmas everyone!
I don't celebrate Christmas. It doesn't hold any particular significance for me except for boxing day sales, which, much to my chagrin, i will miss this year just as i, finally, have sufficient financial capacity to splurge.
However, even the importance of that pales in comparison to the wish of having a good weekend at work.
The week began with being the admitting team and accumulating patients at an insane rate. As the week slowly ticked away, the medical ward pushed and laboured towards getting patients home for the festive season. As the days went by, so my desperation and desolation grew when come Christmas Eve, the ward hardly had any empty beds.
Tonight as i go to sleep i will be wishing that the stress of Christmas not precipitate the influx of these particular demographics on my ward:
1. Freeloaders: homeless, poor people who come into hospital for free food.
2. The desperate lonelies: people with no friends or family who want to have an excuse to be around other people.
3. Malingerers: Druggies who forgot to stock up on happy pills while their regular opiod/benzo-prescribing GP is off to the Caribbeans.
4. Accidental overdosers: Druggies who figured that hey, it's Christmas, perfect reason to get higher than normal and end up with a GCS of 3.
5. Neurotics: People who are so disagreeable that even their own family shuns them, and in their morose disappointment, develop psychogenic chest pain in order to bring family rushing to their "death beds" in guilt.
6. Alcoholics: Alcohol induced DKA, HONK, Hepatic encephalopathy, self asphyxiation... anything!
7. That god-forsaken, ungrateful, intellectually disabled, obnoxious, self righteous, borderline, bogan son of a bitch whom we just discharged yesterday. I swear i will feed him panadol to tip him over the edge of his liver cirrhosis if he decides to represent for the 4th time due to non compliance with medications.
So, as long as these people stay the hell away from my ward... it will be a pleasant weekend.
Merry Christmas everyone!
9 Dec 2009
Queen of ABGs!
Things are looking up. I got to do a pleural tap last week. Woot! *Dances around in glee*
Another soft procedure that i've been having lots of chance to practice is taking arterial blood gases (ABG).
I recall the first time i had to do it was at the beginning of the year during my surgical rotation on a patient who had pancreatitis whom we needed to calculate Ranson and Gleason's score on. Initially, it would take me 2 tries before i managed to get that slippery artery.
Now, my first attempt success rate is 90%. Today, i managed to demonstrate my prowess when i got it at first go after my registrar had 3 failed attempts and co intern had 1.
Ahhh... the opportunity to gloat internally. Bliss.
Give me procedures! I live on procedures.
On other matters, Lai! I'm so jealous!!! Green, is the colour of my bile stained face. (Technically it should be yellow but let's not dwell on semantics.)
I'm counting down the remaining 6 weeks to the end of my rotation, contract and working year and the commencement of 3 weeks of glorious holidays. Time cannot fly by any faster.
Another soft procedure that i've been having lots of chance to practice is taking arterial blood gases (ABG).
I recall the first time i had to do it was at the beginning of the year during my surgical rotation on a patient who had pancreatitis whom we needed to calculate Ranson and Gleason's score on. Initially, it would take me 2 tries before i managed to get that slippery artery.
Now, my first attempt success rate is 90%. Today, i managed to demonstrate my prowess when i got it at first go after my registrar had 3 failed attempts and co intern had 1.
Ahhh... the opportunity to gloat internally. Bliss.
Give me procedures! I live on procedures.
On other matters, Lai! I'm so jealous!!! Green, is the colour of my bile stained face. (Technically it should be yellow but let's not dwell on semantics.)
I'm counting down the remaining 6 weeks to the end of my rotation, contract and working year and the commencement of 3 weeks of glorious holidays. Time cannot fly by any faster.
1 Dec 2009
Ward Rounds
So i started gen med about 3 weeks ago. Day 1 was ghastly, i went through a total of 5 ward rounds/board rounds/handovers that horrific day. My heart sank as i thought about the rest of my 10 week rotation.
The first weekend, my ward round took 5.5 hours to complete. My face was a mask of stony disinterest and contempt, my back was aching from standing around too much, my ears were straining to hear a semblance of regard for the patient from the weekend consultant as my brain was trying and failing in deciphering a plan from all the nonsense he was spewing.
My co-intern is the son of my home team's consultant, who is too bright, cheery, talkative and hyperactive. He was so keen, eager and enthusiastic that we would fight for jobs to do. Many a times he would do things without updating me and we ended doubling up on the work. Despite all his good intentions and his congeniality, it felt suffocating.
Things started looking up last weekend when i was given a free reign to do my own ward rounds and deal with my patients in my own way, only requesting help from the reg and consultant if there was a problem. Sweet autonomy. Things went much smoother and faster.
On the weekend i watched my weekend buddy intern do a lumbar puncture and today, i got to do one myself. Red bloods cells in CSF: <1. Apparently something to gloat about among med circles. Yosh!
Finally a procedure! Hands on, no thoughts required. The essence of see one, do one, teach one.
So my conclusion, i think i really should have gone for a surgical job.
The first weekend, my ward round took 5.5 hours to complete. My face was a mask of stony disinterest and contempt, my back was aching from standing around too much, my ears were straining to hear a semblance of regard for the patient from the weekend consultant as my brain was trying and failing in deciphering a plan from all the nonsense he was spewing.
My co-intern is the son of my home team's consultant, who is too bright, cheery, talkative and hyperactive. He was so keen, eager and enthusiastic that we would fight for jobs to do. Many a times he would do things without updating me and we ended doubling up on the work. Despite all his good intentions and his congeniality, it felt suffocating.
Things started looking up last weekend when i was given a free reign to do my own ward rounds and deal with my patients in my own way, only requesting help from the reg and consultant if there was a problem. Sweet autonomy. Things went much smoother and faster.
On the weekend i watched my weekend buddy intern do a lumbar puncture and today, i got to do one myself. Red bloods cells in CSF: <1. Apparently something to gloat about among med circles. Yosh!
Finally a procedure! Hands on, no thoughts required. The essence of see one, do one, teach one.
So my conclusion, i think i really should have gone for a surgical job.
9 Nov 2009
Shove it up yours!
I've long heard of rumours since medical school that no matter which hospital you work in, every year there will be at least 1 or 2 such cases.
When i was on my 3rd last night shift, scrolling up and down the screen to get an overview of current workload and bedspace available, i came across: foreign body in rectum.
It was a carrot. He had literally shoved it up his ass.
To my disappointment, the treating doctor didn't order any x rays. Imagine what a good film to teach radiology with, me pointing to x ray surrounded by medical students "So what do you see?"
Anyway, last night/this morning was my last ED shift in this shithole ever! My first patient was an old sook of a woman who drank 5 glasses of wine, tripped over with wine glass in hand which promptly shattered and lacerated her. She basically yelled down the house while i was injecting local anaesthetic. Big surprise. A 9 year old kid whom i did the exact same thing to made her look like a wussy bogan cry baby.
The great part was that while i was suturing, a bleeder squirted blood all over my shirt. I was suddenly presented with a very good opportunity to go out into the waiting room drenched in blood, holding a scalpel while saying "Next!".
Hiang hiang hiang... i'd have enjoyed it tremendously. The south park picture of me in the upper right corner has proven prophetic at last.
But alas, one of the nurses liked me too much and got me some scrubs to change into before i could turn them down. Didn't want to hurt her feelings.
So today, as part of my self gratifying celebration at having survived a second horribly drawn out 11 weeks in the shithole known as ED, i'm going out shopping, spending my fat paycheck from nights before i get it.
When i was on my 3rd last night shift, scrolling up and down the screen to get an overview of current workload and bedspace available, i came across: foreign body in rectum.
It was a carrot. He had literally shoved it up his ass.
To my disappointment, the treating doctor didn't order any x rays. Imagine what a good film to teach radiology with, me pointing to x ray surrounded by medical students "So what do you see?"
Anyway, last night/this morning was my last ED shift in this shithole ever! My first patient was an old sook of a woman who drank 5 glasses of wine, tripped over with wine glass in hand which promptly shattered and lacerated her. She basically yelled down the house while i was injecting local anaesthetic. Big surprise. A 9 year old kid whom i did the exact same thing to made her look like a wussy bogan cry baby.
The great part was that while i was suturing, a bleeder squirted blood all over my shirt. I was suddenly presented with a very good opportunity to go out into the waiting room drenched in blood, holding a scalpel while saying "Next!".
Hiang hiang hiang... i'd have enjoyed it tremendously. The south park picture of me in the upper right corner has proven prophetic at last.
But alas, one of the nurses liked me too much and got me some scrubs to change into before i could turn them down. Didn't want to hurt her feelings.
So today, as part of my self gratifying celebration at having survived a second horribly drawn out 11 weeks in the shithole known as ED, i'm going out shopping, spending my fat paycheck from nights before i get it.
27 Oct 2009
Digging a grave
Counting down my last 8 emergency night shifts. Last 8 emergency shifts ever in this shithole of a hospital where the bosses don't care, don't know or don't want to know. Sometimes all 3 in combination.
Initially at the start of this rotation after psych, i told myself to take things easy, slowly, patiently because i no longer need references. If i get angry or frustrated with patients, i'm only sabotaging myself as there is no outlet for this frustration.
For the first 5 weeks, this attitude kept me afloat, and then everything else about the god forsaken place started to wear me down again. The queue of nonsensical presentations pacing in the waiting room grew longer as the weather took a better turn. The number of sick patients stuck in ED grew larger due to the bed shortage. The number of people who could be seen in the available space fizzle down to 0 and the original purpose of being a turnstile was lost.
The interns who are leaving in 3 months time (aka yours truly) collectively don't give a shit. The residents who are stuck here for good and know they will never be fired because of the existing shortage of doctors continue to drag their asses. The bosses who can't get a job in another department of SCH or any other hospital dish out resentment while cracking the whip for patients to get seen faster, always pandering to the bottom line of getting people out, either discharged home or palmed to another department. There is no pride, no integrity and no self respect.
The nurses knowing the cluelessness of most of the doctors snort derisively behind our backs and oppose our decisions, always harrying us to discharge patients out of their care.
Come friday evening, all the GP clinics in the region shut down and every single person trying to get sick leave for the coming monday gravitates towards the ED. The waiting room swells with the influx of people, the number of doctors rostered to work over the weekend decreases against the flow of logic and unsurprisingly, we reach an impasse.
If i don't get out of there at the end of my 2 weeks, i'd start having death wishes, suicidal ideations and perhaps even homicidal tendencies.
Initially at the start of this rotation after psych, i told myself to take things easy, slowly, patiently because i no longer need references. If i get angry or frustrated with patients, i'm only sabotaging myself as there is no outlet for this frustration.
For the first 5 weeks, this attitude kept me afloat, and then everything else about the god forsaken place started to wear me down again. The queue of nonsensical presentations pacing in the waiting room grew longer as the weather took a better turn. The number of sick patients stuck in ED grew larger due to the bed shortage. The number of people who could be seen in the available space fizzle down to 0 and the original purpose of being a turnstile was lost.
The interns who are leaving in 3 months time (aka yours truly) collectively don't give a shit. The residents who are stuck here for good and know they will never be fired because of the existing shortage of doctors continue to drag their asses. The bosses who can't get a job in another department of SCH or any other hospital dish out resentment while cracking the whip for patients to get seen faster, always pandering to the bottom line of getting people out, either discharged home or palmed to another department. There is no pride, no integrity and no self respect.
The nurses knowing the cluelessness of most of the doctors snort derisively behind our backs and oppose our decisions, always harrying us to discharge patients out of their care.
Come friday evening, all the GP clinics in the region shut down and every single person trying to get sick leave for the coming monday gravitates towards the ED. The waiting room swells with the influx of people, the number of doctors rostered to work over the weekend decreases against the flow of logic and unsurprisingly, we reach an impasse.
If i don't get out of there at the end of my 2 weeks, i'd start having death wishes, suicidal ideations and perhaps even homicidal tendencies.
10 Oct 2009
The truth behind it..
5 lacerations in a day - Sweet time to do and not think or talk.
Cannulating a baby who did not scream or cry - New procedural skill acquired; level up baby tricking skills.
Blowing small vein on back of hand and sticking the 18 gauge cannula conveniently lying around into cubital fossa in a needle phobic patient moaning, groaning, rolling around on the floor complaining of 10/10 abdo pain. Ripping off sticky tape and tegaderm from extremely hairy arm when removing cannula. - Take that you malingering drama queen of a wuss; free waxing service with compliments from yours truly.
Telling patient who complained of "blacking out" while lying in bed but "didn't fall asleep, oh i don't know what happened" and insisted on having blood tests done because she was "anaemic" with Hb of 140 a month ago that if her brainless GP who sent her to ED thinks she needs bloods, he can do it himself - Cathartic release of frustration and finally having enough guts and experience at picking out phonies to tell them to get the f*** out of my ED in civilised words.
Picking out vertebral compression fracture verified later by radiologist when supervisor dismissed it. - I knew you didn't know what you were doing all along dumbass.
Cannulating a baby who did not scream or cry - New procedural skill acquired; level up baby tricking skills.
Mesmerising every kid under 5 years and adults over 40 years with flashing oinking keychain piggy - Best investment in equipment ever; the power to control minds... muahahaha.
Favourite drug prescribed: Ketorolac - Jabbing undeserving patients and giving more pain than they originally presented with.Blowing small vein on back of hand and sticking the 18 gauge cannula conveniently lying around into cubital fossa in a needle phobic patient moaning, groaning, rolling around on the floor complaining of 10/10 abdo pain. Ripping off sticky tape and tegaderm from extremely hairy arm when removing cannula. - Take that you malingering drama queen of a wuss; free waxing service with compliments from yours truly.
Telling patient who complained of "blacking out" while lying in bed but "didn't fall asleep, oh i don't know what happened" and insisted on having blood tests done because she was "anaemic" with Hb of 140 a month ago that if her brainless GP who sent her to ED thinks she needs bloods, he can do it himself - Cathartic release of frustration and finally having enough guts and experience at picking out phonies to tell them to get the f*** out of my ED in civilised words.
Picking out vertebral compression fracture verified later by radiologist when supervisor dismissed it. - I knew you didn't know what you were doing all along dumbass.
31 Jul 2009
Code Blue
Jiin was sitting at the desk completing her admission notes of yet another psychiatric patient with her consultant beside her writing furiously in his illegible handwriting. She mentally kicked herself to work faster, frowning at the realisation that she was meant to be home and wrapped up in her snug blanket 45 minutes ago.
The day had begun on an ill-boding note. 4 new names were written on the board as she stepped into the nurses station that Monday morning. 8 hours and another 2 admissions later, she was still stuck in the room with virtually non-existent ventilation writing notes.
Paper work. Gah. I spent 6 years in medical school to be a goddamn secretary.
A small beeping alarm went off in the background. Jiin sat up in her chair, there was no movement and no rushing of nurses in response to the noise. She flicked her eyes over to her consultant who was still writing furiously with no intention of stopping anytime soon. She decided to ignore the alarm in favour of completing her work and getting the hell out of there. This would've made the 4th false alarm that day.
30 seconds later, the incessantly annoying beeps finally got the better of her and she rose to investigate its cause. Stepping out into the ward, she saw a nurse coming towards her.
"Oh good. Dr Jiin. Come quick. Patient WW collapsed on the floor." he said in a hurry.
Jiin's ears pricked up, she walked briskly towards the patients' dining room, thinking that it was most likely a vasovagal that the nurses had over reacted to. In 5 steps she entered the room and immediately zeroed in on the body laying on the ground, already in a left lateral position with another nurse repeated calling out to WW.
No response. Shit. She knelt onto the ground, subconsciously noted the blue lips and pulled open her mouth to check for food boluses. Nothing there. Her patient emitted a single strangled gasp.
"Is she breathing?" Jiin asked aloud, placing her fingers before WW's nose, waiting to feel misting and flow of air. Nothing. No rise and fall of the chest. Jiin felt her own heart starting to pound.
She hurriedly felt for the carotids. "I can't feel a pulse."
Sirens were going off in her head as she rolled WW onto her back. Jiin placed her ears to WW's chest and couldn't fucking hear a heart beat over the 3 layers of clothing.
She ran back to her office for her stethoscope, still in disbelief of what was happening and yelled for one of the nurses to call a code blue, urgency evident in her voice, as she ran back to her patient.
No heart sounds. WW made a few more strangled gasps but was still not breathing spontaneously. Jiin pounced onto the chest as she started doing compressions, her thoughts rushing incoherently, doubts registering at the fore front of her consciousness about whether she was doing the right thing. She brushed them aside.
"Do you have a geudels?" She asked the nurse who was just kneeling there in shock for a tube to secure the airway.
"No. I don't" He answered but did not get up to find one.
In a matter of seconds, another nurse rushed in with the crash cart and asked Jiin what she needed.
"Give me a bag and mask." She said as she continued to jump on the the chest. The nurse returned with a mask without a bag, placed it around WW's mouth and left her airway unattended. Jiin silently screamed in her head.
She had been doing over 50 compressions and she needed to give breaths now. She peeled off the goddamn-sign-of-incompetence of a mask and grabbed the real thing. Noting that this nurse, despite his mistake, at least had the sense to take over the compressions from her.
Jiin struggled to secure the mask over the patient's mouth while doing a chin lift with her tiny left hand and manually pumped air into WW's lungs with her other hand as she heard other people stampeding into the room. The cavalry were here.
The major tasks were taken over from her. Her hand trembled uncontrollably as she squirted the blood into the various colour coded tubes. She fumbled with her pen and could barely control it well enough to scribble tiny details onto the tubes before getting a nurse to run it over to pathology. She stepped back into a minor role as she made phone calls, pulled medical histories, latest investigation results and hunted for equipment.
30 minutes later, the mob of doctors and nurses finally ceased their activity and called time of death. Jiin was left with the paperwork she had abandoned earlier that evening. Amongst the adrenaline fueled chatter back in the office, Jiin finished her paper work, shrugged when faced with comments and smiled goodbye to her colleagues who said she did a good job.
She drove the short distance home, tore into a bowl of canned soup, buried herself in her daily dose of manga and chatted to her boyfriend about the incident over msn as a form of a debrief.
It wasn't until she lay in bed and closed her eyes at 2am that her thoughts went involuntarily to the code blue. The doubts, the what-ifs, the i-should-haves came raining down upon her as she replayed the memory of the whole situation in a hazy adrenaline induced shroud. She muttered "I'm sorry" as the stricken faces of the family members surfaced. Minutes of futile tossing and turning left her with no choice.
She grabbed her bedside phone and clumsily dialed a number in the dark.
"Hello?" She heard her boyfriend's voice tinged with surprise and broke down in a torrent of tears, unglamourous hiccups and nasal whines.
At last, the release of anguish.
The day had begun on an ill-boding note. 4 new names were written on the board as she stepped into the nurses station that Monday morning. 8 hours and another 2 admissions later, she was still stuck in the room with virtually non-existent ventilation writing notes.
Paper work. Gah. I spent 6 years in medical school to be a goddamn secretary.
A small beeping alarm went off in the background. Jiin sat up in her chair, there was no movement and no rushing of nurses in response to the noise. She flicked her eyes over to her consultant who was still writing furiously with no intention of stopping anytime soon. She decided to ignore the alarm in favour of completing her work and getting the hell out of there. This would've made the 4th false alarm that day.
30 seconds later, the incessantly annoying beeps finally got the better of her and she rose to investigate its cause. Stepping out into the ward, she saw a nurse coming towards her.
"Oh good. Dr Jiin. Come quick. Patient WW collapsed on the floor." he said in a hurry.
Jiin's ears pricked up, she walked briskly towards the patients' dining room, thinking that it was most likely a vasovagal that the nurses had over reacted to. In 5 steps she entered the room and immediately zeroed in on the body laying on the ground, already in a left lateral position with another nurse repeated calling out to WW.
No response. Shit. She knelt onto the ground, subconsciously noted the blue lips and pulled open her mouth to check for food boluses. Nothing there. Her patient emitted a single strangled gasp.
"Is she breathing?" Jiin asked aloud, placing her fingers before WW's nose, waiting to feel misting and flow of air. Nothing. No rise and fall of the chest. Jiin felt her own heart starting to pound.
She hurriedly felt for the carotids. "I can't feel a pulse."
Sirens were going off in her head as she rolled WW onto her back. Jiin placed her ears to WW's chest and couldn't fucking hear a heart beat over the 3 layers of clothing.
She ran back to her office for her stethoscope, still in disbelief of what was happening and yelled for one of the nurses to call a code blue, urgency evident in her voice, as she ran back to her patient.
No heart sounds. WW made a few more strangled gasps but was still not breathing spontaneously. Jiin pounced onto the chest as she started doing compressions, her thoughts rushing incoherently, doubts registering at the fore front of her consciousness about whether she was doing the right thing. She brushed them aside.
"Do you have a geudels?" She asked the nurse who was just kneeling there in shock for a tube to secure the airway.
"No. I don't" He answered but did not get up to find one.
In a matter of seconds, another nurse rushed in with the crash cart and asked Jiin what she needed.
"Give me a bag and mask." She said as she continued to jump on the the chest. The nurse returned with a mask without a bag, placed it around WW's mouth and left her airway unattended. Jiin silently screamed in her head.
She had been doing over 50 compressions and she needed to give breaths now. She peeled off the goddamn-sign-of-incompetence of a mask and grabbed the real thing. Noting that this nurse, despite his mistake, at least had the sense to take over the compressions from her.
Jiin struggled to secure the mask over the patient's mouth while doing a chin lift with her tiny left hand and manually pumped air into WW's lungs with her other hand as she heard other people stampeding into the room. The cavalry were here.
The major tasks were taken over from her. Her hand trembled uncontrollably as she squirted the blood into the various colour coded tubes. She fumbled with her pen and could barely control it well enough to scribble tiny details onto the tubes before getting a nurse to run it over to pathology. She stepped back into a minor role as she made phone calls, pulled medical histories, latest investigation results and hunted for equipment.
30 minutes later, the mob of doctors and nurses finally ceased their activity and called time of death. Jiin was left with the paperwork she had abandoned earlier that evening. Amongst the adrenaline fueled chatter back in the office, Jiin finished her paper work, shrugged when faced with comments and smiled goodbye to her colleagues who said she did a good job.
She drove the short distance home, tore into a bowl of canned soup, buried herself in her daily dose of manga and chatted to her boyfriend about the incident over msn as a form of a debrief.
It wasn't until she lay in bed and closed her eyes at 2am that her thoughts went involuntarily to the code blue. The doubts, the what-ifs, the i-should-haves came raining down upon her as she replayed the memory of the whole situation in a hazy adrenaline induced shroud. She muttered "I'm sorry" as the stricken faces of the family members surfaced. Minutes of futile tossing and turning left her with no choice.
She grabbed her bedside phone and clumsily dialed a number in the dark.
"Hello?" She heard her boyfriend's voice tinged with surprise and broke down in a torrent of tears, unglamourous hiccups and nasal whines.
At last, the release of anguish.
10 Jun 2009
Bragging rights
The other day i saw a kid whom i thought had appendicitis. But one of my surgical registrars disagreed, saying that he was well enough to go home. The next night he came back and voila, an inflamed and stuck down appendix was found.
Boy does it feel good. I wanted to sing "I told you so!"
Today i was told by my clinical supervisor that i was the most cynical and jaded intern he has ever met. It took him 3 months working in ED before he realised how much of it was bullshit. I don't know if i should congratulate him for being astute or dumb.
Boy does it feel good. I wanted to sing "I told you so!"
Today i was told by my clinical supervisor that i was the most cynical and jaded intern he has ever met. It took him 3 months working in ED before he realised how much of it was bullshit. I don't know if i should congratulate him for being astute or dumb.
2 Apr 2009
Upwards is the only direction...
When things hit rock bottom, it can only go up from there on. Unless it's a false bottom, then i might continue falling towards an untimely death.
Just like that poor chap who put a chest tube into the liver and quit his surgical training to become an anaesthetist instead.
Did i tell you that i inserted a chest tube the other day? Sigh. Happy days.
Even though i have said many times before that money doesn't matter, it is a huge limiting factor when i'm thinking of quitting a job with a stable income.
Such random thoughts. Blogging in the morning, only when there are late shifts starting at 11am. It will be a good day today.
Just like that poor chap who put a chest tube into the liver and quit his surgical training to become an anaesthetist instead.
Did i tell you that i inserted a chest tube the other day? Sigh. Happy days.
Even though i have said many times before that money doesn't matter, it is a huge limiting factor when i'm thinking of quitting a job with a stable income.
Such random thoughts. Blogging in the morning, only when there are late shifts starting at 11am. It will be a good day today.
27 Mar 2009
11 weeks later...
Today i woke up and thought, "It's the last day at surg and we haven't killed anyone in this rotation."
And i arrived to the news of one of our patients died last night.
But luckily for me, he was in ICU and hence not under my care. This is so going to the M&M meeting next week.
This old chap with multiple comorbidites came in with a pneumothorax which warranted a cold blue. A chest tube was inserted in a hurry by my Reg and it all came good. Unfortunately, our consultant decided to pull the chest tube out several days later, after doing a chest x ray and that was the beginning of our old chap's demise.
Another cold blue was called in the middle of the night and another chest tube was inserted in a hurry but he didn't make it in the end and passed away 2 hours later.
Oops. Sorry doesn't quite cut it huh.
And i arrived to the news of one of our patients died last night.
But luckily for me, he was in ICU and hence not under my care. This is so going to the M&M meeting next week.
This old chap with multiple comorbidites came in with a pneumothorax which warranted a cold blue. A chest tube was inserted in a hurry by my Reg and it all came good. Unfortunately, our consultant decided to pull the chest tube out several days later, after doing a chest x ray and that was the beginning of our old chap's demise.
Another cold blue was called in the middle of the night and another chest tube was inserted in a hurry but he didn't make it in the end and passed away 2 hours later.
Oops. Sorry doesn't quite cut it huh.
20 Mar 2009
I sterilised someone!
On my last scheduled day in theatre, i performed half a vasectomy with the assistance of my registrar.
I was allowed to hold the scalpel and make an incision and cut off a segment of his vas deferens! Woohoo!
No longer just holding retracters, cutting stitches, holding the sucker or coagulating with the diathermy. I cut flesh with a scalpel.
Euphoria. Anybody wants to volunteer for my next vasectomy case?
I was allowed to hold the scalpel and make an incision and cut off a segment of his vas deferens! Woohoo!
No longer just holding retracters, cutting stitches, holding the sucker or coagulating with the diathermy. I cut flesh with a scalpel.
Euphoria. Anybody wants to volunteer for my next vasectomy case?
17 Mar 2009
Sea of blue...
drapes... blue scrubs... blue shoe covers... blue caps...
Life is good when it's blue.
No there are no pink scrubs like in gray's anatomy. As they also said, no self respecting surgical intern would wear pink scrubs.
I'm going to miss it, yet i also desperately want to escape it. Life is full of jobs that you love and yet hate. There's no other way around it.
We bear the bad parts so that we can enjoy the good parts. I wonder if there are any jobs out there that only have good and not so good but never bad. I want that job.
Life is good when it's blue.
No there are no pink scrubs like in gray's anatomy. As they also said, no self respecting surgical intern would wear pink scrubs.
I'm going to miss it, yet i also desperately want to escape it. Life is full of jobs that you love and yet hate. There's no other way around it.
We bear the bad parts so that we can enjoy the good parts. I wonder if there are any jobs out there that only have good and not so good but never bad. I want that job.
2 Mar 2009
Looking forward to the weekend...
Everyone is suffering from Mondayitis. My sign of mondayitis comes in the form of pining for the upcoming long weekend. I am 4 days away from my next short break. A very quick 4 days will pass by and it will be my long weekend.
And then it will be another quick 3 weeks before i finish my first rotation. I feel really happy about that.
The only glitch is that i'm on the wards this week and there is another surgical audit on friday again!
NOOOOOOOO!!!!!
I think tomorrow i'm going to have to go down to the horrendously inefficient medical records department to request for some histories. Or else it'll never get done again.
I felt our entire team cringe collectively when i reminded them that we have an audit this friday.
And then it will be another quick 3 weeks before i finish my first rotation. I feel really happy about that.
The only glitch is that i'm on the wards this week and there is another surgical audit on friday again!
NOOOOOOOO!!!!!
I think tomorrow i'm going to have to go down to the horrendously inefficient medical records department to request for some histories. Or else it'll never get done again.
I felt our entire team cringe collectively when i reminded them that we have an audit this friday.
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