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Red Alert

2011-03-31T20:58:00.002+08:00

It all started off during dinner today when boss and I heard the red alert buzz going off in the general operating theatre.

Since both of us were from ICU and was not in the proper attire to enter, we just poked our heads to see if everything was okay.

And then I decided to ask, so what if the orthopaedics operating theatre has a red alert?

The reply was, this red alert is connected between the orthopaedics, ophthalmology and general operating theatre.

But what if the specialist is in the ICU? Or what if it is the maternity operating theatre?

If it is in the ICU, just call the specialist via phone and they will go. It's just closeby. If it is the maternity operating theatre, we have to run there. (The distance from the ICU to the Maternity OT is roughly 2-3 minutes of brisk walking)

So I casually mentioned, it would be cool to see the specialist running to the maternity operating theatre :D

And guess what, 15 minutes later, boss received a call from the hospital operator.

OBSTETRIC RED ALERT!!

OMG!

I looked at her and asked, so are we running to the maternity operating theatre now?!

YES!!

So, begins the journey of the boss and the konco-konco running to OT while trying not to collapse halfway. :3

It was a good exercise.

The holiday

2011-02-27T21:56:00.004+08:00

Here are a few random pictures of how I spent my holidays. Not in any particular order. Enjoy. :3

Travelling by train

2011-02-25T10:59:00.002+08:00

My first time on an intercity train.

Conclusion: Not too bad for RM12. Air conditioning could have been better. =)

Another 4 months

2011-02-16T18:23:00.002+08:00

Again, another 4 months have passed.

How time really flies. Just like any other 4 months posting, and after the more 'horrorful' stories about being on call in this posting, I am quite glad that it is finally over.

But again like any other posting, just as I was beginning to enjoy the posting, enjoying the liberty and freedom of doing certain things by myself, the time has come for me to move on to a new environment.

And again, the time has come to day dream about where to go for holidays!

But again, it shall be another day dream of going to a place like this =)

Super awesome huh?! I shall go to sleep now and hope I end up somewhere near there :3

Lights

2011-01-22T20:07:00.006+08:00

Actually, I have never seen CNY decoration in this manner before. Probably my lack of celebration of CNY in the last 5 years. But as I was driving back home a few nights ago, these lights caught my attention.

p.s. I'm sorry if the picture didn't turn out as nice as it is supposed to be. Time for a real camera huh?!

Satisfaction

2011-01-11T22:43:00.003+08:00

A friend's message on Facebook read

"Divine satisfaction after saving a pt's life by doing my first needle thoracocentesis in a pt who developed iatrogenic pneumothorax post pleural tap. SpO2 picked up from 83 to 98 under RA, less tachycardic/tachypnoiec, speaking in full sentence, smiled & said "Thank you. I can breathe a lot better now". :) "

That is really indeed satisfying.

I had my own satisfying story today too.

2 weeks ago, while I was having lunch while still in holiday mood, I received a call from my vice captain saying I will be posted into the hematology unit. I remembered just answering No, no, no, no, no. All the horror stories I have heard about hematology. And I am utterly clueless about hematology.

So, I went into hematology 2 Thursday ago after I was on call. And I went through what all my predecessors did.

We woke up at 5 something in the morning to be in the wards at 6 something to take blood.

We went to or called the pathologist and blood bank medical officer almost on a daily basis to update about our patients who require apheresis or who requires transfusion.

We went to the biochemistry lab at least 2-3 times a day to take all the results in hard copy as hand written results are not valid.

We went to the microbiology lab everyday to ask the microbiologist to validate our latest blood and fungal cultures and to check on every subsequent cultures available.

We experienced our fair share of difficult blood taking and intravenous access.

We diluted or gave chemo drugs over 20 minutes and the toughest one I did today; to infuse 3.5ml of chemo over 15 minutes.

When I stepped into the hematology ward, I inherited several patients. And today's satisfying story is about this particular patient.

Mrs S is a newly diagnosed diffuse B-cell lymphoma who was planned for chemo but we couldn't proceed with chemo as she developed persistent fever in the ward. Blood culture grew a rarely found Stenotrophomonas maltophilia which was luckily susceptible to 2 antibiotics which we subsequently gave.

When I first saw her, the antibiotics were already given for the last 1 week and she still developed high spiking fever. To make matters worse, she was vomiting and nauseous everyday. She told me that she was literally forcing food down her throat because she knew she had to eat.

All the scans done for her was normal. There was no source of infection to be found. Blood cultures grew nothing after the antibiotics were started. We were perplexed. Could it really be lymphoma fever? Or drug fever as she developed reactions to one of the antibiotics we gave her.

A decision to start chemotherapy was then made together with the decision to stop one of her antibiotics.

Lo and behold! The fever settled and the most wonderful reply I had from her when I asked her a question at 630am in the morning was,

"Makcik, rasa macam mana semalam selepas chemo?"

"Makcik rasa sihat! Boleh makan, boleh tidur!"

The joy on her face was indescribable. It was as if we gave a miracle cure whether it was the decision to stop the antibiotics or to start the chemotherapy.

She was discharged 5 days later, beaming from ear to ear, well and happy.

I know I did nothing much for her besides causing her pain from repeated blood cultures, blood taking and trying to obtain IV access for her. But to see her being wheel chaired out looking so healthy, words cannot describe this feeling.

This is the sense of achievement that they say doctors get at work. The odd moments when patients or family members thank you for trying your very best despite all odds, or when they happily walk out from your ward. These are the moments that fuels us to keep going!

The year that was 2010

2010-12-31T11:33:00.005+08:00

Here is my 2010 in pictures. Have I changed/aged/grew even younger? You tell me.

As for 2011, I plan to go for one of these 2 looks. Which one do u think suits me more?

A)
OR

B)

A bitter morning

2010-12-24T17:53:00.002+08:00

The morning started off with me being post call. I had 2 hours of sleep last night which was rather decent. I have 4 patients in the acute bay to be reviewed and out of those 4, 1 was a rather demanding patient which I have left for the last.

And upon my first line of greeting him, I was answered with a whole 5 to 10 minutes of shouting and harrassing. The shouts could be heard from 2 cubicles away.

There were many factors contributing to the patient being unhappy and grumpy. First off, he already has a myriad of disease to start with at such a young age. Imagine having diabetes, hypertension, kidney disease and heart disease at 38 years of age.

He was admitted for a pneumonia with a very bad hacking cough. And it was this cough that was the root of all the problems. The bad cough gave him pain in the chest from repeated coughing, pain in the throat, insomnia and also blood streaks in the phlegm. Despite being on 3 cough mixtures (Morphine syrup included) he could not get a good night's sleep.

To further complicate matters, he is having giddiness, early satiety and uncontrolled blood sugar from the complications of diabetes. I understand why he was upset about and not getting better despite being hospitalised for 5 days.

But the straw that broke the camel's back was when he decided to throw his weight around. He started by asking whether I as a doctor am powerless to do anything about certain investigations which was ordered. He was furious about why an echocardiogram was not carried out even though it was planned 3 days ago. He was also questioning why an oesophagealgastroduodenoscopy was not carried out when he is having gastric problems.

Despite politely explaining to him that the echocardiogram is beyond my control as the echo assistant medical officers are doing the procedure based on priority basis for the entire hospital and the scope was planned as an outpatient procedure, he kept on harassing me by questioning why it is not done immediately and causing him so much suffering and not doing much to alleviate the symptoms.

Then he decided to use the trump card.

"Do you want me to call my relative Dato XXX, ENT consultant surgeon to order for the echo to be done?"

"Do you know your specialist Dr XXX? The last time I was warded in her ward, she just made a call and even procedures in KL can be done in 24 hours?"

He even gave me the specialist's number and asked me to talk to her personally and requested for a transfer to her ward. (I was tempted to transfer him out by then :B)

I personally hate this category of people who thinks they know some big shots, have their phone numbers and boss around with their name. But sadly, this is how the society works; by pulling as many strings as one can. And in all his fit and rage, he must have forgotten that he was talking to a junior doctor who cannot organise miracle procedures in 24 hours for non emergency cases. Asking me whether as a doctor am I doing nothing to make him feel better? Am I powerless and must listen to the staff? BAH! I replied him bluntly, yeah I am powerless in many aspects, which is why you do not quote I know Houseofficer so and so and I can get a cardiac MRI done in an hour!

After I had my dose of shouting, when my medical officer came for rounds and he received another dose after which he, too, walked away in rage to cool down.

However, the patient was suddenly tight lipped and reticent when the specialist came for rounds and asked the similar questions that both my medical officer and I asked him. And when the specialist answered that we will try to arrange for an echocardiogram for him, which by the way was the exact answer I gave him, the patient just kept quiet. Such a jerk!

Bah! It was definitely a bitter morning with me half sleepy and patient's who are just bossing around.

So, if you are reading this, and if you so happen to know some big shots, please be more considerate when you enter a government hospital. You are sharing the facilities with the rest of the general public and if your condition does not warrant a hi-fi procedure like you see in TV or in ideal scenarios, please don't ask for one to be done immediately.

I hate to deal with unappreciative human beings like you!

I paid to torture myself

2010-12-21T23:32:00.003+08:00

Guess how much I paid for this 'torture'? Haha. They say the darker the colour, the unhealthier one is I think.

I must be very unhealthy =(

Blood donation drive

2010-12-17T19:13:00.004+08:00

It all started during the university days when I was in the Buddhist Society. We have this tradition of organising a biannual blood donation drive whereby the National Blood Bank and the Blood Bank from Seremban will take turns to come.

Now, as a houseofficer, it is my turn to follow these blood banks on their mobile blood drive to collect blood for the forever depleted blood bank.

So, today, on my 6th time helping them out, I was quite thrilled to see on the board in front of the blood bank that they are actually making a trip to Jusco Kinta City, one of the most happening places in Ipoh. (only because there are no other shopping areas)

Alas, it was not my luck to go there. Instead I went to another mobile blood drive cum health screening cum massive circumcision event at a local mosque. This event is joint organised by none other than one of the largest/richest private hospitals in Ipoh.

However, the turnout wasn't that great although we sort of met our target of 15 pints of blood. The 15th pint was donated by none other than me ~~because I wanted to get an ISH umbrella because I am kind hearted~~

In 5 years, I have only donated 6 times. Such a poor record huh?! Compared to a veteran donor I saw with 78 successful times! I have even heard stories of 100+ times!

There are short term and long term rewards from donating blood, depending on how rich the organiser is.

This is my short term reward. Not one, but two umbrellas from Ipoh Specialist Hospital. One for donating, one for co-organising. Haha. Sounds like I'm indirectly promoting ISH =)

As for long term rewards, depending on how many times you have donated, you get certain amount of years of free treatment in the government setting. Oh well, better than nothing right? Besides, you don't lose much from donating. You don't gain much also I guess except that feel good factor.

So, what are you waiting for? Go donate some blood so that victims of accidents can get enough blood during their life saving operation!

After much bugging

2010-12-07T23:23:00.002+08:00

I finally cut the hair. No more long flowing hair. No more someone mistaking me for a girl when I wear S size scrubs and pink slippers =)

Now shampooing is much faster too!

Petrol Naik Harga

2010-12-03T22:00:00.003+08:00

I joined the queue. Well, at least when I went there was no queue yet. As I left, the cars were lining up.

I wish one day, I will be queueing up at the ATM to withdraw money because a fat bonus was just chequed in.

Wishful dreams!

Venting out

2010-12-01T18:07:00.003+08:00

I am full of bitterness, anger, contempt and biasedness as I am writing this.

This probably is only because of the current work place that I am in. But it really annoys me to no ends.

And the source my annoyance, a handful of nurses. (I'm really sorry if you are one of the hardworking, passionate, responsible nurses)

Today's scenario which almost made me rupture an aneurysm, if I had an aneurysm to begin with was like this.

KC is a 70 years old gentleman who was admitted for uremic encephalopathy which was attributed to obstructive uropathy due to an enlarged prostate. We inserted a urinary catheter and ran fluids.

Soon enough, KC became better as the uremia settled and was fit for discharge. He had an appointment in the surgical outpatient department in 2 weeks time to review his prostate condition.

On discharge, would you have, bearing in mind that patient has an enlarged prostate and was uremic because he couldn't pass urine.

a) kept the catether
b) removed the catether
c) not sure and I will ask

Well, my nurse chose the answer b) in all naivete even though the answer should have been c) for her. And what irked me to no end when I asked her the reason for her actions, she replied.

"Doktor tak tulis to keep the CBD jadi saya off kan saje lah. Semua patient yang discharge akan off CBD sebelum balik ma"

Sounds logical if you have never worked where I'm working. Anyone should have everything inserted inside them removed right?

But where I work, I have not seen a day when my management plan for patients are ever carried out to the dot. For example, to discharge a patient, I need to write clearly DISCHARGE TODAY even though it is already implied in the rounds that the patient is to be discharged. To have blood pressure, pulse rate and oxygen saturation monitoring done 2 hourly, I probably would have to do it myself 2 hourly while they continue on the erratic monitoring.

So, to even have the guts to tell me just because I never write to keep the catether they removed it, that made my blood boiled. And bearing in mind the patient's medical condition, they should have even asked prior to removing!

Then I was thinking. What exactly do the nurses do in my ward?

They work 7 hour shift, or 10 hours if they are night shift.
They have a minimum of 1 meal per shift, sometimes 2 and even 3 if lucky.
There are about at least 15 student nurses of different seniorities in my ward. And these 15 students will do the feeding, sponging, observation, and sometimes even serving some medications.
And then there are about another 10 student assistant medical officers in the ward. They will do the hard job of sending patient for x-rays, sending patient here, transferring patient there.

So what else is left for the full time nurses to do?

New admissions.
Discharges.
Appointments.
Watchover the students.
Write 6-7 lines in every patient's ticket.
Passover.

Might have missed out on several more things but I'm not too sure.

All of these work, even if they had to do all of them, are only for 7 hours. Can't you people work with more commitment? I'm not even hoping for them to be compassionate. Just commitment to get the job done.

Sigh!

What has happened to patient care nowadays?

Winning a prize

2010-11-27T20:56:00.004+08:00

It was the Medical Night 2010 yesterday.

I was "unlucky" to be chosen to go up to do a group singing. The last time I sang in public was when I was doing my electives in Kapit. That was years ago.

The song we did that time was Westlife - Uptown girls. We in fact changed the lyrics a little to suit the Kapit atmosphere. And we even had a group name. Haha.

Yesterday, again I had to sing in public. This time, we chose an even harder song to sing which was Belaian Jiwa. I swore that I really thought for that moment we sang, we might be pelted with the shells of the prawn dish that they were serving when we were called up to perform.

But for our bravado, each of us received a consolation prize. Mine was this.

Nicely wrapped thing which could have passed off as a wrapped brick.

But when I opened it, I found this. A treasure chest?! o.O

I'm quite sure you all could have guessed what this is though.

Neighbourly feud

2010-11-21T17:54:00.005+08:00

It all started today afternoon as I was munching on my Ngan Yin groundnuts and sipping my ice cold Pepsi Twist.

First I heard someone shouting what sounded like Meng Jai very loudly. Initially, I thought the voice was calling for my neighbour since he is chinese and my name is no where near Meng Jai and noone I know shouts for me like this.

After like 10 times of Meng Jai reverberating, I sensed something amiss. Then I thought, maybe he was shouting Leng Jai (Handsome boy) instead of Meng Jai (Someone's name). Moreover, the voice began shouting louder and louder.

So, I put on my shirt and was prepared to walk down the stairs when the shoutings of Leng/Meng Jai became shouts of HOY, HOY, HOY.

At that moment, I swore if he was anywhere near the hospital, I would have asked for physical and chemical restraints and signed some Form A, B or C thingey. Instead, I cringed at the rather 'violent' shouts and decided to lay low and quiet.

I peeped out of a room window when the voice finally left and alas, found out why he was shouting for me.

*click to enlarge

My neighbour drives a lorry and I, a small small, old old car. Usually, we park at this empty land opposite of our houses which belong to another neighbour. We have our "usual" spots, so to say.

Today afternoon, as I reached home, I found that someone has parked in the middle of our spots, slightly closer to my end than his end. So, I thought, never mind, I shall park at his spot for a short while first.

And hence, caused the shoutings. I watched him parked the lorry at the current spot and left in another car. Then I thought that I should better remove my old old car just in case he decides to steamroll over it with a lorry.

In the end, my car is parked far far away in Zimbabweland and hopefully the lorry driving neighbour would be appeased.

I wish

2010-11-20T22:01:00.003+08:00

I wish I would go to a workplace where there are enough tubes to put my blood sample.

I wish I would go to a workplace where there are enough blood culture bottles everyday so that I do not have to go to another ward to beg, borrow or steal a bottle because waiting for my nurses to order the attendants to get a bottle would take half a day.

I wish I would go to a workplace where there are enough laboratory forms for me to fill in so that I can send my blood samples.

I wish I would go to a workplace where there are enough dressing sets, disposable or non, so that doing my job would be faster and more convenient.

I wish I would go to a workplace where the sterile gloves are not at least 1 size larger than the average size of all the doctors and nurses in the wards.

I wish I would go to a workplace where the 3 computers facing me at the counter can be used for better things such as tracing results.

I wish I would go to a workplace where the nurses from one ward does not think that their counterparts from the other ward are completely useless and bitch about them everyday.

I wish I would go to a workplace where every ward I go, the things that we use everyday is located in almost similar places so that I do not get remarks such as "Doktor, you ada cari dengan mata tak?" "Doktor, carilah sendiri." "Doctor, kami sibuk la sekarang."

I wish I would go to a workplace where every order I write down is followed just like how I am expected to follow their orders.

I wish I would go to a workplace where the ward Sister knows what is lacking in the ward instead of finding someone to blame everyday for not keeping the heparin bottle back into the fridge.

I wish I would go to a workplace where passover rounds are not the biggest event at 7am, 2pm, 9pm until the whole ward will stop momentarily. Especially since not everything is passed over also.

I wish I would go to a workplace where at least patient care is somewhat higher in the priority and not getting remarks such as "My on call starts from 1pm. Please settle everything that happens before 1pm even if it is 12.55pm"

I wish that now I have many wishes that can be fulfilled.

Be yourself

2010-11-17T12:39:00.002+08:00

The song has nothing to do with the title but I guess the song title is roughly similar to what I'm going to say.

How often you hear in movies or even from others asking you to be yourself? I think the answer would be quite close to maybe once a week or something.

But in reality, how often can I be myself?

Considering I'm a lazy slob who doesn't give a damn care about most things and considers a lot of things to be a nuisance, how can my actual self survive in this community?

Given that I, or rather we, face pressure from many sources, family members, work colleagues, supervisors at work, even from your other half, how many people actually like your actual self?

I succumbed to the pressure obviously, being nice and more polite than what my usual self is. Haha. So after reading this, at least know that I'm not that nice, and I'm more mean than what I'm portrayed to be =)

Who wants to live by this motto now? LOL

Escape to a far far away land

2010-11-13T15:22:00.004+08:00

How much do you think it would cost to stay there? With the salary I'm drawing, probably I can afford one night of stay there.

Anyone wants to join me?

Mammoth task

2010-11-08T18:05:00.001+08:00

Anyone wants to start a studying group together? LOL. Just opening this book makes me sleepy.

The rooms I have stayed in

2010-10-31T23:53:00.004+08:00

Seremban was the first time I actually rented a place and stayed outside of home. Haha. After 2 decades easily =)

Totally liked the place I stayed in. Just nice and cosy with a cooling breeze although it can get quite hot in the evening.

Stayed and had lotsa fun in Seremban for 2 years until it was time to move to Batu Pahat for 1/2 year.

The criteria we had in mind while choosing a place in Batu Pahat was - cheap! And so we got a cheap place which was fully furnished =) And this is how my fully furnished room looks like.

Yups, the room belonged to a girl prior to me =) Which explains the colour.

Then work came along and I had no place to stay initially besides the hospital quarters for amoebas like me.

Quarters was not that bad. It had hot water for shower, a bed, wardrobes, tables, chairs, desks and plenty more for a very very decent price. But I have a problem with it. No washing machine and it was the first time I had a roommate in my life! Haha =)

The pictures were taken on the first day I moved in. Subsequently, due to the owner feeling slightly richer with money, he decided to buy even more things.

And before long, the eviction notice came.

And here is where I stay now. If you observe carefully, I still have many things which I recycled from my student days! Haha.

Proves a thing, my buys are definitely worth the money or I'm a cheapo! >.<

p.s. click on pictures to hopefully enlarge.

Fun-Tags-Tick-Four

2010-10-30T23:42:00.002+08:00

Rawr!

First time in years I have been tagged. I guess rather than letting the blog die off, why not just do some random tags =)

So, here goes.

1. 4 Jobs I've Had in My Life

(Never even had 4 in my life. LOL)

- Waiter in Swenson's SS2 (around July 2004)

- Doctor in training (2010 - current)

2. 4 Places I've lived in

(To compensate for the lack of answers above, I shall answer 6 here)

- Damansara Utama

- Subang Jaya

- Seremban

- Batu Pahat

- Ipoh

- Kuching-Sibu-Kapit

3. 4 Places I've been on Vacation to

(err.. since young or how? If recently, no answers for the past year)

4. 4 Places I would rather be in

- Penang (First choice for my work application)

- Taiwan although my Chinese is not good

- Japan for obvious reasons! LOL

- Somewhere in the west =)

5. 4 of My Favourite Food

- Prawn mee

- Italian pizza with beer =)

- Roasted duck

- Tomyam fried rice

6. 4 Lucky souls tagged

(Dunno anymore people who still actively blogs, so the first 4 to read this, please tag yourself and let me know!)

1 year at work

2010-10-23T00:53:00.003+08:00

This week marks the 1st year that I've been appointed to civil service. Can't imagine that time has passed so quickly.

Felt like only yesterday when I passed out and waited for my induction letter. Now, I am already considered as a senior, being mistaken numerous times to be more senior than what I'm supposed to be.

I don't really know how much I have grew as a person in the past year. Definitely more bitter I guess. Whether I am a better person is definitely debatable. Knowledge wise, I have definitely deteriorated. Empathy wise, perhaps, I do understand human nature slightly better. Understand that most of us are only interested to safeguard our interest over the common interest.

And while my peers have already started to take a deep interest in their postgraduate studies, I am still finding myself bumming around. Taking my 2 year break, that's what I've been telling myself. But most probably the reason is I'm just too reluctant to pick up another book after slogging through so many years of studying.

Sigh!

I really don't know what I want in life.

Really looking forward to have something to look forward to.

The first picture is how I look like 1 year after starting work. Compared to the second picture, have I grew any more matured? Or just more lethargic?

This festive season

2010-09-21T23:18:00.003+08:00

I haz Kuih Raya! Many thanks to those whose kuih raya I munched on while I was hungry! =D

New design, alas

2010-09-04T20:49:00.001+08:00

Author's note: Minimal or no hepatocytes were damaged in this process. =)

rwoww rwoww

2010-09-04T19:09:00.004+08:00

After 33 hours of waiting, I still can't access my own blog due to the server failure. Since Fengy suggested on my FB to access his blog. So, here I am, a legal intruder! Miahahaahahhaa...

I think Fengy needs a new header. What do you guys think?