Tales from the Ward

Low Profile

2012-01-15T05:16:00.000-08:00

Despite working in Palong for almost 10 months and my reputation for being ferocious, I surprised that some folks there still unaware that of the fact that there are already doctors, especially me, in Palong. Probably they had been put under house arrest for 8 months previously and were just released recently.

I was having my lunch in somewhere opposite the school near my clinic some day when this guy approached me.

Guy: Awak ni baru pindah ke sekolah ni ke?

Me: (chewing food and shaking my head) Tidak.

Guy: Awak cikgu baru kan. Saya tak pernah jumpa awak pun.

Me: Saya bukan cikgu.

Guy: Oh ya ke... jarang saya tengok ada orang Cina kat sini, biasanya guru-lah.

Me: Saya kerja dekat klinik.

Guy: Awak kerja doktor ke?

Me: Ya.

Guy: Oh... doktor baru ke ni?

Me: Saya sudah kerja 8 bulan kat sini.

Guy: Oh ya ke.... kenapa saya tak tau.

Me: Sebab kau tak pernah pi klinik.

Guy: Saya ada kencing manis tapi dah tak lama tak pigi klinik ambik ubat.

Me: Kalau macam tu, jangan biar saya nampak awak dekat klinik saya.

Guy: -.-"

I don't entertain defaulters. If you do not care about your own health, why should I?

Country MO and City MO

2012-01-01T17:51:00.000-08:00

8 months spent in Palong has opened my eyes in many different ways, for instance how primitive our public health delivery system is, how stubborn the rural patients are, and many other more. With all sort of financial limitations, I guess working in the smallest clinic of the most primal district in this state has taught me to be resourceful and malleable.

Anyway, there seemed to be this concept of a "Country MO" and a "City MO" thing. A Country MO usually is a doctor who works in a health clinic setting - laidback and relaxing - and hence are usually perceived by the others as unambitious and incompetent, and consequently being looked down upon. Well, what can I say? When I was working in the hospitals, I did encounter a few ex-KK MOs who have been too comfortable sitting in the clinics until they haven't had the simplest clues of what they were managing! Well, not everyone has an idea what they want to pursue when they have finished their housemanship, and when you're been constantly laved by that sort of working luxury in a health clinic, it's not unusual for you to be deeply in love with it.

On the other hand, a City MO are doctors who constantly work in a hospital setting. Archetypally, these doctors already had made up their mind on their future and would just do anything to cleave to their plans. Most of them have not even stepped a foot out of the city boundaries and have been accepting referrals from places where they don't even know exist, i.e. my clinic.

Well, my fall from grace was a bit different. Having done over with my housemanship, I was first exiled to Hospital Kuala Pilah for 6 months, to facilitate my transition to working in district. God knows why. The reason JKNNS gave was to give me time to learn more in a hospital setting and be more confident later when I get sent to district. Ok fine. And 6 months later, they sent me to some god-forsaking area like what they promised earlier and I accepted gladly. Ironically, I was sent to a clinic where the facilities are so limited, I can't even practice much of what I have learnt back in Kuala Pilah; I can't even intubate patients as there ~~weren't any patients who needed intubation~~ was no other sedative agents available, and I can't even pronounce death properly as ~~nobody has ever died in my clinic~~ I have no cardiac monitor in my disposal! Pronouncing death would require me printing an ECG of the long lead II with my ECG machine instead.

Now where was I again? Oh city and country MOs.

Probably I have been stuck in a health clinic for too long. Maybe that is why nobody in Hospital Jempol remembers me anymore, and the fact that 1 year ago I had been accepting their referrals and taking over their cases in Kuala Pilah. Or probably they think I've lost my touch and succumbed to the luxury of working in a health clinic. No wonder nowadays when I refer cases I am being fed with sarcasm and mockery.

So I guess I'm being labelled as a "Country MO" now after all. Well, not for long. I'll be mocking Hospital Jempol pretty soon, and I'll remember whom I need to mock. :)

Disaster!

2011-10-10T00:10:00.000-07:00

My clinic has always been that chill until I've put on lots of weight due to too much resting my butt on my chair. Once in a while I would ~~pray~~ wish for some excitement or some adrenaline rush to tune up my delapidating senses, and guess what? It did happen.

It was another beautiful sunny Friday, just like any single Friday which all clinic doctors would adore. Less patients to see, long lunch break and time to catch a shut-up, and most of all, its the final working day of the week. Undoubtedly, it's my favourite day of the week!

Glancing at my wrist watch which read 11.25am, I was bracing myself for my long lunch break -- out to buy lunch and take a nap -- when my nurse popped into my room.

Nurse: Doktor, tadi sekolah talipon cakap ada beberapa budak kena racun suruh kita bersedia.

Me: Dia cakap tak jumlah berapa?

Nurse: Tak ada. Dia sudah letak talipon.

Me: -.-"

And so I went out to my clinic's entrance and stood at the door, asking my clinic staffs to prepare themselves for the imminent horror. And within 15 minutes after the phone call, they appeared... 5 cars loaded with almost 2 dozens of students whom accidentally inhaled pesticide fumes in school while pest control was ongoing in their school.

Me: Fuck. This is something my KK has no capability of handling.

So, I rang the nearest KK and asked a colleague to come over to help, as well as asking Hospital Jempol to be prepared for the imminent cases that I was about to send.

So, one by one the 21 school kids trudged into my clinic, and sat onto the couch awaiting to be manhandled. And being the only doctor in my clinic, ultimately I have to take charge and issue orders. Hence, I delineated my KK into a mini ER, with the main hall as the waiting room, the MA room as my green zone, the treatment room as my yellow zone, and the emergency treatment room as my red zone.

Me: Siapa yang rasa betul-betul tak sihat, sesak nafas atau sakit dada sila angkat tangan.

And 15 of them raised their hands. 15 kids complained of difficulty and I only have 2 oxygen tanks in my clinic. Great. By innovating my nebulizer machine, that makes 4 altogether. And I have to identify the sickliest among them for immediate oxygen therapy, while the rest have to wait.

As my paramedics ran around like headless chicken taking vitals, putting on face masks for oxygen therapy and providing simple first aid treatment, I continue zooming in and out into each zones and the waiting room, screening through the students to identify the sickliest which may need urgent attention.

Me: Kau boleh gelak-gelak lagi tu tanda awak tak serious. Siapa yang rasa tak selesa I kasi injeksen sekarang.

And everyone stopped complaining they're feeling unwell except one or two who complied to be given a jab. And that is how I differentiate those who are really feeling unwell from those who just want attention.

And the first ambulance arrived from the nearby clinic in 30 minutes together with my colleague.

Me: Muthu, you just keep an eye on the green zone kids while I hover these red and yellow zone kids onto the ambulance to Jempol.
Muthu: Aye aye.

And one by one, I dumped the kids from my red and yellow zones into the ambulance, waiting to ship them off to the hospital. And as I cleared these 2 zones, Muthu started pushing the other kids in, as they had now in turn become the sickliest kids. There was nothing much we can do except giving them oxygen and wait for the next ambulance to come.

So, finally when the last ambulance came and transported away the final batch of the kids warranting admission, Muthu, me and my clinic staff were already exhausted, and most of us hadn't had lunch yet. We managed to discharge 9 kids and admit the rest of them to Hospital Jempol for observation and symptomatic treatment. Even though we were starving and weary the adrenaline circulating in our bodies still kept us moving on till we settled everything at 4.00pm.

It was just a very minor disaster, honestly, but then it was a great lesson. I'm ready for more. Give me your best shot!

Chasing Patients Away

2011-09-28T07:53:00.000-07:00

Being away from my clinic for almost 1 week, I was rather unmotivated to go back and work in my God-forsaken clinic, and dealing with my patients. Well, a doctor's gotta do what a doctor gotta do. And my mood got ruined again today.

Nurse: Doktor, makcik ni fasting glucose 16.0

Me: Ok I tengok dia. (turns towards the makcik) Makcik makan ubat tak?

Makcik: Saya makan ubat pagi saja.

Me: Oh. Kenapa macam itu? Makcik lupa makan ubat ke?

Makcik: Saya memang makan ubat pagi saja.

Me: Tiap-tiap hari makan pagi saja ke? Kenapa? Ubat terlalu banyak ke? Susah telan ke? Ada kesan sampingan ke?

Makcik: Tak ada. Saya memang nak makan ubat pagi saja.

Me: Tak boleh macam tu. Ubat tu memang kena makan 2 kali satu hari, kalau tak nanti gula makcik tinggi.

Makcik: Saya nak makan ubat pagi saja.

Me: (spits fire) Makcik, awak yang sakit, bukan saya. Kau jangan harap aku nak pujuk kau makan ubat. Kalau tak nak makan ubat, jangan jumpa saya. Bazir masa saya saja. Tak pernah saya jumpa pesakit bengong dan gila yang kena saya pujuk makan ubat.

Makcik: Tengoklah. Kalau saya rasa nak makan malam, saya makan-lah.

Me: Tak nak makan ubat tu suka hati awak. Kalau koma kat rumah, awak punya masalah. Lain kali tak payah jumpa saya. Keluar.

And so she got chased out from my office. If I had a shotgun in my room I would have shot her to death.

Goddess of Hypertension

2011-09-27T20:53:00.000-07:00

Being a doctor isn't easy. Most of the time it is already arduous to reach a correct diagnosis or finding an appropriate explanation for a patient's complaints, but the biggest challenge is to make sure the patient complies to the treatment you offer.

What is more frustrating is that when a patient comes to see you and eventually you find out what is wrong with him. And then he refuses every single treatment you offer despite you wasting your breath counselling him the consequences for doing so. I wouldn't really care much if that patient dies or ends up with some serioud morbidity, but then it goes against my conscience; there is this agonizing pricky feeling that constantly haunts you whenever you think of the fact that someone is dying because he refuses to get treated.

Having arrived in KK Bahau for my locum, I saw my colleague talking to a patient.

Me: Still seeing this last patient?

Suba: Yah. Giving me a real headache.

Me: How come?

Suba: This Indian uncle came complaining of headache and dizziness and his BP is shooting high. When I advise for admission he refuses treatment and say he wants to go home.

Me: Then why is he putting his hands together and worshipping you?

Suba: He's praying asking me to let him go back home.

Me: Maybe he thinks you're the goddess of hypertension and you can reduce his BP with your magic powers. LOL.

If you don't plan to follow the doctor's advice, don't see a doctor then.

The Lion King Musical

2011-09-23T09:05:00.000-07:00

So here I am, in Singapore, a country which I last visited 23 years ago when I was still a kid. I could still remember me visiting the Singapore National Zoo, the science center, the nauseating ferry trip to Sentosa Island, and me being lost in some shopping complex in Orchard Street. Anyway, those are history and what matters is I am back in Singapore again!

Well, the main reason I came to Singapore again, is actually to catch a glimpse of critically acclaimed award winning The Lion King Musical. Initially I was a bit reluctant to go all the way down to another foreign country, just to watch a musical, but then the temptation was too strong, augmented by showers of compliments from friends who had watched the musical saying it was just too good to be missed. Eventually, I yielded when another old friend of mine too wanted to watch the musical with me.

And it was freakishly fabulous. It was practically the most vibrant and colourful musical that I've come across so far (I haven't got the chance to watch Joseph and His Amazing Technicolour Coat yet). I just love how the way the show starts, with mannequins of African wildlife being maneuvered to life to the beats of African tribal music. Very creatively choreographed and detestably unforgettable!

The casts were splendid; the kids who played the young lions sang and acted really well, the hyenas was grotesquely hilarious and Zazu was cracking full of jokes. Timon and Pumba only appeared at the later half of the show and made the musical even livelier. I couldn't stop myself giggling at Zazu, the hyenas, Timon and Pumba. And not to forget the schizophrenic old Rafiki, who managed to drop a few bombshells of laughter once in a while. But I wished her butt could be made more livelier.

I remembered watching the cartoon when I was 12 (17 years ago) and still the music sounded fresh in my ears. "The Circle of Life", "Can't Wait To Be King", "Can't You Feel The Love Tonight", and "Hakuna Matata" were just a few songs that got engraved deeply in my memories and it was just lovely to hear them again.

Anyway, its was just fabulous. Creativity at its max. You'll definitely regret if you miss this! I know I would.

So, what's next? Wicked in December, anyone?

Malaysia Day

2011-09-17T20:10:00.000-07:00

Finally I get to savour a long weekend break after having to spend the Merdeka Raya long holidays rotting in my clinic. And for this, I've got to thank Hari Malaysia, which recently was only declared as a public holiday (in order to woo votes from East Malaysia I suppose). Anyway, the main thing is that it's one day where we can just stay at home, relax and ponder on the meaning of our country's independence.

We've been bombarded with sensational political headlines in the local media; some ridiculous, some outrageous, and some agonizingly saddening. Somehow it made me feel that this country somehow has ended up as a joke. 54 years ago, this country was poor and divided due to British colonization. 54 years later, this country is still poor and divided, and worse, stagnant.

During my internship I could still remember one touching moment I've witnessed in my ward with my MO while we were doing rounds. There was this Chinese lady who had just undergone her Caesarean section the night before and currently was bedbound; she had no caretakers beside her and visiting hours were still long ahead. And just 2 feet away from her was a cot with her newborn baby inside, wailing at the expense of her lungs, demanding for milk. I suppose she was still vertiginous due to the remaining effects of her anaesthesia, hence she had difficulties reaching for her baby.

What surprised me was another Indian lady next to her actually climbed out of her bed, walked towards this Chinese patient, and brought her baby to her from the cot. The Indian patient smiled at the Chinese patient, and gently tucked the baby between her armpits and asked her, "Achee haus tak?"

The Chinese patient nodded her head and the Indian patient actually bent over and started to feeding her sips of clear fluids.

At this moment, another pregnant Malay woman who just walked by handed the Chinese patient a pair of new socks. "Achee kena pakai stoking. Kalau tak, nanti kaki sejuk." And she helped herself onto the patient's feet with the socks before sitting next to the patient, comforting her with supportive words.

This was nothing but a instantaneous tear-milking scene; they were 3 women who had barely knew each other and they were helping each other, honestly, sincerely, gratuitously. And at this moment MO whispered to me. "If only the politicians could stop squabbling between themselves and see how beautiful this scene is..."

I nodded, and tried to stop my eyes from tearing.

No matter how screwed up it could be, this is still my country. Happy Malaysia Day.

Mat Rempits

2011-09-06T10:25:00.000-07:00

In the past 17 days of on call in my clinic, I've aldy encountered a few Mat Rempits who came to my clinic in a bloody state. I was wondering if I really should sacrifice my beauty sleep to entertain these suicidal idiots, and since they were so enthusiastic to get themselves killed, would it be better to let them taste a bit of the noxious fruits they sow. Still, it's my humble duty to treat the needy, ~~no matter how idiotic they could be~~, hence unconditionally I lay my ~~agonizing~~ healing hands on them when they seek for help.

So, just an hour ago, I had 3 motorbike accidents which incidentally happened in 3 different places around my clinics. Still, although the locations vary, but still they were all minors, with no helmet fastened on their head, with driving skills comparable to a rabid baboon.

And it was this one that sustained the worst of my sardonism.

Me: Kenapa Puan? Accident pula ke?

Mother: Ya doktor. Anak saya accident tadi.

Me: Malam buta-buta pun accident, mesti rempit lah ni.

Mother: Tak tau lah.. anak ni baru bulan 5 saje kena accident dan tulang tangan kiri dia retak.

Me: Amboi. Dah patah tangan pun nak rempit lagi. Nak mati ke?

So I was determined to give this kid an experience of a lifetime. And there this scrawny 14 year old kid climbed onto the examination bed, not knowing of the horrors awaiting him.

Me: Jatuh macam mana tadi?

Patient: Tak ingat-lah.

Me: So you tak ingat apa berlaku lah? Ada pengsan ke?

Patient: Tak tau. Saya tak ingat langsung.

Me: Ok tak apa. Sekarang ada sakit dada, sakit perut, sesak nafas, sakit leher, sakit belakang atau mata kabur tak? (I spilled everything out in one puff)

Patient: Tak ada. Tangan saya sakit teruk. Tolong saya doktor.

Me: Saya rasa tangan ni patah teruk.

Patient: Betul ke doktor? Tapi saya nampak luka tu luar saja.

Me: Kalau luka biasa takkan sakit teruk kan?

Patient: Yalah doktor. Sangat sakit. (Started screaming and yelling like hell)

Me: Jangan jerit-jerit. Ini saya bagi ubat tahan sakit sikit. (Jab his ass with some IM Ibuprofen)

Patient: Sakit.... sakit... tolong... sakit...

Me: Jangan bising. Saya nak cuci luka awak. Duduk diam saja.

Patient: Doktor cuci ngan apa? Sakitnya. Tolong.

Me: Sebab kau luka teruk saya tengah cuci ngan asid kuat ni. Nak bunuh semua kuman.
Patient: Apa? Asid? Tolong. Sakit. Tolong.

Me: Kalau ni betul asid, kau dah mati dah. Ini air garam saja. Jangan gerak, nanti lagi sakit.

Patient: Oh bukan asid? Dah tak berapa sakit dah. Nampak kawan saya tak?

Me: Kawan mana pula?

Patient: Saya rasa ada kawan saya ikut saya naik motor tadi. Mana dia?

Me: I tak tau. Setakat ini awak saja yang muncul kat kelinik ini. Kalau kawan awak tak ada tu, sama ada dia okay takde cedera langsung, atau dia dah mati terus dan mayat dia tidak dijumpai lagi.

Patient: (Starts sobbing even louder)
Me: Itulah. 4 bulan lepas dah rempit accident tak takut lagi. Suka sangat ke nak cari mati.

Patient: Arghh... Kawan saya hilang... Arrgh...

Next time probably I should just rub salt into the wounds instead of using saline water.

Annoyed

2011-08-31T04:37:00.000-07:00

My Merdeka Raya calls so far have been pretty good, except for today when I was awakened up by shouts outside of my window. Obliged, I had to answer the shouts, in case there was really some boiling emergency.

So outside the door was this grey hair guy with this annoying fault-finding look.

Me: Kenapa ya?
Him: Saya punya anak nak bersalin dah. Dia sakit perut.
Me: Oh. Dah talipon missi belum?
Him: Belum lagi.
Me: Kalau kes bersalin pakcik kena talipon missi dulu.
Him: (Yelling like some mad men) Apa talipon talipon. Ini klinik apa takde orang buat kerja. Kalau you nak rehat dalam rumah you rehat-lah.
Me: (Severely irritated) Semua kes yang berkaitan dengan mengandung akan dikendalikan oleh missi. Nombor talipon dia ada dekat papan di luar klinik.
Him: Biarlah. Tak guna betul klinik ni. I nak pi Hospital Serting terus.
Me: (Annoyed till the brink of smashing this guy's head with a grave-digging spade) Cik, cakap biar betul. Hari ini cuti, so memang tak ada orang duduk dalam klinik.
Him: Habis awak pun patut kena duduk dalam klinik.
Me: Awak ingat klinik saya tu ada bilik tidur ke? Awak nak saya ngan jururawat saya duduk dalam kelinik saya 24 jam ke? Kan luar klinik tu ada papan besar dan sana tertulis nombor talipon jururawat dan doktor. Kalau ada kes talipon saje kita akan datang lah. Kau ingat ini hospital ke?
Him: Mana papan tu?
Me: (pointing at the huge 1m x 1m board) Papan besar ni tak nampak ke?
Him: Ok ok... maaf. Awak doktor ke?
Me: Ya saya doktor. Ada apa masalah ngan tu ke?
Him: Erm.. tak ada apa dah.

Some people just have no brains.

Weird Compliments from Patients

2011-08-27T00:51:00.000-07:00

Working in such a desolated area renders me vulnerable to develop good rapport with my patients, since I am the only medical doctor there and they have no one else to seek, except for me. For the past few months I have been showered with a few compliments by my patients, which at times drive me insane.

Scenario 1.

Patient cut his fingers while washing the window panes of his living room.

Patient: Doktor ni bagus la... jahit tangan saya tak sakit pun.

Me: Ya ke?

Patient: Yalah. Saya tak rasa apa-apa pun.

Me: Pakcik kencing manis sudah teruk, so saraf sudah rosak, lagipun saya dah cucuk ubat bius sikit. Sebab tu takde rasa apa-apa.

Patient: Begitu ke... tapi saya tengok tangan doktor tu sangat steady.

Me: -.-"

Scenario 2:

Brainwashing a diabetic patient with horrible glycaemic control.

Patient: Doktor ni Melayu ke?

Me: Muka saya nampak macam Melayu ke?

Patient: Tak, masa doktor marah saya tu doktor cakap tu takde pelat langsung.

Me: Oh begitu.

Scenario 3:

Brainwashing another hypertensive patient with poor drug compliance.

Patient: Doktor ni sporting la.

Me: Kenapa?

Patient: Masa doktor marah saya sangat lawak...

Me: -.-"

Patient: Saya suka doktor buat lawak masa marah saya. Kalau saya sakit teruk pun terus sembuh dah.

Me: Ada pula macam tu?!

Damn. I'm too used to working in my KK now.

Suicide

2011-07-27T05:49:00.000-07:00

I just came across a few published papers citing Palong as one of Malaysia's top 5 champions for worst glycaemic control, worse BP control, and worse waist-hip ratio. Not bad. I wonder why.

Taking care of my Palong patients can be somehow life-draining, especially when you realize that most of they don't even care bout themselves. Despite multiple times of blistering your tongue advising them to adhere to their diet modification and drug compliance, somehow they just fail to listen. I have tried various ways to terrorize them with amputation, blindness, impotence, kidney failure, and even death, but somehow they seem to be obstinate enough for my death threats to work.

Me: Pakcik, kawalan gula tak pernah bagus ar.

Pakcik: Oh... Saya semalam sahaja tak kawal makan.

Me: Jangan tipu-lah. Buku kecil ni tunjuk sejak pakcik ada kencing manis 3 tahun dulu, sampai sekarang tak pernah kawal gula.

Pakcik: Hehehe.. ya kah?

Me: Pakcik ada injek ubat tak?

Pakcik: Ada. Saya injek 2 hari sekali.

Me: Apa? Kenapa injek macam tu? Siapa ajar punya? Sepatutnya 1 hari 2 kali-lah!

Pakcik: Oh... saya modify sendiri.

Me: Mujur pakcik tak pengsan lagi. Dah-lah tak injek ubat betul-betul, sekarang tak kawal makan lagi.

Pakcik: Doktor saya ada kawal. Semalam saya makan 3 ulas durian sahaja.

Me: APA!?!?!?! Patutlah gula tinggi sangat.

Pakcik: Tapi lepas makan durian saya minum air banyak.

Me: Minum air masak ke?

Pakcik: Tak. Tiap-tiap malam saya minum air laici tin.

Me: Oi! Nak bunuh diri ke?!

And everyone outside my clinic room peered in. I swear if I had a gun I would have just put on his head and pull the trigger myself.

Dreamgirls

2011-07-23T20:28:00.000-07:00

Having recovered from my utter disappointment from watching Magical Musicals, I was somehow a bit hesitant to dump another RM120 bucks to watch Dreamgirls; the psychological trauma I sustained from watching a lousy musical was a bit too hard to take. So, after a month of careful repetitive contemplation, I finally succumbed to Jessica's invitation to watch Dreamgirls, and thanks to the Phamacist's superb idea of using a GroupOn voucher, we got ourselves a First-Class seat with only half the usual price!

We beat the ridiculous traffic jam along Jalan Tun Razak and Jalan Kuantan, and managed to arrive Istana Budaya just 5 minutes before the show starts, and already there was a small crowd. Hmm... I din't know the manatee shows would attract that much people too. Moreover, no drinks are allowed in the theatre, and in one gulp I have to flushed down 750mls of mineral water that Jessica bought for me for RM2! Lucky my bladder did not fail me throughout the show!

So, with the RM248 seats (of which we bought for just RM124) we were like 10-12 meters away from the stage and the view was excellent, for my meager expectations; its near enough for us to get a close look at the casts' faces, and its far enough that we can see the entire stage without turning out heads.

Anyway, the casts, which I think all of them are local artistes, were fantastic and boy could they sing! Effie has a great voice and so does Lorelle, but I think Deena's was a bit shaky. Jimmy's role was played superbly well and he brightened up the early parts of the show where the best scenes have yet to come. Their costumes were mesmerizingly bedazzling and so were the backdrops. I am somehow very fond of the giant DREAMGIRLS sign in blue, and I think that stunned me in awe for a few minutes. Not to forget the pyrotechnics, which are just simply marvelous.

I'm glad I did not miss this. I'm looking forward to seeing more musicals now. :)

Diabetic Diet

2011-07-23T08:10:00.000-07:00

At times I'm just totally sick of my job, or to be more exact, of my patients. Sitting in a district health clinic and taking charge of your community's primary care is taxing, especially when you deal with Malaysians. And it's extremely depressingly frustrating.

Out of a hundred diabetic patients that I see, only 10 has a satisfactory glycaemic control. Out of the ninety poorly controlled diabetic patients that I verbally assaulted, only half takes their medication properly whilst the rest can't even tell me how many tablets they take a day. Out of the poorly controlled diabetic patients who are non-compliant to their medications, a quarter of them are still in self-denial that their diabetes is treatable and CURABLE. Sigh. I wish I could just rest my case and let them die miserably. Too bad diabetes is a slow dying process.

Me: Makcik punya gula kawal tak cantik la. Semua dua digit sahaja. Ada makan ubat tak?

Makcik: Ada, saya makan tiap-tiap hari.

Me: Makcik makan ubat mana? Pagi berapa biji, petang berapa biji?

Makcik: Errr.. (trying to confabulate) Pagi makan dua tiga biji.

Me: Dua atau tiga?

Makcik: Tak ingatlah saya.

Me: Itu ubat makan hari-hari takkan tak ingat?

Makcik: (trying to act cute) Hehehe... tak ingat.

Me: Gula hari ini tinggi pula. Semalam makan apa?

Makcik: O... semalam ada pesta durian.

Me: Saya kan dah cakap makcik tak boleh makan durian.

Makcik: Orang kasi takkan I tak makan?

Me: Orang kasi racun you makan tak?

Makcik: (another futile attempt to act cute) Hehehe..

Me: Saya nak mengamuk ni. Dahlah orang bagi nasihat tak nak dengar. Makcik kan tau hari ini nak jumpa saya check gula, tak boleh ke kawal makan sekurang-kurangnya malam semalam? Susah sangat ke bagi saya gembira sikit?
Makcik: Hehehe.. sorry doktor.
Me: Apa guna sorry sorry. Bukannya badan saya yang sakit. Makcik dah spoil mood saya hari ini dah.

I'm just pissed off. Totally.

Kancil and Lori

2011-07-06T20:54:00.000-07:00

I have been basically doing nothing for the past 1 month, except for treating simple ailments and swatting flies in my clinic. Sigh. And I was trained in HKP for 6 months as medical MOs, just to treat fever and cold, and disgruntled housewives who need attention.

Basically I go to work at 8 plus and leave around 4.55pm since my punch card machine is still stuck in PKD under repair. I usually take my lunch around 12.30 (it's getting earlier day by day) and get my afternoon nap from 1.30 till 3.00 unless I get disturbed for patients who somehow needs to see me. And if I get insomnic, I'll just wander around my clinic aimlessly till it's almost 5.

Anyway, I've been making up lots of new stories to illustrate bout my patient's condition, so as to make them understand bout their own illness.

Me: Makcik, you punya sendi sudah rosak lo.
Makcik: Kenapa ya?
Me: Macam-lah kereta dah tua, spare part sudah rosak lo.
Makcik: Saya tak tua sangat pun. Kenapa sendi saya sakit teruk?
Me: Sebab gris dalam sendi tu sudah kering.
Makcik: Sendi pun ada gris ke?
Me: Ada.. gris spesial.
Makcik: Habis tu kena buat macam mana?
Me: Ada beberapa pilihan. Saya boleh kasi ubat tahan sakit, dan makcik kurangkan berat badan dulu lepas tu kita tengok macam mana. Atau makcik nak jumpa pakar buat operation tukar sendi.
Makcik: Saya ada exercise hari-hari. Saya jogging 1 batu sekitar kampung.
Me: Makcik... kalau jogging tu sendi akan jadi lebih sakit.
Makcik: Kan doktor suruh exercise.
Me: Ya-lah. Tapi makcik ni saiz besar macam lori, tayar kecik Kancil tu mana boleh tahan. Patutlah rosak cepat.
Makcik: -.-" Doktor ni teruk-lah.

Fresh Stillbirth

2011-06-27T06:42:00.000-07:00

Everytime I start work after a long break, I know there will always be something eventful awaiting for me. And today was not exceptional.

While, like usual, as I was busy managing my ~~Empires and Allies~~ clinic, my nurse called for me saying there was a patient who came in complaining of lower abdominal pain and some funny sensation of things coming out from her vagina. Reluctantly I had to leave my serious business and attend to the patient.

So, there was this obese lady lying on the bed, groaning in pain, while my nurses stood around her awaiting further instructions from me.

Me: Puan, kenapa ni?

Patient: Saya perut sakit sudah 1 hari... Sekarang rasa macam ada benda nak keluar dari bawah.

Me: Hmm... Ya ke? Berapa lama tak datang kotor?

Patient: 2 bulan lebih.

Me: Betul ke? (Presses tummy) Perut sakit kuat ke?

Patient: Tak kuat sangat... tapi macam rasa ada benda nak keluar daripada bawah.

Me: (turn around to my nurses) Staff Nurse tolong sediakan trolley ngan VE set. Nak buat speculum dan vaginal examination.

Well, after 5 minutes of buzzing around in the clinic like headless chickens, my nurses managed to get me what I wanted. And when the nurses stripped the patient's pants off, the imminent sight just confirmed what I suspected. There were blood stains all over this perineum and inner thighs.

Me: (turning towards the nurses) Pergi ambik itu Doppler dan check fetal heart rate. Tolak US scan mesin ke sini juga.

Nurses 1, 2 and 3: Aye. (Screeching away efficiently)

Me: (turning towards the patient) Cakap betul-betul. Berapa bulan dah tak datang kotor? Ini bukan 2 bulan. Saya rasa sekurang-kurangnya 4 bulan. You ada tak cuba nak gugurkan anak?

Patient: (Still in shock) Doktor saya betul-betul tak tau saya mengandung.

Me: Ok tak apa. Dapatke fetal heart?

Nurse 1: Takde lah boss.

Nurse 2: US machine dah sedia boss.

Me: (Holding the US probe and scans up and down): I nampak baby tapi jantung baby macam tak ada. Tak apa, kita buat VE sekarang.

As I gloved up my hands and start digging, I felt something... soft... and bulging... And I summoned my midwife nurse.

Me: I rasa os dia dah full... dan rasa benda... macam kepala macam membran... dah lama tak buat benda ni dah...

Nurse 3: Tak apa... saya check... (And she stuck her gloved up fingers in) Betul-lah, itu membrane!

Me: Ok. Prepare transport patient ke Hospital Kuala Pilah. Set line bagi IV drip.

So as I was busy discussing the case outside the room with Hospital Kuala Pilah's O&G team, I heard a commotion from the room itself.

Nurse 1: Doktor, cepat!

Me: (gasping in my heart) Ok... Apa jadi?

Nurse 1: Doktor mari tengok!

And the entire gestational sac splurted out onto the bed, with no fetal signs of life. It was a fresh stillbirth.

Me: Puan, baby dah keluar tapi tak dapat diselamatkan dah...

(And she burst into tears and wept)

Me: Staff nurse... treat as post delivery... dan hantar ke Kuala Pilah once ambulans dah sampai.

Nurses 1, 2 and 3: Ok Boss. Doktor ni jonah lah... setiap kali mula kerja mesti ada kes pelik.

Me: -.-"

I guess I had better start visiting door-to-door to check for any unbooked pregnancies then.

The Sound of Music

2011-06-27T01:21:00.000-07:00

Finally I get to catch (more than) a glimpse of the acclaimed The Sound of Music! And damn, it was just terrifically breathtaking! Awesome!

I presume many of us have been exposed to the movie version of The Sound of Music, which starred Julie Andews and Christopher Plummet, and definitely the high-ly contagious songs such as "The Sound of Music", "Do-re-mi", "Eldeiwess", and "My Favourite Things". For me especially, I grew up with the constant brain-bashing of The Sound of Music; numerous times have I watched the movie on tv/VCR, listened to the songs from my sister's piano and not to forget the airwaves, and in school where the teachers are obsessed with "Do-re-mi". Hence, I could say it's the only musical that I'm totally familiar with.

Anyway, finally I satisfied my lust for The Sound of Music on last Thursday in KL Convention Center with Jessica and ChingYing. The hall itself wasn't that big, contrary to my belief, but still at our RM293 seats, I still can't clearly see the casts' faces. Maybe we should have got the RM393 seats instead? LOL.

The backdrop was nice, but the staircase was a bit annoying with the casts running up and down numerous times. I almost held my breath watching Gretl climbing up and down the stairs, just in case she falls and break her neck or something. There were a few different scenes, compared to the movie version, especially the part where they sang "My Favourite Things" and "The Lonely Goatherd", and not to forget a few extra songs, which was splended nonetheless. Then again, the 15 yo Frederick was just as tall as 11 yo Kurt; maybe he's having some underlying nutritional deficits perhaps?

Anyway, it was simply wonderful :)

Magical Musicals, on the otherhand, was a total disappointment. Overpriced and overrated too. Mentioning about it will just make my day gloomy. Sigh.

Glycaemic Control Reality Show

2011-06-20T21:54:00.000-07:00

3 months in KK doing mundane work day after day has made me even more cuckoos that I was ever before, especially when I have been reviewing deranged fasting sugar profiles and cholesterol again and again. Hardly once in a week I get to see a fabulous, not even to say satisfactory, blood sugar control. Sigh.

Hence, to keep myself from getting bored I have to come up with new blackmails and death threats to continue terrorizing these folks into controlling their sugar, as well as keeping me and my staff well entertained.

Me: Makcik, kawalan gula makcik ni dahysat tau.

Makcik: Ya ke?

Me: Sejak makcik kena kencing manis 3 tahun dulu sampai sekarang, gula tak pernah dikawal. Semua dua digit lebih sepuluh.

Makcik: (giggling) Ya ke?

Me: Saya rasa makcik ni juara gula paling tinggi kat Palong, tiada orang dapat lawan gula makcik. Kalau nak bagi anugerah, mesti makcik menang tanpa saingan.

Makcik: Takde lah sampai macam tu.

Me: Tak tipu tau makcik. Saya rasa kita kena start program baru macam Akademi Fantasi tu. Kita buat satu pertandingan siapa punya gula paling tinggi. Lepas tu kita minta semua warga Palong 9, 10 dan 11 undi sms. Siapa yang menang akan dapat cucuk insulin seumur hidup.

Makcik: -.-" Doktor ni mengarut-lah.

Me: Apa nak buat? Saya dah nak gila hari-hari tengok kau orang tak kawal gula. Dulu kata takde doktor jaga nak minta doktor, sekarang dah ada doktor pun tak dengar nasihat doktor. Macam ni lebih baik tak payah tengok doktor, tengok pawang lah.

Entertaining oneself is really difficult.

CT Scan

2011-06-16T05:52:00.000-07:00

Today was a remarkably busy day for me, as all of my MAs were not in the clinic. One was on leave while the other was in some funny pointless course. Anyway, since I have to take over their duties and see every single ~~fuckin'~~ case, so obviously I had to be busy today.

Amazingly, the number of patients I saw today was like the total number of patients I usually see in a week's time. What's more? Most of these patients are complicated ones, with unresolved unsettled problems that I feel obliged to untangle, which inevitably resulted in me taking such a long time to see them. And as expected, every single patient that walked into my room got an awful lot of scolding from me, aside from their deserved treatment.

So, one of this old Malay uncle walked in to my room.

Me: Pakcik, selamat pagi. Kenapa datang klinik hari ini ke?

Pakcik: Saya nak buat scan-lah, doktor.

Me: Oh.. kenapa pakcik nak scan? Mana tak sihat?

Pakcik: Saya rasa okay, tapi saje nak buat scan.

Me: Tak boleh macam tu-lah, pakcik takde tempat tak sihat, macam mana saya tau nak scan mana?

Pakcik: Saya nak scan seluruh badan.

Me: (starts losing patience) Pakcik takde masalah apa-apa sekarang pun, kenapa pula nak scan seluruh badan?

Pakcik: Sayan nak scan seluruh badan nak tau mana tak sihat?

Me: Klinik kecik saya ni takde mesin scan.

Pakcik: Hantar saya pergi Seremban buat scan-lah.

Me: Pakcik tau ke scan tu untuk kes kecemasan atau kes yang perlu saje.

Pakcik: Tak ape. Hantar saya buat scan saje.

Me: Pakcik mesin scan itu sekali scan kerajaan terpaksa guna beribu-ribu ringgit tau? Kau nak scan dari kepala sampai otak tu kena pakai sepuluh ribu. Kau keluarkan 10 ribu ringgit I hantar kau pigi hospital privet scan.

Pakcik: Tak ada duit.

Me: Kalau tak ada duit, jangan mengada-ada macam orang kaya pula. Pakcik ada kencing manis kan? Mari I tengok gula you hari ini berapa.

So, my nurse came in and took his random blood sugar, and unsurprisingly, it came back as 14.1.

Me: Makan ubat tak hari ini?

Pakcik: Lupa-lah. Saya rasa gula tinggi sebab saya minum teh-o manis pagi tadi.

Me: -.-" Dah tau sendiri ada kencing manis, ubat tak makan, minum air manis lagi. Lepas tu gatal nak scan seluruh badan buat ape? Bazir masa saya, bazir ubat klinik, bazir wang kerajaan.

Pakcik: Hehehehe...

Some patients just deliberately want to be scolded.

Cardiovert, or not to cardiovert?

2011-06-09T12:44:00.000-07:00

My KK life is pretty mundane and monotonous; work starts at 8am, ends at 5pm, and the cases I see are pretty much the same. Uncontrolled diabetes, uncontrolled hypertension, uncontrolled diabetes, uncontrolled hypertension, uncontrolled diabetes, uncontrolled hypertension, etc.

I remember once when I was in Kuala Pilah when I had a unstable SVT in my ward. Thanks to one of my ex-colleague who happened to be in Kuala Pilah A&E then, I have a undiagnosed unstable SVT patient whom was admitted without an ECG being done. And my HO had to inform me about it at 4.30pm, when I was already well-braced to leave the hospital.

It was some 60 yo Malay guy who came in for some funny complaint, was admitted by HKP's great A&E for some funny diagnosis, and was seen by my diligent house officer. So, since his ECG showed AF and his BP was somehow, not that great, my HO informed me and dragged me into the scene.

Well, standard procedures state that any unstable arrhythmias warrant emergency cardioversion, and so I had to counsel this so called pakcik before he drops dead and we end up with even more work to do resuscitating him.

Me: Pakcik. Kita dah check jantung pakcik tadi, nampak tak berapa cantik la. Wayar pakcik macam rosak sikit, so kita nak betulkan dia.
Pakcik: Apa doktor nak buat?
Me: Kita nak kasi current sikit betulkan jantung.
Pakcik: Saya nak bincang dengan isteri saya dulu.

So, I turned my head around and counselled his wife, who was standing beside him.

Me: Makcik. Kita dah check jantung pakcik tadi, nampak tak berapa cantik la. Wayar pakcik macam rosak sikit, so kita nak betulkan dia.

Makcik: Apa doktor nak buat?

Me: Kita nak kasi current sikit betulkan jantung.

Makcik: Saya nak bincang dengan anak saya dulu. Dia nak sampai dah.

Me: Ok...

So, having waited for 5 minutes. I prompted both of them again.

Me: Makcik. Anak belum sampai lagi ke?

Makcik: Dia dah nak sampai. Tempat kerja dia dekat saje.

Me: Dia kerja dekat mana?

Makcik: Dekat Gemas. (On weekdays off-office hours it takes one 1 hour to drive from Gemas to Kuala Pilah)

Me: Jauhlah tu. Nak sampai sini perlu 30 minit, tambahan lagi sekarang masa lepas kerja, mesti sesak jalan. Keadaan pakcik ni tenat, kena buat cepat-cepat.

Makcik: Macam ini doktor talipon anak saya bincang dengan dia-lah.

Me: Ok.

So, after the pakcik and the makcik, it was his son's turn to be counselled.

Me: Encik. Saya doktor yang merawat ayah encik ni. Kita dah check jantung pakcik tadi, nampak tak berapa cantik la. Wayar pakcik macam rosak sikit, so kita nak betulkan dia.

Son: Apa doktor nak buat?

Me: Kita nak kasi current sikit betulkan jantung.

Son: Boleh tunggu sampai saya datang ke.

Me: Ini kecemasan ni. Kalau tak betulkan jantung, pakcik boleh tiba-tiba pengsan dan jadi sangat tenat.

Son: Tak apa, kita boleh tunggu.

Me: Kalau tiba-tiba pakcik berhenti nafas macam mana?

Son: Itu dugaan Tuhan.

Me: (frustrated) #%$#^&%*#$%$^&^%! Suka hati encik-lah.

As I slammed the phone and started to arrange for this patient's transfer to the CCU ward, this pakcik waved at me.

Me: Kenapa pakcik?

Pakcik: Saya lapar-lah doktor.

Me: Pakcik kena puasa dulu. Nanti kalau anak sudah datang, kita nak buat prosedur bagi current tu.

Pakcik: Saya nak makan juga.

Me: Pakcik kena sabar sikit-lah. Kalau pakcik makan, bila kasi current pakcik mungkin termuntah dan makanan tu masuk paru-paru.

Pakcik: Macam ini matilah saya.

Me: Kenapa pula?

Pakcik: Mati kelaparan. Sekarang pukul 5 lebih dah. Tadi saya tak makan tengah hari lagi.

Me: (spits fire) #%^&*&&^%^%@$@#$! Pakcik kau ni gila ke?Kalau tak kasi current jantung kau akan berhenti dan mati serta-merta. Awak langsung tak bimbang mati sebab jantung berhenti tapi takut pula mati kelaparan. Saya dah malas nak layan kau sekeluarga. Tak faham-faham ke ni keadaan kecemasan.

I stormed out of the ward without turning back. That was just too much to bear. Sometimes, some patients are just not worth your time and patience.

Witchdoctor, again...

2011-05-20T20:35:00.000-07:00

After a week of hiatus from work, it feels nice to be back at work again. Damn. Have I become a workoholic or what? Or I just have a mundane life that working actually kills my boredom?

So, back to work with the endless cavalcade of antenatal scans and petty URTI/AGEs to deal with. I think I really need some excitement in life; some adrenaline rush should be good, but still I savour the idea of being able to have afternoon naps in my clinic.

Anyway, so I encountered another "witchdoctor" thingee again in my clinic.

BabyMother: Doktor... anak saya ada bonjol dekat tempat bawah dia la..

Me: Oh.. sejak bila u perasan bonjol tu? Baby aktif? Minum susu bagus?

BabyMother: Dia ok saje, tapi bonjol tu saya pun tak ingat bila ada...

Me: Ok... nanti saya periksa jap.

So, as expected. It's a left congenital inguinal hernia, simple and unobstructed.

Me: Baby ada muntah susu tak? Berak bagus?

BabyMother: Oh.. takde muntah.. berak pun macam bagus saje.

Me: Mak.. nampaknya baby ada angin pasang la... Kalau takde muntah atau berak macam biasa saya tak risau sangat, tapi kena jumpa pakar bedah untuk terus follow-up la.

BabyMother: Serious ke doktor?

Me: Takut nanti usus dalam tu boleh terlekat dan tersekat.

BabyMother: O.... tak apa doktor. Saya nak cuba 'ubat kampung'.

Me: Oh? Ubat kampung? Ubat jenis apa tu?

BabyMother: Nak tanya bomoh dulu...

Me: Itu maciam... bagus juga. Tapi setakat ini saya tak pernah tengok ada orang rawat angin pasang dengan baca jampi ataupun minum air jampi la.

BabyMother: -.-" Ya ke...

Me: Mungkin bomoh tu pandai operate.. tapi pakai pisau cukur atau pisau untuk sembelih kambing punya kot?

BabyMother: Erm.. okla doktor. Saya pigi jumpa pakar bedah lah.

I hope the bomohs don't sue me for ripping off their source of income.

Cabaret

2011-05-15T08:17:00.000-07:00

Just gonna blog something which is unrelated to my mundane worklife. :)

I had been planning to be in town for the past few days and upon a friend's ~~insistence~~ persuasion, I've decided to watch Cabaret. Since I don't really love venturing to unknown places alone, I've asked my fellow pharmacist lady friend to tag along. At least I won't be bored to death if the show sucks.

For the past few days Pan Production's Cabaret has been staging in KLPAC (I've no idea that this place actually exist, but damn! the environment's classy) and albeit asking around my colleagues (who aren't really bothered bout musicals anyway) nobody seemed to know anything about it. The media barely speaks bout it so I figure that's the reason why.

Anyway, it was breathtaking. My first wonder semi-broadway experience.

We were greeted by lovely ushers dressed in silky fish-fin laces and sailor clothings (hmmm... I think they did pop up on the stage too) and the RM105 tickets that I had purchased landed me at the last row of the front section, and surprisingly this 988 FM dJ was seated next to mine.

Throughout the show the musical numbers were superb and innovatively choreographed. In my humble opinion, Stephanie Van Driesen's superb role as Sally Bowles were alluring but I think Peter Ong outshined everyone else with his versatility; somehow he kept everyone of us awake and yearning for more. Then again, if I were to vote for the best couple it'll go to the Zalina Lee and Alizakri Alias. Bernie Chan's slutty role was an eye-opener too. :) Too bad she din't sing.

The music was astounding, even thought it wasn't a big ensemble. Having heard Liza Minellli's movie version as well as Kristin Chenoweth's + Lea Michele's version, I was heartily anticipating Stephanie Van Driesen's version of "Maybe this time" and it was definitely not a disappointment!

During the intermission I took a direct approach and said a "hi" to the 988 FM dJ who was beside me, and erm, well, he gave me an expected response.

Me: Sorry, you're the 988 FM dJ right?

Him: Yes. Is there anything?

Me: Nar.. just to confirm.

Him: Ok.

And that was it. 3 hours of close proximity and only 4 lines of conversation. LOL.

Nevertheless, it was totally a wondrous experience for me. Definitely a recommendation to watch, but too bad tickets are sold out :) I guess I'll be dying to see more musicals in the future. The Sound of Music is playing next month and the tickets are farking expensive (sigh). West Side Story and Dreamgirls are on the way. Well, I'm always interested to find company to watch with me. :)

At least I've got something else to do instead of sulking in my KK.

Annoying phonecalls

2011-05-11T01:56:00.000-07:00

Just as I thought I could take a week off my stupid PKD starts irritating me with phonecalls. Pointless phonecalls that doesn't make sense at all.

Phonecall 1.

Ring-ring.
Me: Hello
Idiot1: Hi. Doktor, saya call dari pejabat ni. Nak tanya doktor terima faks tak?
Me: Faks apa?
Idiot1: Faks yang kita hantar semalam.
Me: Kan saya cuti minggu ini.
Idiot1: Oh... doktor cuti... So doktor tak tau lah?
Me: Saya tak baca faks tu macam mana say tau?
Idiot1: Ada kursus untuk doktor besok lah, bla-bla-bla.
Me: Ok. Saya cuti sampai akhir minggu ini. Saya akan suruh orang lain ganti saya.
Idiot1: Ok doktor.

After 30 minutes. Ring-ring.
Me: Hello again. (sounds like Idiot1 but can't be sure)
Idiot2: Doktor, saya talipon dari pejabat ni.
Me: Ok, apa pula?
Idiot2: Doktor tau tak doktor kena attend program kesihatan yang dianjurkan PM pada 21 Mei ini. Saya dah fakskan semalam.
Me: Kan saya cuti minggu ini, saya tak terima faks dan tak tau apa-apa. 1 minggu lagi kan? Ada apa-apa urgent ke?
Idiot2: Oh, doktor cuti minggu ini. Oh tak apa-apa. Saje nak tanya doktor terima tak faks.
Me: #$@#%@^.... Ok, bila I balik klinik I akan check. Terima kasih.

After 30 minutes again. Ring-ring.
Me: Hello.
Idiot3: Doktor I call dari pejabat.
Me: Ya, kenapa pula?
Idiot3: Erm, ini doktor siapa?
Me: You tak tau I siapa kenapa you dial nombor I?
Idiot3: Oh sorry sorry.
Me: *&^%$##%^&*!

I wonder if they use their brain to work.

Teenage Pregnancy

2011-05-03T05:24:00.000-07:00

Today was another eventful day in my KK; one of my MAs are on leave, leaving me and another MA managing my KK. And jeepers, I think it's the long Labor's Day weekend, which is the main reason why my KK is unusually full today.

Anyway, I saw this 24 year old girl who came to clinic because both her ankles have been swollen for 2 weeks.

Me: 2 minggu dah bengkak ke? Ada muntah, cirit, batuk, demam, sesak nafas, atau sakit dada tak? ( I uttered everything in one breath, my usual script)
Patient: Takde. Kaki bengkak saje.
Me: Ok. Kita check kencing-la. (scribbles scribbles on a lab form for Urine FEME)

After 15 minutes...

Me: Kencing you kotor-lah. Ada tak rasa selalu nak kencing ke atau sakit perut ke?
Patient: Takde.
Me: (Press press belly) Perut macam ada benda-lah.
Patient: (In denial) Macam biasa saje.
Me: You kotor last kali bila ar?
Patient: Dah lama... 1 bulan lebih.
Me: Oh... apa tarikh hari pertama kotor awak?
Patient: Erm.. tak ingat.
Me: Takkan 1 bulan dulu pun tak ingat.
Patient: (blushes) Erm... dah lama lah kotor tak mari.
Me: 1 bulan tu tak lama pun.
Patient: Sebenarnya 3 bulan tak datang dah.
Me: Apa!?!? Baring atas katil, saya nak scan. (Turns around and ask the nurse) Tadi kencing tu ada lagi tak? Nak buat UPT ni.
Nurse: Dah habis tuang dah.
Me: -.-"

So as the US probe glides through her belly, clearly the shape of a 3 month old fetus with a beating heart takes place in the screen.

Me: Cakap betul-betul. You tau tak you dah pregnant?
Patient: Erm.. Ya... dah tahu.
Me: Kenapa you tak cakap you pregnant? Dah kahwin belum?
Patient: Dah bertunang.
Me: Lepas tu? You ingat saya tak akan tau ke you dah pregnant?
Patient: (Tries to pull an innocent angelic smile) Hehe... saya ingat doktor tak akan tau.
Me: Jangan cuba tipu saya. Saya ni Pakar Pengesan Penipu!

Everybody lies. I know.

Witchdoctor

2011-04-28T05:24:00.000-07:00

It is often an annoyance that your patients requested to be discharged so they can go back home and see their local bomohs for their medication, especially those that came in dying and you've worked your asses hard so they would survive. If they had trusted the bomohs in the first place, why wouldn't they have brought themselves to see him while they were dying then?

I remembered during my varsity days my Psychiatry lecturer used to say how he thinks bomohs can help play a role in helping a patient. His patient actually told him that the bomohs claimed its not a spiritual problem, but more of a psychiatric disorder and hence advised him to see a psychiatrist instead. Well, if there were more of these bomohs I guess our jobs would be much more easier!

On the other hand, I don't mind asking patients to see bomohs if they refuse my management, since it would make my life even better. I don't have to scratch my head to ensure their compliance or throw death threats and blackmail them into adherence.

Me: Makcik, gula memang tak terkawal-lah. Ubat semua makan tak?

Patient: Makan hari-hari lagi. (answers confidently)

Me: Saya rasa makcik kena start injek dah.

Patient:Tak payah-lah. Makcik sekarang okay lagi.

Me: Sekarang okay tak bermaksud besok akan okay lagi. Takkan nak tunggu sampai koma dalam hospital baru nak start injek.

Patient: Tak apa doktor.

Me: Macam tu makcik pergi jumpa bomoh sajalah. Saya nak rawat makcik tapi makcik tak nak. Mungkin bomoh tu lagi bagus, jampi sikit sikit kencing manis makcik boleh jadi baik. Senang lagi kerja saya.

Patient: Doktor janganlah merajuk...

Hmm.. The witchdoctor thingee reminds me of another conversation with Uma.

Me: Arrrghh.. so pissed off.

Uma: Why-lah Kang?

Me: Some patient la. Came in such a bad shape and we susah-susah resus-ed him and now after he's better he wants to AOR to see bomoh.

Uma: Hmm.. Is it? Which bomoh he wants to see?

Me: Not sure. Why? You're well liaised with bomohs one izzit?

Uma: No-lah.. but all the Bomohs in Kuala Pilah are under my psy clinic follow-up.

Me: @#$%(%^&%^$#^$#&#*!

Rocket High HbA1c

2011-04-19T18:50:00.000-07:00

3 weeks in KK has made me dumb, I suppose, and at times I wondered to what extent I can do here. And I forgot the fact that I can actually insert CBD here!

The patients I see here are basically the same; pregnant mothers, children with cough and cold, adults with cough and cold and the sort, uncontrolled hypertension, uncontrolled diabetes, and the rest you name it. Only once in a blue moon I'll have my hands on some acute medical emergencies, for instance the septic shock I had yesterday.

Still, I've never seen a HbA1c of 15.6% in my life, with a FBS of 24 and 2HPP of 35! I wonder if it's even compatible with life! And for this same patient, his total cholestesterol level is more than 10mmol/L!

Me: Pakcik tahu tak kawalan pakcik ni amat teruk? Dahsyat sekali!

Patient: (acts innocently) Ya ke?

Me: Pakcik jawab jujur. Pakcik makan ubat tak?

Patient: Makan hari -hari (confidently). Teruk ke keputusan darah saya?

Me: Pakcik, biar saya berterus-terang. Saya amat hairan kenapa pakcik tidak koma lagi. Pakcik tau tak kandungan gula pakcik ni 3 kali ganda orang biasa? Mujurlah otak tak bengkak tak koma lagi.

Patient: (turns pale) Betulke?

Me: Pakcik saya kena adjust semua ubat Pakcik la. Kalau tak okay lagi, kena tukur injection dah bulan depan.

Pakcik: Saya janji doktor. Saya akan cuba.

Me: Pakcik, satu hal lagi. Sebab Pakcik giula dan kolesterol tinggi gila, Pakcik kena ada persediaan sikit.

Pakcik: Untuk apa?

Me: Pakcik bila-bila masa boleh mati kena serangan jantung atau koma kena strok.

Pakcik: (Face turns bloodless instantaneously) Ok doktor...

At times you just have to throw death threats to patients so they'll realize how bad their condition is. Sigh.

Endless Cavalcade of Meetings

2011-04-16T18:08:00.000-07:00

One of the downside of being the MO I/C in a KK is attending numerous pointless meetings. There are so many meetings to attend that I barely go to work more than 20 days in a month!

What's worst? During the meetings, all sorts of nonsense happen. The Medical Assistant Chief will be squabbling with the Nursing Matron on which has more teamwork, the MAs or the nurses. Things that can be discussed and accomplished in 30 minutes will be dragged till 2 hours just because the chairman has expressive dysphasia and difficulty in making a consensus.

Maybe I'm not an admin person after all :)

Resuscitation... in a KK setting

2011-04-09T07:08:00.000-07:00

And I thought life in my KK would be peaceful.

On my 3rd day of life as a MO in my humble KK, I had a collapsed patient brought in early morning while I was busy managing my ~~cityville~~ clinic.

JM: Doktor.. ada patient collapse...

Me: (rushing towards my mini ER) Ok... kita resus sekarang. Panggil semua staff.

JM: Ok...

E1V1M1. No pulse felt. Cold clammy skin. Gasping. This does not look good. I hopped onto the patient and started bouncing on his chest, while my paramedics rummaged through the emergency trolley for equipment.

Me: Kita ada cardiac monitor tak?

MA: Tak ade...

Me: Har? Macam mana nak tengok heart rhythm ni? Ada ECG machine tak? Pasang limb leads dan buat long lead II saje.

SN: Ok.

Me: Ambubag dia. Pasang SPO2 dan ambik BP dia.

SPO2 36%. Heart rate 178. BP 188/110. Still pulseless and not breathing. I could see one of my MAs struggling to get a intravenous access, while the other one ambubag-ging him, with no oxygen supply connected to the ambubag. -.-"

Me: Ambubag takde oksigen la. (connects the O2 supply to the ambubag) Baru reservoir bag dia kembang. SPO2 dia tak naik-lah. Intubate dia sekarang.

As the other MA hands me a laryngoscope....

Me: Erm. Ini peds punya blade la... I perlu blade untuk adult... Yang besar punye... ngan ETT size 7.5 atau 8 lah. Prepare IV atropine 3mg dan IV adrenaline 3mg. Hentam semua.

And the resuscitation continues... with a 2 minutely long lead II... and no cardiac monitor... And unfortunately the patient din't respond to resuscitation despite being intubated and whacked with inotropes.

Me: Oklah.. dah 40 minit... Pronounced death lah...

Staff: Ok doktor.

Me: You orang pernah resus patient kat sini tak?

Staff: Ini first time la doktor... biasanya patient bawa masuk sudah mati. Doktor jonah ke?

Me: -.-"

I think I seriously need to retrain my clinic staff.

STEMI without ECG ST changes? WTF?

2011-04-04T20:53:00.000-07:00

Like usual, I was doing first call where I received a phone call while driving my way back to the hospital after a 30 minute nap in my place. As expected, it was from my hospital's A&E.

A&E MO: Hi. I need to refer you a case... It's an inferior STEMI and I'm going to strep him soon.

Me: I'm almost there. I'll come and see the patient while you prepare to strep him.

(Apparently, in my hospital A&E has to refer every single goddamn case to MOs to double confirm -.-"

So, upon my arrival in A&E...

Me: Hmm... I don't see any ST changes in the ECGs. Why would you think it's a STEMI?

A&E MO: Here.. see this lead (pointing at lead II)

Me: Erm, it's just an artifact. The rest of the lead is normal. Plus, patient is so comfortable so I don't think it's a STEMI.

A&E MO: I did an echo of the heart. There's hypokinesia at the inferior MI.

Me: Obviously, since there is already Q waves in II, III and AVF. It's an old infarct.

A&E MO: No.. it's a STEMI.

Me: I'm not convinced. I don't think we should strep him.

A&E MO: I've spoken with my emergency physician (that infamous one). She asked me to just proceed.

Me: But there's no indication. It's not a STEMI!

A&E MO: (ignores).

Me: Wait. I'll have to call my specialist to stop your specialist then.

After 40 minutes of unnecessary waiting and multiple attempts of faxing the ECGs to his house, my specialist finally responded (or rather yelled). It was a normal ECG.

Me: My boss has spoken. It's not a STEMI. We're not doing anything, but since your boss is soooooooooooooooo adamant it's a STEMI, we'll just keep him our cardiac ward.

A&E MO: *blunted facies without a sign of remorse*

There is a reason why a STEMI is called ST-Elevation Myocardial Infarction, instead of a USHAMI (UltraSound Hypokinesia Area Myocardial Infarction). Hence, I strongly think that it is pointless to do funny funny things that you don't comprehend (i.e., echocardiography) when you can't even interpret basic ECG.

Palong, another new start?

2011-03-31T23:58:00.000-07:00

Having endured 6 months of serfdom in Hospital Kuala Pilah's medical department, I continued my journey here in KK Palong 9,10, which is around 70km from my previous hospital. Maybe much would not have known, but it was who I voluntarily chose to come over here instead of KK Gemencheh for numerous reasons. :)

Anyway, for starters, my KK is located almost 30km away from Bandar Sri Jempol and I'm a bit lucky that it's the nearest to Jempol compared to the other KK Palong-s. Moreover, it's also pretty small, and hence with a minimal patient load. My KK only has 2 MAs, 1 SNs, and a whole bunch of JMs with a MLT. So, there's nothing much I can do I suppose, besides referring cases off to KP and Jempol.

And so, here I am, sitting in my MO room, which is located in between Maternal Child Health Clinic and Outpatient Department, doing nothing but blogging. Maybe I really have time to study for my exams after all. :)

What's more? Najib's coming over to visit in 2 weeks.

Office Politics

2011-02-09T05:36:00.000-08:00

Time flies; it's already my 4th month as a MO and the responsibility that I bear sometimes is heavy. Being a MO in a small hospital does have its benefits - less patient loads and office politics - still, at times I tend to get suffocated.

When I first joined this hospital, my department happened to be a Gerakan party, with a fair share of bumis and non-bumis. As more and more of my non-bumis colleague get transfered to somewhere else, slowly my department has evolved into a UMNO party. Hence, somehow, the remaining bunch of us gradually gets demarginalized.

My boss's erratic temper has started to manifest and I am getting a fair amount of scolding nowadays. I do not really mind being yelled at for my own share of mistakes, but then, being reprimanded for other people's screw-ups is somehow a lil' bit difficult to digest. Being a medical MO somehow means you have to clean up people's shit, and occasionally getting banged on their behalf.

Somehow the other colleagues seem to undermine me resourcefulness; I may not know what is going on, but I know how to find out what is going on.

It's time for me to tread my path with caution. Look to the left, look to the right, then only should I trample across my path, for God knows when I'll end up being a roadkill. Being a big tree attracts the most violent winds, but being the lowliest shrubs gets you crushed by some big fat animal. Ironic.

My Daily Intern Routine

2010-09-25T18:54:00.000-07:00

Everyone thinks we lead an exciting life working in a hospital, with all the constant adrenaline punch, just like what you see in Emergency Room, and with all the dramas one see from Grey's Anatomy. Sadly, it is unbelievably very mundane and monotonous.

Here is a simple illustration of what I used to do everyday in the wards on weekdays if I'm not on call.

6.30 am - Having arrived into the ward, with my daily disgust of how crowded and stuffy it is.

6.35 am - Starts to do my own rounds, but compelled to spend 20 minutes looking high and low for the case notes and observation charts.

6.55 am - Manage to get hold of the case notes and the observation charts, starts to do rounds, occasionally interrupted to find X-rays / investigation results.

7.00 am - Rounds interrupted by staff nurses who are eternally obsessed with their passing over sessions till they would rather let a collapsed patient die than to delay their passing overs.

7.10 am - After a frustrating tug-of-war with the nurses, finally managed to get back the case notes to continue doing rounds, but then have to start finding the observation charst and X-rays, which somehow got misplaced again during the nurses' passing over.

7.20 am - Continue doing rounds.

8.00 am - MOs arrive and starts doing their rounds. Surprisingly, case notes and observation charts disappear after HOs do their rounds, and hence have to spend another 10 minutes looking for case notes, observation charts, X-rays and investigation results.

8.45 am - MOs finish their rounds and everyone waits for the specialist to do rounds.

9.10 am - Specialist rounds commences, and for the 4th time in the day, case notes and observations charts have to be relocated.

10.00 am - Specialist rounds end. HOs carry out MO/specialist orders, running up and down like headless chickens, taking bloods, ordering X-rays, refering cases, doing discharges, etc.

10.30 am - Clinic starts summoning HOs down to clinic, despite the fact that there are still loads of unfinished ward work.

10.35 am - Attends to hundred(s) of patients in the clinics with the other 10 fellow HOs, under the supervision of barely 2 MOs and 1 specialists.

12.30 pm - Depending on one's luck, clinic might by over by then, hence an hour of short rest and lunch, provided the wards do not call you for some stupid reasons.

2.00 pm - Back to the wards to deal with unfinished ward work and pm rounds. Fight with the nurses for case notes and observation charts during their passing over sessions ~~again~~.

2.30 pm - MO rounds commences followed by specialist rounds.

4.00 pm - Usually most of the work has been completed, unless you have unproductive colleagues who procrastinated in the ward when you were away, hence beseeching you for your assistance with their work.

4.55 pm - Sits in the counter and waits...

5.00 pm - So long suckers! (Walks out of the ward and waves at the miserable-looking patients)

Phase 2 of my life - Residency

2010-08-13T23:53:00.000-07:00

The end of internship, and with it, the beginning of my residency. Finally, I'm a fully registered licensed medical practitioner. It feels like you're being liberated from some form of slavery, and this intense feeling can be described like a drop of dew in a barren drought, as a ray of light in bleak darkness, or even as a flicker of flame in brackish coldness.

Like what Zarina had said ~~or rather quoted from Peter Parker's uncle~~, "With greater power comes greater responsibility." The power to heal, or kill, lies now in this pair of bare hands (and God's too). And as my internship gradually climbs to an end, I have started to feel this responsibility crushing my spine and my chest, as I start to make decisions that decides life, or death.

Having witnessed a few of my ex-colleagues turning into MOs one by one, I wonder what kind of MO I would end up as. I doubt I could shed off my innate traits that I had during a HO, and I can feel the bitchiness and cantankerousness seeping into my veins. Will I be a benign, or a malignant HO in the future? (Kindly refer to RcKs' Classification of MOs)

Working for 24 months also gave me ample opportunities to work with various MOs. Suck-ups. Dumb-asses. Sleazy-bags. Neurotics. Green-eyes. Fart-faces. Body odours. Some you would die to work for, and some you would try to avoid at all cost!

Some memorable quotes I had from my MOs. I can't remember much, but these are a few that I just cannot forget.

"Oh damn! We're forgotten the most important thing for on call tonight! What's for dinner?" - O&G

"You are just a HO! You know nothing. Don't touch or write anything or I'll whack your fingers!" - O&G

"Before you leave please make sure all the IV lines are working! The MO on call today doesn't know how to set one! - Medical

"If My mother comes for treatment later you all are going to kill her like how you kill that patient with your stupidity is it!" - Medical

"When I was a Houseman, I used to take care of the wards so well, from the first patient to the last patient in the back" - Orthopedics

"This is not a normal ECG! There are so many T inversions! Oh sorry... I read it upside down." - Orthopedics

"If you don't tuck in your shirt next time I'll write you a pink form" - Pediatrics

Anyway, the good thing bout being a MO now is that, you get to terrorize not only medical students now but house officers as well. :)

Internship

2010-08-10T07:36:00.000-07:00

It's amazing how time flies; I can still vividly remembered my first HO call in O and G - my virgin call. And now? I have finished all my HO calls and I will be starting my MO life in barely a few more days.

It was a "fourth" call in Obstetrics and Gynaecology department; you're basically a runner and the wards calls you for every single thing that goes wrong, i.e. contraction pain, per vaginal bleeding, fever, diarrhoea, headache, cough, etc. And basically you run around answering to the calls and make sure everyone survives through the night. You do vaginal examinations on mothers complaining of burst waterbag or increasing contraction pains and when the os is right you are to send the patient to the labour room for delivery. Moreover, the nurses call you if the newborns don't poo or pee, or if they vomit and stuffs like that.

And so I remembered. I was just a fresh graduate who is still learning, and my vaginal examination was not that accurate then. I have had my fair share of sending patients to the labour room even though their cervical os still is not suitable for delivery, and in turn I get mocked and screwed for that.

I was so terrified that I did not sleep that whole night, fearing that something might go wrong! I was worried that I might slept off and could not answer the ward calls should some mishap befall, and consequently result in some catastrophic incident and I would be one to be blamed. After all, you are blamed for everything, since you are just the house officer, and especially if you were a new officer.

Anyway, it was a rather uneventful night as nothing much happened that very night, except for a few inaccurate vaginal examinations. Still, it was a memorable night.

I survived my first house officer call!

And now, I endured all my house officer calls!

Tender Loving Care

2010-07-31T20:33:00.000-07:00

Everybody expects the moment they step into a clinic, they would see an amiable smiling doctor waiting on the table, radiating auras of love and compassion. True, I wished it happened to me to, and ideally it should be in that way.

But, if you had only pay RM1 to see a doctor, whom has already been entertaining 50 patients, complaining of only sore feet or itchy nose in late hours, please brace yourself for extreme manhandling and voracious sarcasm. And, trust me, by then, TLC has run out of stock.

Contrary to what other people believes, I do offer TLC to my patients, of whom I seriously think deserve so. If you had come in the middle of the night with idiotic demands, then I would be offering you my own home-made concoction of sarcasm and sardonism, which miraculously do cure some of these late night visitors!

True. One should not separate the body from the mind, and from the soul as well; if any one of these elements are not taken care of well, definitely one's general health would not fare. A healthy man is someone with a healthy mind, a healthy soul and of course a healthy body!

So where was I again. Oh, tender loving care. I recalled once I saw this old aunty who had came to see us for many a times with various complaints - knee pains, back pains, headaches, visual blurrings, etc., and no one could diagnose what was her problem and hence she was bombarded with analgesia and vitamins. Still, she comes back every 2-3 days, each with a different complaint.

Unfortunately for her, I was the doctor she had to see on that lovely sunny morning. I remembered her being wheeled in by her husband, both of which are septogenarians. So, this old aunty was miserably sitting on her wheelchair, coercing herself to put up a faint smile at me, and complaining about her sore foot.

As I delve into her history I could not find anything of significance - no history of fall/trauma/infection/inflammation, so I started delving into other subtle parts of her life. And the moment I asked bout her children, she sprung into tears like a leaked water tap, and that instantaneously set me up in my "Caring" mode. Obliged to console her, I handed her a tissue and patted her back gently, as I digged deeper into her problems.

Old Aunty: My kids abandoned me... They don't care about me anymore...

Me: Do you know where they are now?

Old Aunty: One is in Australia and the other is in US. They never call me anymore.

Me: Have you tried calling them instead Aunty?

Old Aunty: I don't want to disturb them... They are busy with their work. They never come back to see me anymore...

Me: But are they still financially supporting you and your husband now?

Old Aunty: Yah... they sent us lots of money... but I just want to see them and their kids...

Me: Aunty, you should have told them instead! Call and tell them that you miss them and I'm sure they would definitely come back and visit you..

Old Aunty: You sure? Maybe they are really busy with work...

Me: If you never tell, they'll never know. And if they can't come back to see you, why don't you go over and see them instead!

Old Aunty: Oh.. how come I never thought of that? Thanks doctor.

Me: Ok... So how's your foot now?

Old Aunty: It's better already.

Me: Hmmm... your back and your knees?

Old Aunty: It doesn't hurt now.

Me: -.-"

And I miraculously cured her sores without doing anything!

On second thoughts, I've been away from home for 7 years already... Mayb it's time to go home now?

Resuscitation

2010-07-03T23:54:00.000-07:00

Orthopaedics is quite a layback posting; you don't really get to see emergencies at all (unless you're pathetically jonah) and your servantile duties are only to make sure patients are fit for ops, and to become an object of insults of your egoistic surgeon-bosses. And since the day I finished my A&E posting, I have not done any actual resuscitation for a sick patient. *grins*

So, like any other day, after having got myself a decent excuse to escape clinic duty, I was loitering in the wards, when the nurses bugged me that a patient's blood pressure was a bit lowish and her dressings were soaked with blood. And so, I attended to that patient immediately, and obligedly.

And there she was, palely lying on her bed,

with blood oozing out, from her wounds so red.

Her pulses tachy, her BP starts to fade,

"Oh my!" I sighed, I guess lunch will have to wait.

As I started pumping crystalloids and colloids into her veins, I watched her as she dropped into drowsiness. Barely arousable, her complexion was as white as paper, and as cold as snow. I shooed my colleague off to run for bloods and an immediate full blood count, telling him to use his own judgement on how many units of blood he needed.

As the GCS dropped to 6/15, I knew I had to do the inevitable... Emergency intubation for airway protection

"Intubate patient!" I yelled, as the nurses answered to my summons and scurried around like a troop of worker ants (Only 3 nurses were working actually :X).

"Should we inform the MO first?" One nurses suggested.

"Ermm... just call-lah." I totally forgot about the. Either I was too carried away, or subconsciously I knew I did not need them.

"I want a size 7 ETT tube with a stylet in it and get me a laryngoscope that works mind you!" I pulled the patient upwards with his sheets and tossed his pillow aside. "Intubating now!"

I struggled to slide the laryngoscope and attempted a first-class view of her larynx but she writhed in a serpentine fashion and shut her mouth.

"She's fighting!" I screamed. "Pump her with IV Midazolam 5mg!"

My MO showed up as I smoothly jacked the laryngoscope into her throat.

"You needed help?" He asked as he stood behind me.

"Not really. I can see the larynx now. Just a little bit more." I replied as I slided the ETT tube in. "Voila, it's in! Secure the tube and bag her please!"

I gallantly removed my gloves, like how the fake doctors in the movies do, with a grin of satisfaction. Yeah, somehow the orgasmic pleasure of successfully resuscitating a collapsed patient came back to me after 3 months of barrenness.

"Oh lucky you were here." My MO grinned at me. "I don't think I know what to do."

"Erm, it's okay. I did A&E before." I could feel my ego swell up like a fully inflated balloon!

And as we pumped 4 pints of packed cells into her veins to boost up her 40 g/L haemoglobin, I knew she will probably be safe, for tonight at least.

Anyway, I think I'm going to do A&E after I finish my HO-ship. :)

VIPs and Fake VIPs

2010-05-01T20:06:00.000-07:00

I get very annoyed when people starts to exert pressure onto me with their status or their backstairs influence. I just despise them. Period.

"I'm Datin XYZ and I know your consultant Dr. ABC, so I demand this this this that that that bla bla bla..."

" Are you acquainted with Dr. MCD, he's this pengarah in this hospital and he's my mom's uncle's cousin's grandson's son-in-law?"

"I am your hospital Pengarah's neighbour so bla bla bla bla bla bla..."

This genre of people will come and make loads and loads of demands, and treat us like butlers, instead of doctors. And whenever they do not get what they want, they will start whining and complaining like spoilt children. So if you really do know them well, why don't you just make a direct phone call and ask them to come over to your fancy bungalows and entertain you there?

For that meager amount of hospital fees they pay, it is a bit unpractical to make demands as if they are warded in a five-star superhotel. Well, maybe its time we remind them that there are private hospitals around to entertain their wishes?.

Here's another encounter I had with another pain in the arse.

Some 16 year old kid got admitted into A&E for a fracture over his right femur and so while we were waiting for his X-Rays, some idiot barged into the Yellow Zone and asked for me.

Idiot: Hi. I am Mr. Capatti. This kid is my neighbour and I happen to

Me: So. There's no Dr. KFC Singh here in this department. Maybe you should find him somewhere else.

Idiot: He is an orthopaedic specialist in this hospital actually. I've called him already and he said he will be here shortly.

Me: I have never heard of any Dr. KFC Singh in orthopaedics before. Anyway, if he's here I don't mind talking to him.

Idiot: So, can you see my neighbour first?

Me: I have already attended to him and we're waiting for his X-rays. Could you please wait outside as I have other patients to see to, and you won't be doing much help standing here.

After 10 minutes, this so-called Dr. KFC Singh appeared and he was not even a surgeon at all. Having informed him about this case and as expected he asked us to inform him when the X-rays were done.

After 20 more minutes, the X-rays came back together with the idiot.

Idiot: Have you reviewed the X-rays yet, doctor? Can you please call Dr. KFC Singh to tell him that the x-rays are back?

Me: (pissed off) Am I the doctor here or are you the doctor here? I know what I should do and you don't have to keep on giving me instructions. Please wait outside or I'll have someone escort you out!

And he's not even a Datuk or a Tan Sri!

RcKs's Classification of MOs

2010-04-10T19:41:00.000-07:00

Having worked in HTJS for almost 18 months, I had the opportunity to work with most of the MOs in the hospital, from different departments and I just have to say that working with them is more of an art. It is just tactful and requires different strategies tailored individually.

Yet, to make things easier, MOs generally can be classified and we shall emply the RcKs MOs Classification today, which divides these MOs according to their ability and aptitude.

(I) Abilities
Impressive

Aspiring MOs are a rare species in the hospital and you do not get to see them much often. Very knowlegeable and very seasoned, these MOs are safe to work with and most of the time you will be awed by their knowledge/skills. Like they say, a superb teacher inspires you, a good teacher guides you, and a lousy teacher spoonfeeds you. It is just dashing to work with them, albeit them being outnumbered by the Idiotic species.

Idiotic

Doctors who basically know nothing, but happened to be your MOs because they graduated years earlier than you. At times you wonder how these folks can survive in a hospital when they barely know anything! Either they were lucky enough not to screw up at all, or they were too lazy to screw anything up at all. Frequently, this group of MOs enjoy boasting on how fantastic they were while during HOs, but God (and everyone else) knows the contrary. Anyway, these group of doctors can be spotted loitering in the pantry and yapping their time away while enslaved houseman have to do most of their errands.

(I) Aptitude

Benign

These group of MOs are the best to work with! They practically never yells or screams at you, nor do they backstab you. So far the numbers of these MOs are severely limited, until some would even label them as "endangered". Often exhibiting compassion and amiable qualities, they will make your job easier with their presence, constantly teaching and encouraging you so as to perform better. It is high advisable to treasure these group of MOs, so as they will not somehow mutate and exhibit malignant features.

Malignant

The omnipresences of these genre of MOs are astonishing. Only God knows why they are outnumbering the other group of MOs, probably it's one of the sign indicating that apocalypse itself is imminent. Anyhow, these group of MOs will yell, shout, scream, shriek, howl and wail whenever they feel like to, even though at times it's not even your fault. And whenever things go wrong, they'll be the first to point their finger at you. Hence, it is highly advisable to be extra cautious in their presence, avoid all unneccesary contacts and elude yourself from them!

Indeterminant

It's kind of difficult to actually pinpoint the exact nature of these group of MOs, as they share both benign and malignant features. At times they may demonstrate benign properties, yet one cannot predict when their malignant element will manifest. Depending on your luck, any encounter with this group of MO will either result in a pleasurable day, or a hell-of-a-life torment.

Ok. So which type of MO do you want to be?

Poisoning

2010-04-09T07:01:00.000-07:00

Today's post would be a little bit incendiary as there are some elements of racism. Basically, when we talk about poisoning in Seremban, the first thing that pops into our vivid imagination would be - Indians.

Sad, but true. 4 months in A&E and 8 out of 10 poisonings are Indians, and no one can deny about it! Indians drink basically everything they can reach - Insecticides, herbicides, bleach, antiseptics, Paracetamol, kerosene, petrol, rat poison, and etc.. Malays and Chinese, on the other hand, appear to be a little bit more fastidious, in which they would settle for poisons a bit more poshy, for instance, expensive over-the-counter drugs.

And the reason for their futile parasuicidal attempts would be simple. Fighting with husband, fighting with wife, fighting with in-laws, fighting with neighbours, fighting with friends, fighting with their children, and fighting with ahlongs. Most of them do not really want to die, but expect extra attention from paramedics and doctors, who of course rarely shed an empathetic tear on them. Well, if they really wanted to die, might as well just let them feel like what it is like at the brink of death.

I remembered lavaging a few patients who came in for alleged poisoning. You see, when someone tries to kill him or herself but yet presented to us within 1-2 hours after ingesting some form of poison, we are obliged to perform gastric lavage unless contraindicated. Hence, whenever the opportunity presents itself, we are certainly delightful to do so. Personally for me, the entire idea of lavaging is to create so much misery and agony that one would think twice to poison oneself again. To have a tube plumbed into your stomach, followed by deliberate acts to force liters of fluid into your guts is not something pleasurable, or bearable, I would say. Nonetheless, it is somehow life-saving, and to save your lives, we ~~are fuckin' glad to do it~~ just have to do it.

On one occasion, there was this 18 years old Indian girl who was shoved into Red Zone for alleged poisoning. She came to the triage counter, unresponsive and in excruciating pain, with foam around her mouth. Then my colleague started yelling, "Poisoning", and all of us prepared to lavage her. As we forced the tube down to her, she struggled and yet say nothing. More colleagues came to us and started restraining her while we attempted to lavage her. Eventually, we managed to stick the whole tube into her and at the exact moment she vomited. Chunks and chunks of undigested food came out instantaneously.

And we just stared blankly at each other, and later at the colleague who cried "Poisoning!"

"The parents said they found her unconscious with her mouth foaming. I tried to wake her up but she was drowsy." Gopi explained. "So I thought it was poisoning."

We turned and looked at the girl coughing away as she rubbed off the chunks of vomitus from her face.

"Well, she's not drowsy anymore after we lavaged her." I chuckled. "And that awful amount of food she ate!"

You can't really blame us on that. Any young Indian girl who is unconscious or drowsy is always alleged poisoning until proven otherwise.

The mother walked in, and suddenly felt like telling us what was actually wrong. Apparently her daughter, who as allergic to crab meat, accidentally swallowed some crab meat while having lunch and started having itchiness. And like any other Indians, she chose to present herself as dramatic as possible just to get the maximum attention that she desired. Furthermore, the mother who was enjoying the scene of her daugher being treated with the utmost priority, just let us did so.

Fantastic. Crazy mother-daughter combination. More like a Munchausen Syndrome and Munchausen Syndrome by-proxy combo.

Anyway, having experienced first-hand our efficient management on poisoning, I bet she regretted ever being such a drama queen!

Late night outpatients

2010-04-06T06:42:00.000-07:00

Somehow Seremban folks enjoy going to the hospital whenever they cannot sleep. Intriguing, yet I am perplexed with their fascination of late night visits to the hospital. I would not mind waking up in the middle of the night to see patients with appropriate complaints, but at times you just get fucking annoyed with some of them. Hence, as the night dies off so is my patience.

x-- 2.30 am. --x
Me: Yes, what is your problem?
Patient A: I have been suffering from this heartburn problem for years and I realized that when I stopped smoking the heartburn goes away. Hence I stopped smoking for 3 weeks already.
Me: Erm. So? What's the problem tonight?
Patient A: Just now I smoked a cigarette and the heartburn comes back.
Me: Then? Don't smoke-la!
x-- 3.30am --x
Me: Yes, what is your problem.
Patient B: My tooth hurts.
Me: Hmmm. There's nothing much I can do about it. There's no dental services in the middle of the night, so I'll just write you a referral letter to see a dentist early in the morning.
Patient B: But I can't stand the pain anymore.
Me: How long has the toothache been?
Patient B: 2 weeks. I've been taking Panadol for the pain.
Me: What? For 2 weeks you can endure that agony and right now you can't wait for another 5 hours? No dentist is going to wake up in the middle of the night just to get rid of your tooth. Why don't you extract it yourself with a pair of pliers then?

x-- 4.00 am --x
Me: Yes, what is your problem.
Patient C: I have this pain at my head.
Me: Ok. Show me where it is.
Patient C: (pointing at this huge acne on his forehead) Here. It started with this acne.
Me: (%$^%#&$%^!) So, you came in such late hours because your pimple hurts.
Patient C: Yes, it hurts so bad that it's making me dizzy.
Me: So you are really sure that your pimple is the cause.
Patient C: Affirmative.
Me: Then just poke the stupid thing-la. You want me to poke your pimple is it?

x-- 5.30 am --x
Me: So what is your problem.
Patient D's Dad: I think my son broke his arm. He jumped off from his bed while playing and since then he has been complaining of pain over his left shoulder.
Me: Ok. So what time did it happen?
Patient D's Dad: At 4 am.
Me: And why is your son playing at 4 am when most kids are supposed to be sleeping?
Patient D's Dad: Errr...
Me: So it's your negligence that your son injured his elbow then. I hope you feel bad about this.
Patient D's Dad: Errr...
Me: Ok. Go get an X ray and come back here later.

x-- 6.30 am --x
Me: Ok this better be a serious problem or else.
Patient E: My loin hurts. There's this sudden grasping pain and it hurts a lot when I'm peeing.
Me: (Finally! Something relevant!) It sounds more like a renal colic, most likely due to a renal stone. I'll give you a jab and the pain will go off.
Patient E: Ok.
Me: The pain may come back within these few days so I'll write you a referral letter to the surgical outpatient department. While waiting to see them, whenever the pain comes back you can always come here for another jab.
Patient E: Sure.
Me: (Finished jabbing the patient) Ok. You can go now.
Patient E: But doc..
Me: Yes?
Patient E: The pain is almost gone but whenever I do this there is this discomfort. (Patient turns his body in some awkward posture that normal people usually do not do)
Me: So? Don't do that then. Ok I'm off to sleep. You can go now.
Patient E: -.-"

Seriously, I think it is time we increase the registration fees for outpatient department from RM1 to RM5.

My first dying patient

2010-04-01T21:35:00.000-07:00

The first time my patient died was during my medical rotation. Cause of death? Advanced lung carcinoma with liver metastases and possibly right adrenal metastases.

He was already cachexic to begin with, like a wilted willow tree. Weak, he may seemed to be, but he was as stubborn as a donkey. He was really such a pain in the ass.

His relatives admitted him for poor oral intake and delirium, and from the investigations we had done for him, it seemed like he was hyponatremic. My medical officer had reviewed him and ordered for immediate sodium infusion.

It was awful difficult to set up an IV access for a cachexic patient, who is furthermore stubborn and uncooperative. Again and again, I have repeatedly set up IV lines for him, which he would ultimately pulled them out. He yelled and cursed at me whenever I pricked him with the needle; I cursed him back.

Eventually I have to resolved to restraining him just to avoid him from pulling out his IV lines. I was already in a desperate state; he might be a patient with an irrevocable advanced stage of cancer, but then, I could just prolong his life a little bit more if his sodium infusion goes well.

"Hey, why you tie me har?" He barked. "You want people like to be tied up is it?"

"You gave me no other options." I responded coolly. "If I don't, you'll die faster."

"The die-lah." He shouted and started spitting all over himself. "Don't worry. You'll get what you wished."

His blood sodium levels were plunging into the drain and if he had not had his sodium levels rectified, he would have gone even more cuckoo-ier.

And he really died the next day. I came back to the ward the following day hoping to see he was still there, yet my colleague who was on call that day told me he did not make it.

"He died a few hours after you guys left." My colleagues told me. "Suddenly all the cursing stopped and he just died."

I nodded as silence captivated me.

My first patient died, and it's probably just the beginning. There will be more to come. There will be.

I gave my patient a heart attack

2010-04-01T07:13:00.000-07:00

I just had my lunch and was leisurely strolling back into my ward towards my cubicle; I was taking care of the subacute cubicle in my ward during that whole week. Anyway, the moment I stepped in the ward the nurses informed me that I have a new case to clerk.

Hence, I grabbed the patient's files and marched towards her bed when I saw this middle aged women of medium built lying comfortably on her bed half asleep. So, I walked nearer her and woke her up.

"Aunty! Wake up!" I blared. "Tell me what brings you here today."

She woke up with a startled, and she started to sweat as she gasped. Yes. I could see pearly sweat drops rolling down from her forehead as her face carved itself into agony.

"My chest hurts. I can't breathe."

I quickly grabbed her hand and felt for her radial pulse, feeling it increasing as her breaths started to hasten.

"Staff nurse!" I yelled towards the nursing counter. "I want this patient's BP and ECG stat!"

My words sprang like an alarm as the nurses started running towards me, one pushing the trolley with the ECG machine resting upon it, while the other dragging the automated BP machine towards me.

Within flashes of seconds, the chest leads were already cupped onto the patient's chest and the ECG strip rolled. I pick the strip up wif my fingers and started scanning through the leads readings.

"Not good. This isn't good." I mumbled.

Coincidentally, my specialist Dr. Asmah just happened to be behind me. She is always early for afternoon rounds, and I am grateful that she is so.

"What new case do we have here." She asked as she beholded the patient. "Oh my, she's sweating. Can I see the ECG?"

I shoved the ECG readings to her as I could feel my body saturated with adrenaline.

"Oh dear." She exclaimed after looking through the ECG as she flipped the patient's notes. "We have a fresh myocardial infarct. Come let's strep her now."

It has always been nice to work under Dr. Asmah. She never really orders you around like a slave driver. Oh maybe she does, but she is such a nice person that even when she gives orders it does not sound like one.

I watch as the nurses run around like headless chickens preparing to streptolyse our patient. A crushed aspirin tablet was shoved into her mouth and later a sublingual GTN later was popped under her tongue. I fastened a nasal prong around her and propped her bed up a bit.

"At least she is stable now." I whispered to myself, as Dr. Asmah started writing into the patient's notes. "Dr. Asmah the nurses are done preparing the streptokinase, so shall we start?"

She nodded as she continued scribbling her notes. And thus we started our streptokinase.

"Rcks, this patient was rather stable just then and she was admitted only for unstable angina." She slid the tip of her pen into the edge of her mouth and started biting it. "What would have caused the heart attack."

"Erm." I shrugged my shoulders. "Maybe my loud voice gave her a heart attack."

Dr. Asmah chuckled as she turned towards the patient."Maybe."

And I really gave my patient a heart attack, I guess.

I am rude and I like it.

2010-03-27T09:10:00.000-07:00

"Doctor, you are very fierce." An old lady once commented.

"You made me so, Aunty." I replied bluntly. "You never answered my questions properly, so I figure a bit of scolding might make you orientated."

That's not the first time I received such comments. My patience towards conscious patients is very limited; tell me what is your problem and I will deal with it. No point beating around the bush telling me long winding stories. I am not paid to listen to irrelevant details.

Now, back to that old lady which I gave her a bit of scolding a few weeks back.

"Aunty, tell me what is your complaint." I greeted the patient.

"Doctor, I feel very bad. Everywhere is uncomfortable." She replied.

"Ok. Be more specific. Are you having any chest discomfort or abdominal pain or headache."

"I don't know." She added. "I just feel very uncomfortable everywhere. I feel very bad. I want to die. I want to die. I want to die."

"Aunty, I can't help you if you don't tell me exactly where you don't feel comfortable. Is there pain or discomfort or anything and where is it?" My patience has started to run dry.

"I don't know. Let me die. Let me die. Let me die." She went on whining.

"If you want to die then die at home and don't call the ambulance for nothing." I snapped. "Now I'm seeing you here so kindly tell me what is wrong so I can help you. Otherwise don't waste my time."

I guessed those words stunned her for a moment.

"My stomach hurts." She replied timidly.

"Ok. Then I know what is wrong. If you keep on whining for no reason and refuse to tell me what is wrong, how am I supposed to help you." I gave her a final whip. "I am a doctor, not some spirit medium."

And after having examined her, I started jotting down into my clerking sheet. That was when she commented. "Doctor, you are very fierce."

I grinned. I know. I am just doing my job and saving your miserable lives.

The hag from hell

2010-03-19T07:40:00.000-07:00

It was while I was working in the medical wards, as far as I remember, when she appeared... The hag from hell.

She was gasping for air as the paramedics escorted her into the ward. With her devillish eyes she scanned the ward and indifferently glared at us as we attended to her. Her hands clinging to her son, a neat looking gentleman who turned out to be some fastidious lawyer, as she sat restlessly on the bed, huffing and puffing into the high flow oxygen mask.

"Damn. Not another APO?" I whispered. "Why din't they intubate her down there instead?"

Gopi, my colleague, was one step before me as he started clerking the patient and her son. Hence, I trudged back to the counter and lazed around, waiting for another case to come.

30 minutes later, Gopi walked towards me.

"Rcks, I need your help." He pleaded. "That old lady just punched me."

"Come again? You're kidding, right?" I chuckled.

So I followed Gopi and headed towards the old lady, who was now lying in the ward beds, gasping, with her son standing beside her. On the trolley was a kidney dish with branullas and syringes inside, and I could see that Gopi had attempted few times to insert a venous access for her. As we approached, the old lady raised up a hand and showed us her fist.

"I tried to set a line and she punched me on the head." Gopi muffled to me as we paced closer and closer to her. "I'll distract her son, while you poke her again."

I nodded. Having sat beside her, I tried to talk some sense into this old lady, that she is sick and urgently needed some medications, thus we have no choice but to set up a venous access for her. After few words of coaxing, finally she agreed as I promised to do it as slowly, gently and painlessly as I can.

As I inserted the branula, I felt a blunt blow onto my head. That bloody old hag punched me! ~~Fuck!~~ And I swear it did it as painlessly as I could!

I swallowed my anger and gave her a forceful smile, as I secured the access and walked away. From far I could see Gopi laughing at me as I waved my middle finger to him.

"Rcks. It's ok. I got boxed on the head too!" He bleated. "One more thing, we need an ABG for her."

"No way. I'm not going to do it!" I snapped, as I walked away. "You're on your own!"

"Oh come on. Please?" Gopi grabbed my arm like a venus fly trap. "Just once and we'll send her away to CCU."

"Oh well. Let's get on it then. We need serious backup, man." I compromised. "Anyway you owe me a big one!"

So, this was how our battle plan look like. HO A will distract the son, while HO B and C will ~~chain~~ pacify the old lady. Gopi will hold her hand and I will jab the needle into her wrist for her ABG. Sounds perfect!

Things went smoothly as we expected. Her son got distracted as my colleague A took him to another room for some "discussion", while my colleagues B and C grabbed both her arms. Gopi steaded her hand as I attempted to get her ABG. She roared as I jab her and started cursing us in some dialect, and she started struggling to free herself from my colleagues. I aspirated her arterial blood as fast as I could, and voila! Mission accomplished!

Just when I thought things were over, she jumped over me and pulled my ears! An old lady with acute pulmonary oedema on 15 liters of oxygen per minute! And's she ~~fucking~~ aggressive even though she's 80 already! As my ears were being pulled I instantaneously reacted and pinched her hands, and I guessed I surprised her. She seemed a bit dumbfounded, as she slowly let go of my earlobes.

As I reach for my earlobe to see whether they were still attached to my head, I waved a fist at that old lady. That's for being such an ungrateful hag!

Later we got rid of her by sending her down to CCU, since her ABG wasn't that fantastic. Since then I have never hear from her again. Could she has survived? Or was she dead already? Anyway, I'm sure she did not die because I pinched her!

My Ambulance Crashed

2010-03-17T00:50:00.000-07:00

It was an emergency call; some old dude was dyspnoeic and required medical assistance.

"So, do you want to take this call?" My MO asked, since I was loitering aimlessly in Yellow Zone, striving hard to avoid the other 2 colleagues I had to put up with in Triage. One gibbers endlessly like a dripping prostate, and the other, is simply an annoying drama queen.

I looked at the time -two-thirty pm. 30 more minutes and my morning shift would have ended. Oh well, I was too bored anyway.

We trudged towards the awaiting ambulance, and my MA pleaded me to sit in front. There were 5 of us this time; me, my MA, a PPW, a SMA, and also a PPK. Quite an entourage. "It's just a medical case, not worth the company," I told myself, as I climbed into the front passenger seat.

Anyway, this ambulance had no seat belts. So, your entire life depends on your hands, one on the dashboard steadying yourself while the other clinging onto the overhead handle, as your ambulance careened on towards its destination with its sirens howling like a mad hound. And as we journeyed towards our destination, in a steep downhill road leading to a almost-blind end, we had the shock of our life. And there was this big bang!

It barely happened in minutes, but I remembered it clearly, as though it happened in a slow-motion manner. In front of us, just about 5 meters, was this old Indian motorcyclist, stunned, in the middle of the road, staring at us, as though we were monsters from another world. He stared at us, petrified, and we stared at him, horrified. As the ambulance driver made an evasive endeavour, out of p"anic the motorcyclist accelerated towards us, and it just happened. A head on collision. A loud bang, and I witnessed him flying from his bike, with a sommersault spin, and landed on the railing of the bridge where we collided.

"Fuck!" I whispered. "He's going to be in a bad shape."

All of us scurried out from the ambulance, and we sped towards the victim, hanging upside-down and clinging onto the steel railings of the bridge. His eyes were opened, unresponsive; his chest heaving with loud breaths from his facial orifices; and what striked me most, was that his right knee was folded onto his chest. In other words, it was not good. Really not good.

We were struck with panic. My MA started yelling into our ComSat device informing HQ and requesting for backup, the ambulance driver cursed his luck, while the rest just stared at this unfortunate victim, who was basically motionless, saving for the heaves of his chest.

I pulled myself together, and decided to take charge, evoking memories of what I had learnt during my Basic Trauma Life Support Course, and started assessing the victim. I tried to wake him up by smacking his shoulders hard. No response. His eyes were opened wide, staring blankly into me, and he was groaning with no other comprehensible words, and his uppers limbs were motionless.

"E4M1V1," I whispered, as I skimmed through the life-saving ABCs that they taught me. "Good, breathing spontaneously and radial pulses felt bilaterally, almost tachycardic."

I turned around and faced my other entourage, who were still dumbfounded, and yelled. "I need a cervical collar stat!"

I guessed those words dispelled their state of shock and we started working as a team. Having taken off his helmet and stabilized his neck,I fastened the cervical collar onto him and auscultated his chest. Equal air entry. Both chest moving adequately as well. Abdomen was soft and no signs of pelvic fracture, yut the floating right knee halted me. My MA took out a splint and immobilized the wobbling right lower limb, and we dragged him out of his awkward upside down position.

We were somehow fortunate, as a passing by ambulance from another hospital stopped by and helped us. "Reinforcements have arrived, finally." And more people added to our entourage.

We scooped him up onto the trolley with a spinal board and loaded him into the ambulance as it sped towards my hospital like a bolt of lightning. I turned around and only realized the damage it had caused to our ambulance. The front part was smashed hard, with the motorcycle still stuck beneath it.

As we spent another 30 minute waiting for another ambulance to pick us back to the ambulance, I started wondering how the victim would fare. He was stable when I despatched him back, but with that low GCS and floating knee, what are the chances of his survival?

Crowds that swarmed around us started to disperse on their own when they finally got fed up of snapping shots of our ambulance and us, and the vehicles that crammed the road moved on. Well, some just gave us this blank stare while others shot us with blames and sarcasm.

"Oh, an ambulance do kill people, eh?" Some jerk on a motorbike ridiculed.

"It's the ambulance fault, there's no siren." Some guy who was wearing the same uniform as the victim bleated.

"Are you ~~fucking~~ deaf?" My MA thawrted. "If this isn't a siren, then tell me what is this deafening howling sound".

"But there were no emergency lights on." He snapped back.

"Yah, emergency lights on broad daylight." My MA retaliated like a whiplash and instantaneously silenced this fault finding dude.

I grinned. My virgin experience as a first responder; it felt thrilling. Maybe I do like Emergency Medicine.

A&E for 4 months

2010-01-10T22:29:00.000-08:00

Am finally done with Peds. A sense of relief.

I'm now being posted in casualty department, and one of the good things here is that everyone else here is either a 4th poster, or above (which means that I'm already acquainted), hence, I should not be experiencing any difficulty in working with the others, except for some bad apples. Nevertheless, it's nice to work with new people once in a while.

The impression my MOs give me are way more better than what I had in Peds. Maybe we're senior HOs, that's why they treat as more like colleagues, except for certain U48 hags whom still treat us as slaves. Instead of working FOR them, I enjoy the feeling of working WITH them, and occasionally I get consulted for medical conditions. :) It's nice to know that you're being appreciated by your colleagues and your superiors.

Still, I'm having certain difficulty working with people with moods even more labile than mine. Moods that fluctuate like KLSE stock market indices, up and down, down and up, are simply a nuisance to bear with. I wish I do not have too many shifts with him. (crosses fingers and pray)

In my honest opinion, the nurses and AMOs are really taking advantages of HOs posted in the casualty department. I don't think we should be running errands FOR them or DOING their jobs; it does not pain to help occasionally when they are tied down, but it is not our OBLIGATION anyway. I'm not going to suck up to them, not like some people!

Anyway, looking forward to our promotion to UD44! :)

Breastfeeding Fanatics.

2009-11-11T06:57:00.000-08:00

My hospital just had its triannual "baby-friendly hospital" assessment last few weeks, and both the pediatrics and obstetrics department worked real hard to make sure they don't lose it. Within 2 days, the corridors are stuffed with all sorts of paraphernalia promoting breastfeeding and condemning bottle feeding. Although 70% were of last minute toil, but the outcome was somehow salutable.

My MO revealed to me stories of a subversive gang of people, known as breast fascists, who dedicated almost all of their lives making sure breastfeeding occurs in newborns. These breast fanatics simply do not tolerate any form of bottle feeding, even though at times they were justifiable.

Anyway, due to the fact that some of us might be assessed in conjunction with this baby-friendly hospital assessment, most of the HOs had gone paranoid and started memorizing breastfeeding policies, so as not to screw up if they, unfortunately, got called up. Even the poorly-motivated nurses could be seen reading. What a scene. Lucky for me, I hadn't read anything bout it and I wasn't being assessed by anyone. Thank God.

Anyway, 2 days after the assessment, the hospital was efficient enough in getting rid of all the paraphernalia. As expected. Everything it just a show. Posters were stripped off instantaneously and midwives stopped brainwashing mothers on breastfeeding. Babies are back on the formula feed and things had gone back to what it was before.

I guess that's how things work. We all love to put up a show.

Fake OKUs

2009-10-29T07:07:00.000-07:00

I'm being posted in the nursery recently, and the constant crying and wailing of sick babies have sort of diminished my blogging libido, hence explaining my absence for 3 weeks.

I was happily strolling along the hospital corridor walking towards the nursery when this guy interrupted me and started yelling at me. Well, I do not recall seeing this guy before but his rude bellowing was nothing but a humiliation. There wasn't much I could do so I just ignored him and carried on with my stuffs.

It was only on the second day that things unfolded itself and revealed more; this guy's baby sort of got admitted days before and was discharged over the weekend after its jaundice subsided. Yet, the jaundice rebounded and the baby had to be readmitted. So basically, the parents were just dissatisfied that they have to readmit the baby. And since this guy stayed next to the state pengarah's house so he made a complain about the department that we are not managing his baby properly.

It turned out that the baby's cause of jaundice was due to underfeeding; in other words, we treated the baby in the ward and the jaundice subsided, but since the stupid mother did not feed her baby properly, the jaundice came back. Just that simple, and we got blamed for nothing.

As my specialist tried to pacify the anxious father, he flashed his OKU card. It was then it struck my mind; he could see, hear, fuck (since he has a baby), talk and walk, so why the hell does he has an OKU card? And I guessed it has been his habit of flashing that stupid OKU card, that he was basically exploiting it to get attention and special priveleges. How disgusting! Moreover, to be able to think of such shameful idea, he can't be mentally retarded.

Anyway, he sent a sms to my specialist, threatening to drag TV3 reporters into the scene if we do not comply to his wishes. Well, if he really does that, I should just disclose that he's actually some phony OKU.

Fake OKUs. That really make me sick.

Internal Inquiry

2009-10-03T03:35:00.000-07:00

That day I got summoned to attend an internal inquiry. Some relatives of a patient who died wanted to file a lawsuit and the hospital wanted to brace itself, just in case anyone of us get subpoena-ed or something. Me and my colleague, unfortunately, had to be there because there is a minute possible chance that we may have to testify in court.

Actually, I was involved because I happened to be on call when the patient died and I wrote his discharge summary. My friend got called because he took consent from his family for a life-saving surgery that never happened in time. So, anyone who had scribbled his name inside the patient's ticket is dragged into this pile of mess, including an A&E MO who just left 3 lines of comments on the patient's X-Rays.

Well, after the bickering and the squawking, the big shots (the hospital director, the HODs, and the specialists) had come to a consensus, that the hospital was not at fault since we managed the patient properly. Still, some trees will not bear fruit even if you grew the right seeds in the right way, just like how this patient ended up. We did what we were supposed to do, but it turned out different as what we expected.

The cause of death for the patient is still unexplained, and yet eventually, we decided that what killed the patient was something which is possible but unlikely to have occurred, and it's all theorectical.

My colleague and I remained silent throughout the entire proceeding but we had some great laughs. It was full of drama, but still comical most of the time.

Anyway, I hope I do not get subpoena-ed or something; I never like the whole court thing.

Now and then.

2009-09-28T07:26:00.000-07:00

My MO ordered me to follow him for a standby in the labor room while I was on call some night; apparently there's an imminent fetal distress.

Well, as I stepped in the labor room again, there was this overwhelming feeling of de javu. Anyway, I still share that distasteful feeling while I first entered the labor room a year ago, but the only difference this time is that instead of walking in like a green HO who knows nothing, I'm actually trudging in as a senior HO who now knows, well, a bit of something.

I was greeted by the labor room nurses, of whom most HO would fear and some might rever; honestly I've never thought they would remember me anyway, yet, I do hear some hard-to-believe comments from other HOs that the nurses did compliment me and my colleagues then for being diligent and efficient in the labor room last time. Surprisingly. I could still remember my first day as a HO where I could barely set up an IV line, and I got whacked by this grumpy labor room nurse badly. She screwed me up and down for not being to set up an IV line confidently; and now I've had no problem setting lines, even for nephro patients or lil' kids.

Gone were the days where nurses would twist me around with their lil' fingers. It was rather amusing to remember that we use to fear these nurses so much, and a mere squeak from them would make us all jump. Things were that ugly until we have to adjust ourselves according to their moods, just to avoid shriekings and yellings. And some nurse tried to take compromising photos of us in order to threaten us! (and got screwed by our consultant badly when we gave her off!)

And now they greeted me as I walked into the labor room. It felt weird. Very weird. But it felt sweet.

Nurse A: Hi doktor! Doktor sekarang sudah jadi junior MO ke?

Me: Belum lagi-lah, senior HO sahaja.

Nurse B: O... tak lama-lah. Masa tu jangan lupakan kami ya!

Me: Ok. -.-"

Well, 1 year of seniority does make a difference after all.

Anecdotes on death

2009-09-19T06:24:00.000-07:00

We fear death as we do not comprehend it; we simply fear the unknown. For all we know death could be just the answer to all our miseries we encounter in life.

I recently pronounced death for this small lil' girl; in fact she's the first pediatric patient that I pronounced death after I started peds. Pediatric deaths occur so rarely that even the nurses are unfamiliar with the postmortem procedures and I myself have to explain to them.

Back to this lil' girl, who was born with a hydrocephalus secondary to semilobar holoprosencephaly, and albeit corrective surgeries had been performed on her but still it was futile. No way could she ever grow like a normal little girl. She would never have had the chance to play with dolls, dress herself in her mom's pretty clothes, or toy around with her mom's cosmetics. Nor will she ever have her first dance with her crush, or will she ever get her first kiss.

Everytime she's been warded, her mom would request for a DNR. Nonetheless, everytime we manage to prolong her life, or rather prolong her suffering. Her condition had been deteriorating; initially she could move her limbs, and by the time I tended to her, she was floppy and vegetative. Her eyes barely could respond to her mother's calls. And I whispered to myself repeatedly that this probably she won't make it through this time.

Day by day I witness life siphoning out from her helpless little body. Her breathing pattern became irregular and her palms and soles loses their warmth. Her oxygen saturation levels fluctuated with an ultimately decresendo style and I had to keep an eye on her, in case she might go off anytime. Time after time we informed the mother that her death would be imminent; we wouldn't know when she would go, but soon we predicted. Her anxiety pulsates whenever I examine her, pondering when my lips would utter the magic words and end her of her misery. Yet so far, her daughter struggled on.

Well, finally I said it. I pronounced her death eventually and she sobbed. It was a natural thing for parents to mourn over their dead offsprings; but from her tears I could actually empathize her relief, hidden amist her sorrow. I understood the suffering she had endured, and that her child's death might be a liberation for her. Maybe she had been bracing herself for this since she had been informed of her child's illness. Maybe she had not. Still, we made her ready for it, and when it happened, she was ready for it.

Death comes to us no matter how we try to elude from it. Why fear death when death itself do not fear us?

Evil Nurses

2009-09-12T19:08:00.001-07:00

I believe many of us do have difficulties in dealing with nurses. Who would have known that these little Florence Nightingales wanna-be-s are actually bloodthirsty demons hiding beneath their angelic white uniforms? Anyway, having worked with these nurses for almost a year, I managed to unravel a bit, just a meagre bit,of their clandestine nature, and here I shall disclose them to you, even thought it may put my life in danger.

Fresh new nurses are always filled with enthutiasm, since they have not been tainted by the dark side yet. Most of them are cheerful and fun to work with, even thought their inexperience might be a lil bit irritating as they will bug you most of the time for every little single thing. Yet, as they are gradually being engulfed by the dark side, their pernicious nature starts to unfold. They'll start to act grumpy, mean, and sometimes manipulative. Slowly they'll start to work cunningly, doing things the fast and cheap way.

And as their evolution progresses, they start exerting their control over house officers, especially those fresh docile sheepish ones, twisting them with their little fingers. Nonetheless, fortunately, when a house officer has attained enought experience and credibility to gain their trust, life often would be much better, as these nurses are skillful enough to run some of the most basic HO errands, for example, setting up venous catheters. Still, one should always be cautious and constantly vigilant, as in case some mishap befall HOs will still have fingers pointing at them, including scrawny fingers of evil nurses whom they thought they could trust.

Aside of the conservative (and slow) way of gaining their trust by exerting your diligence and modesty, there are other shortcuts in currying their favours. Shamelessly one can bribe their way into the nurses' hearts with flirtish debaucheries, insincere compliments, lavish gifts or even free meals, and as for that I have seen many a housemen winning the nurses hearts with such blasphemous desecrating approaches! A man's meat really is another man's poison, plus I am not gifted with the talents of suck-ups.

Oh well, 11 months left for me to dance with the wolves. Bite me not!

Hospital or Hotel?

2009-09-08T03:24:00.000-07:00

All patients are irritating; and there are some of them who are even more irritating.

I wonder why people find hospitals attractive. It's a place loaded with virulent germs and dissatisfied health care workers. That's all. Yet, people still strive to get themselves admitted, albeit being repeatedly persuaded and convinced that there was simply no need for an admission. Could it be the tasteless monotonous food? The dust-mites-infested beds? Or the vicious grumpy nurses and doctors? I ponder.

Even though the health ministry has issued warnings about the H1N1 pandemic, which of course the ministry has failed to curb and control, and the hospital administrators have diligently tried to dissuade the public to keep on flooding into the hospitals, so far it has been a failure.

Despite the daily reportings of H1N1 deaths involving pregnant mothers and young children, unfailingly, pregnant mothers still drag their children to the wards even though there are posters the size of their plasma tvs everywhere telling them the dangers of doing so. Possibly, it's a good way of, you know, murdering your own offsprings which you conceived unintentionally yet were forced to look after them because you can't abort them in vivo. Or is it possible that most of the public are dyslexic? Or are they trying to innoculate themselves with microbes, just in case they might get lucky and develop antibodies against the H1N1 virus? What's more? Most of them were there to visit their neighbours, or some third cousins, or some old folks whom them have not even seen in their lives. Idiots.

Things are going the same way in the pediatric wards. Mothers would beg for the children to be warded just because of some mild influenza symptoms, even though they had been warned that there were no indications for admission, and there's a possibility of contracting the H1N1 in ward itself. And after they have been admitted, they started asking for discharge after 3 hours of admission. Attention seeking buffoons who possibly lost grey matter during their pregnancy, I suppose.

Oh well, maybe people do love to stay in hospitals, after all, since it's much more cheaper than staying in a hotel. With free food, free meds, and free room service, why not?

Sentiments

2009-08-19T06:10:00.000-07:00

It's been a year already. How time flies.

Well, if I were in the old system, I probably have become a MO and would be dumped in some remoted area. Now, I'm starting my 2nd year as a house officer.

*Sigh*

Working for a year was great; having new experiences and realizing how different actual life was, compared to my medical students life. I actually feel the immense stress of people's lives in my hands. I don't think I have killed anyone yet, intentionally, or has anyone died from my negligence. No one has lost a limb or an eye yet, so far, thank God. *Grins*

I'm feeling sentimental again, after a year of hustle and bustle. Maybe I was too immersed in my work until I have no time to feel depressed. Anyway, as I start tagging tomorrow, most likely I'll be too tired or busy to get depressed. Still, its nice to sulk for a few hours before I doze off to slumber.

Having flipped back my old blog entries 2005-2008, I can at least feel a bit of maturity within myself after so many years. Probably Sarawak was a good place to grow up, was it not? Anyway, most of the bloggers whom would comment my entries have disapparated, while some are still there blogging along. Forgive me for my astute disappearance, then I figured I need to be back within my closet and blog something less explicit. *wink*

Anyway, most of the entries in my old blog were whines and laments of my pathetic sex life. LOL. Still, I've got to admit, relationship is something I fail to learn after a quarter of century, and once in a while it does drive me mad, but then, you just can't live without it.

Nonetheless, it's time to leave bygones for bygones. Let's look ahead. One year left before I start making serious decisions about my future. So, it's time to start working. MRCP, here I come!

Screwed again!

2009-08-02T19:20:00.000-07:00

My MO screwed me, verbally, on Saturday night, while I was on call. Well, it was somehow my fault, but I just find it unreasonable.

-xxx- Here below is a factually correct conversation but modified to sound severely prejudiced againstthe author! -xxx-

MO: I am very disappointed with you. You are not living up to your reputation.

Me: (I didn't know I have a reputation anyway) Sorry, I was stuck in the front (female surgical ward) and barely had the time to have a look here at the back (paediatric surgical ward).

MO: It's not an excuse. Although you have 40 patients to look after and tons of urgent orders that your MO and Specialist had ordered to carry out, you still have no excuse to neglect your paediatric patients. I don't care if you were busy correcting patient's sodium and potassium so you can post them for emergency OTs or observing two potentially dying MVA patients - one with a lung contusion whom her SPO2 may crash anytime and one with a crush pelvic who may bleed intrapelvically and die instanteously, you should have come to the back and see those stable cases.

Me: The nurses said there were nothing urgent back here and had not inform me of anything. So I threw all my attention at the front there.

MO: You are the boss of the ward, so you should come and check if the nurses were doing their work. Although she admitted it was her fault for not informing you that I had discharged a patient, you are also wrong for not coming and see personally what my orders were, despite being stuck in the front ward running up and down like a dog. You are here to supervised the nurses, not doing what they tell you to do.

Me: (Ok, it's my fault no matter what I explain so I'll just shut up) ...

MO: Like what I said, it is always your fault as you are the HO. Whatever your bosses say is right. I don't care if you had been toiling the whole day and did not even have time for your dinner or bath or whatsoever, you are doomed to work as a slave as long as your are a HO. It's your job to accept all our sarcasm unconditionally as well. Wait, your shirt stinks of puke. Did you vomit?

Me: I'm actually not feeling well and I vomited a few times just now.

MO: I see. No wonder your performed so bad today. Yes you are sick, but you are still obliged to work like a dog.

Me: .... (Silence is golden)

Partisanship

2009-07-29T07:41:00.000-07:00

The wards are getting a bit more crazy, day by day. The call last night was horrific; I only slept 90 minutes instead of my usual 3 hours slumber.

Anyway, the whole department has become more and more crazy by the day. Who would have thought a department full of egoistic surgeons would be that dramatic, saturated with backstabbers and gossipers.

The obvious partisanship itself is bewildering; I guess that is inevitable if you have a young HOD leading a department with old consultants and specialists conspiring for mutiny almost every single hour. Then you have other MOs with their respective factions, where most of them would ally themselves with their respective ward consultant / specialists. Ultimately, the house officers get stuck in between, in despair.

My ward specialist sort of implied that she dislike backstabbers, but then she herself is rather a amateur backstabber. Frequently, the OT itself has become a guild for surgeons to perform operations, and while they are at it, to gossip. For some HOs who happen to hover around the corner, it's juicy information.

I sometimes do enjoy watching the drama, but then, it's just pathetic. Spare the politics, will ya? Some people are just trying to make a living.

Meeting with the State Pengarah

2009-07-25T19:53:00.001-07:00

Due to the letter incident, suddenly everyone is enthutiastic to meet house officers in Negeri Sembilan; and it's only been 1 week ago since our hospital pengarah came and talk to us. 1 week later, it's the state pengarah's turn.

Fortunately and unfortunately, I was on active call and was paged away to review new cases, hence I missed this meeting. Apparently, house officers from the nearby hospital also attended as well. Hence, it was bunches of house officers meeting state administrators, something which everyone thought it would turn out to be some formal conference or something.

So, from what I gathered from my colleagues who attended.

State Pengarah: Please kindly tell us what you all want and what you all want to change.

Houseman A: I'm sorry, Sir, but are you aware that we've been having this kind of meeting again and again, and nothing has been sorted out.

Houseman B: What's the point of having all these meetings when nothing has been done. All you people say is you are trying to work on it. There's no answer at all.

Houseman C: We have voiced out our demands and our dissatisfaction, but so far nothing has been done.

Houseman D: So, why the futile meetings?

So,a cavalcade of house officers stood up and re-questioned the necessity of such meetings, until the pengarah got pissed off.

State Pengarah: If you people think this meeting is pointless and a waste of your time, you all could just leave. (already merajuk)

To his surprise, everyone left en bloc.

Anyway, I heard he's going to meet us next week, again. Oh well, some people just do not learn.

A Letter to the Yang DiPertuan Negeri

2009-07-17T20:52:00.000-07:00

Rumors have been blaring within the wards, and I guess it's true. Someone, or rather some moron, has written a complaint letter to the YD Pertuan Negeri. Intriguing. Instantly two big questions echo inside my mind. First, which numbskull would do such a thing? And secondly, what's the point?

So, as how we anticipated, the Pengarah ordered for an extraordinary meeting with all of us house officers. I would have expected a bashing, or more of an interrogation-like sort of meeting, still, the meeting was more of a beseechment for us - let's work hard, and please do not write such complaint letters.

Regarding to which brainless house officer who would do such an ingenious act of stupidity, I myself have a few theories. Based on our previous experience with a moronic Russian graduate who apparently stormed herself into the Pengarah's office during a formal meeting to make demands for more teaching and ward rounds, I can't lay my suspicions off her. Look, I'm not trying to be judgemental nor biased, yet, we do know that 9 out of 10 Russian graduates are useless. (Ok, 8 out of 10. I'm being nice here) My personal experience with other Russian graduates are similar, either they talk too much and do nothing, or they don't talk much and do nothing.

On the other hand, news have reached our ears that there is another new house officer, a so-called local private uni grad, who could have been the culprit. Apparently she had been whining and complaining of having to work 7 days a week in ObsGyn. What's more? Her dad is a Datuk. So, most likely our new colleague is having a life crisis? Probably she expected to work from 9 to 5, with cosmetics allowance as well? Well, if you can't work like a doctor, don't be one then! If the other bunch of us survived the harsh working ours of ObsGyn, so should you.

Anyway, I'm not that devoted to really delve into this and find out who the instigator was, just that she had just made a clown out of herself, and almost costed us a wonderful Friday evening.

Post-Call Mania

2009-07-13T07:28:00.000-07:00

I tend to be very erratic and manic following my calls; at times I would just be absurd and ridiculous, even at the presence of a specialist. I guess my sleepiness has disinhibited me.

For instance while doing clinic after the uneventful morning rounds, I ridiculed this young girl who had been complaining of generalized colicky abdominal pain for 1 year duration, which had spontaneously resolved after an Ultrasound Abdomen was performed on her.

Miraculous, wasn't it?

So, I told the mother that probably those soundwaves emitted from the ultrasound probe has cured her. Perhaps she should contemplate of buying an ultrasound machine and use it at home whenever the pain recurs. Then I burst in laughter, together with the patient's mother.

And my specialist, who was sitting beside me running the same clinic, was dumbfounded. I think I gave her a shock.

Anyway, it's just my post-call mania taking over my brain.

Suck Ups

2009-07-11T06:20:00.000-07:00

Come to think of it, albeit working for almost 10 months in this profession, there is still a skill that I failed to master, or even possess the desire to learn -- the art of suck-ups. Rational thinking would say there is actually no harm in flattering your bosses, and it actually makes your life much more easier' but then, it goes against my principles of life.

At first impression, I may not seem to be a pleasant house officer; I don't make nice introductions, nor do I tend to put up a nice juicy smile to anyone I see. I do not buy coffee or breakfast for my bosses, nor do I complement their sense of fashion or the cars they drive. We're just co-workers, so why should there be such absurd acts of breasts/balls-foddling?

Anyway, I strongly believe that I would be looked upon, with dignity of course, once it is clear that I am competent in my work. Fortunately throughout these few months I have gained trust and confidence from my superiors, even though they were only a bit better to me at the end of the few weeks I had in that particular department.

It is obvious that as house officers, we do not really get credit for what we do. Most of the time, many a blames are thrown upon us whenever things go wrong, as we are protected by the system -- we will never get sued if things go wrong. Nonetheless, it is somehow brackish to know that even if you do your things right, nobody ever acknowledges you, well, not until there comes a new house officer who is totally useless, making you relatively a better asset to the department.

I do not desire vivid complements from my bosses, but then, a simple acknowledgement or sign of confidence do suffice. There was a time in my Medical department where my MO would trust me enough to let me handle them by myself; she never counter-checks my plan of management as she trusts me. She gives me positive comments on my plans, and she criticizes contructively if they weren't good enough. She acknowledges me, and she laments when I left the department.

In the notorious ObsGyn deparment as well, I was lucky enough to have a MO who trust me. He would let me manage the labor room while I was on call, as he knew I do know my limits and would inform him if any trouble arises. Even if things go wrong, he would back me to the end, even though he had to confront my infamous ObsGyn H.O.D. (trust me, he is insane). It was his acknowledgement that matters.

Sucking up would have made my life better, but then it's not my thing. I'm not a hypocrit, so just live with it.

10 reasons why being a HO sucks.

2009-07-05T01:27:00.000-07:00

1. You usually work 7 days a week, and on public holidays too (applicable for most departments, such as medical, ObsGyn).

2. You don't get complimented for saving a life, yet you get screwed hard for killing one.

3. You get bullied by everyone, from your consultants, specialists, MOs, nurses, to the lowliest cleaners.

4. You are expected to perform versatile duties, from picking up your bosses' laundry, walk your MO's dogs, changing your patient's pampers, ringing patient's families to force them to pick them up upon discharge, etc.

5. You work 36 hours while being on call, and still get blamed for not working hard enough.

6. You are expected to know every single patient who is in the ward, was in the ward and will be in the ward, otherwise you'll be labelled as imbecile, uncommitted and incompetent.

7. You are supposed to be in the ward whole day, hence you should eat in the ward, sleep in the ward, shit in the ward, as if the ward is your house.

8. You get screwed all the time; your boss kills someone on table, and you have to break the bad news to the relatives.

9. You get phucked if you don't look or act busy enough.

10. You have to endure 2 years of slavery and get blamed for it.

H1N1

2009-07-04T01:10:00.000-07:00

KKM has started freezing all health staffs' leaves. So everyone in the hospital is discouraged to apply for leaves, even the hospital cleaners too. The main reason is that they may need to mobilize staff to handle such cases.

So, my guess is next month, they'll be tons and tons of H1N1 cases flooding all the departments. Surgical department will be flocked with H1N1 with lipomas, H1N1 with sebaceous cysts, or even H1N1 with hernias that require extensive surgical care. Orthopedics however will deal with H1N1 with diabetic foot, H1N1 with ganglion cysts, or H1N1 with carpal tunnel syndrome.

Furthermore, ENT side will be allocated with H1N1 with nasal polyps, H1N1 with laryngeal nodes, or even H1N1 with bat ears. Eye team will not be left out too, as there'll be H1N1 with pterygium, H1N1 with cataract, and even H1N1 with visual defects! Psychiatry ward will be congested with H1N1 with psychosis, H1N1 with panic attacks, and even H1N1 with alcohol problems! Forensic side will have to deal with tons and tons of dead bodies infected with H1N1 to confirm their death.

So, in a nutshell, all health staffs are not allowed to take leaves with immediate effect, including house officers who only have 10 days of leave for every 120 days of work in a particular department.

Bullshit. I strongly suspect our health minister is suffering from H1N1-related encephalitis. Kindly quarantine him.

6 weeks left to rot

2009-06-27T06:54:00.000-07:00

It seemed almost impossible, yet I'm almost done with it. 6 weeks left for surgery, and it's my 1-year anniversary as a house officer. I survived my first year in this profession.

Come to think about it, I haven't been learning much. I've forgotten a lot bout O&G as I slowly tumble across Surgery, trying to remember the bits I've come across in Medicine. Well, 3 more postings to go - Paediatrics, Orthopaedics and A&E - and I'm a Medical Officer. Gulps.

Although medical's tiring, but I still like it. Maybe I'm not good with scalpels. Or maybe I just don't like the blood and gore. Or could it be the OT gowns, caps and masks that itches my skin. I just don't like surgery, period.

Having gone through MRCP's official website, only have I realize that you'd need a year's working experience to be eligible to sit for the Part 1 exams. Oh well, 6 more weeks to wait.

Housemen Out Patient Department (HOPD)

2009-06-16T07:34:00.000-07:00

And I would like to divulge a secret; a secret of which one might have known but just did not realize.

The MOH established polyclinics and health clinics to ease the congestion for hospital clinics, for which you know, there are not enough hospitals to cater for our growing population. (And don't ask me where has all the $$$ to build hospitals gone?)

So, what we usually do is we'll despatch patients whom were warded and does not need anything fancy, to these clinics to be followed up there. Yet, nobody wants to go there but insisted to have their follow-ups in hospital clinics.

Nobody knows that actually in these clinics you will be under a family medical specialist, which is technically a general practitioner specialist who did study 3-4 more extra years for such a title. Moreover, the chances of you seeing a FMS is far more higher than any respective specialist in the hospital clinics!

Plus, in most government hospitals, 60% of the sessions of the clinics are actually run by house officers, 25% by medical officers, 10% by specialists and 5% by consultants. So, do you want to see a specialist or a house officer?

Anyway, it's time to rename Specialist Outpatient Clinic to Housemen Outpatient Clinic.

Renovations

2009-06-02T20:15:00.000-07:00

Almost ten months of working in this hospital and the renovation work still isn't completed yet. Fishy eh?

This hospital is okay to me, I suppose, albeit its age and semi-dilapidated status. You can't expect much from a hospital >20 years of age, but then, if someone wants to innovate or improve it, then do it properly and rationally.

The A&E has been constantly in a banging and drilling state and it still looks like a piece of crap. The MOs and Emergency Physicians are already acting like crap and now the working environment has to become like one too. What's the point of having a labyrinthian casualty department which has lots of stupid useless functional rooms and a small treatment bay. No wonder they just sent every Tom, Dick and Harry up to the wards without assessing them adequately. Damn, and I'm going to casualty next in a few months time. And they say it's not the first time they renovate it.

The labour room, however, was a comfort. Renovations for 2 weeks and hola! it looks better. Probably it's because of the head of department, whom for your information, has the guts to shout and yell at anyone just to get things done.

Anyway, what matters is how can a hospital be renovated again and again, in and out, up and down, left and right without any proper planning? It's like patching a hideous dress; already its ugly and one still wants to add patches of cloth randomly to it. Oh well, I guess these projects keep the pockets of some of the people (you know who) full and heavy. Maybe for every 100k spent on these projects, 10k goes to the you-know-whos and the-other-you-know-whos; probably that's why everyone is so keen to renovate their rooms?

Oh well, crappy as it seemed, I still have to work there. Sigh.

Shift System

2009-05-29T08:37:00.000-07:00

So it's finally come true. By next month, we're officially using the shift system.

Months ago, somehow the dumb KKM amazingly squeezed too many house officers into HTJ, and consequently, the wards are congested. Too many house officers and too few patients for them to cater for. So, in order to get rid of us, the hospital bigshots have resolved to dumping us to radiology, forensic or pathology department to perform clerical duties and run PPK errands.

My guess is they were too immersed with watching Grey's Anatomy or House MD thatsuddenly an idea struck them. Eureka, why don't we make up a shift system for the house officers?

So, instead of house officers working from 7am to 5am (For certain departments 6pm or 9pm), they'll make housemen work from 7am to 7pm (dayshift) and 7pm to 7am (nightshift). But then, too many housemen working at the night shift would end up as a luxury with them chitchatting whole night joblessly. So, why not have only ONE houseman for the nightshift, but we'll give him a day's rest the following day.

Now that's too much. 24 hours of rest is just way too much for their primitive brains. Let's make them stay till the morning rounds. Oh, what's better? Let's make them come for the morning shift of that day their on call! Hmm... but then it's still not enough to make up for their 24 hours rest, erm, so we'll ask them to work 1 extra hour the day before they do their calls! So, they'll be doing the same working hours, and think they have 24 hours of rest! What a fantastic plan. Oh, what's more? Those who are working on weekends will have to do TWO shifts, either TWO morning shifts consecutively on both weekend days or TWO night shifts consecutively!

Still, it does not really sound cruel enough, so let's take off their claims and let them toil to their death. So, with that, we'll have free slaves and extra money to renovate our offices and our houses too!

Ok, so now we'll just go ask the housemen about our fantastic idea, and go on with it regardless whether they agree to it or not! So, they can't accuse us of being autocratic since we did ask for their opinions (yet ignored their say).

And that's how the shift system was born. :)

Radiology

2009-05-28T01:00:00.000-07:00

Am currently stuck in radiology. Erm, well, since there are too many housemen in my hospitals the director has resolved to exiling some of us to other minor departments just to unclog the stuffy wards.

Hence, after suffering for 5 weeks in female surgical ward, finally I can have one week off from that putrid horrendous place!

Still, since radiology isn't my cuppa tea, I find myself loitering purposelessly in the corridors between the CT suite and US room. Walking up and down, repeatedly, continuously, just to burn my time. The only thing that intrigued me was CT Brain scans, which possibly could be a hint of my liking for neurology.

The radiology MO has started to throw me advices to start pursuing for a postgraduate study. Should I?

I just ponder.

K session

2009-05-08T23:54:00.000-07:00

I've got to admit, surgical is rather mundane. Methinks me am a medical guy.

Few of my colleagues are contemplating to attempt MRCP Part I, just for fun. I'm interested, but then a bit hesitant though. Yeah, I do like my life as a medical doctor, but then at times I'm feeling I'm doing things which I'm supposed to do, instead of doing things that I think I like to do. Anyway, at least I was able to steal some time just to pamper myself. :)

My colleagues dragged me to a karaoke session (more like me and my colleague dragged another colleague) and we started going wild. Honestly it was my virgin K session, but at least my colleagues survived that night. 4 hours of singing (more like shrieking and crowing) has left us exhausted both physically and mentally, not to mention that we actually went to sing on a Monday night! Fortunately, our vocal cords did not fail us the second day during ward rounds.

3 crazy HOs singing K on a Monday night.

It's been months since I've ever had some fun. Maybe I should do more. *evil grins*

I survived 2 postings!

2009-04-26T05:05:00.000-07:00

I can't believe I've endured 2 postings, which is equivalent to 8 month. Quite an achievement, eh?

Before my brain atrophies from over-work and under-sleep, let me regurgitate what I've accomplished in this 8 months.

Made new friends - HOs, MOs, specialists, consultants, nurses, etc.. Well, at least now it's easier to ask favours. (cross referrals, making appointments, etc.)
Made new enemies - you just can' help to wonder why there exists certain people with no brain, no shame and no use in life.
Finished the worst 2 postings in any hospitals - no weekends, no public holidays, and super stress!
Never failed to be acknowledged by your peers and superiors - I maybe dumb but I'm not stupid, at least at the end of my postings some people know I'm actually an asset!
Bought myself a new car - well, now I have to use up 1/3 of my salary to pay my car loan.
Moved in to a new house - with such new housemates you just can't say no! (and i'm still not saying no!)
Irritated IMU medical students - oh well, they do not impress me at all, what can I say?
Survived on calls - at least my blunders haven't killed anyone yet.

Anyway, have some new ideas. Hmmm, maybe I should write a book on Surviving Housemanship? Wahaha. Too little time and too many things I want to do. Oh well, it's time to fix my PC anyway.

On calls

2009-01-24T00:04:00.000-08:00

I've survived a few calls, and most of them was pretty ok, albeit having only an average of 2 hours sleep throughout the night.

Medical calls, to me, are a lil' bit more brain-brawling than ObsGyn calls, methinks. You have to entertain a wide range of medical illnesses, from the brain, down to the butt, and at times you don't even have a diagnosis. In such circumstances, the only thing one can do is merely stabilize the patient throughout the night to buy time so we can run a battery of tests in the morning, hopefully to solve his or her medical dilemma. Then again, nothing beats the excitement of making a correct diagnosis and laying out a splendid effective plan of management, subsequently liberating the patient of his agony.

Nonetheless, sometimes your calls may be full of crap. Often you'll be awakened up because some restless patient , especially those scraggy one with needle thick veins, deliberately pulled out his intravenous port repeatedly although it is vital for his or her intravenous medications. Hence, instead of dealing with some life-threatening emergencies, you are stranded with this patient, poking him numerous times just to get a line. What's more? There's never a "thank you" from that patient, who would be cursing you and your family over and over again for giving him a new intravenous port.

Or there are times when the brilliant medical officers from A&E would admit funny cases which are not even half of a medical emergencies! For instance, a patient diagnosed with acute coronary syndrome and yet loiters around in the ward as if he's of NYHA Class I; or a patient with acute pulmonary oedema who gibbers non-stop after having admitted; or worse, a patient got sent into the medical ward so the medical team can treat her anaemia as she bleeds like hell per vaginally. Perhaps they have forgotten that there's a gynaecological ward in the hospital?

The amount of sleep you can get depends on a number of factors, so as to say. Weather of course is a significant element; clearly nobody wants to be drenched and soaked like a wet pussy on the way to the hospital just because he has loose stools. Thus, often the night staff and on call team rejoices whenever any thunderstorms are imminent.

There is also this MO-HO combination factor and I am not being stupendously superstitious. Well, there are some MOs or HOs who are ISO certified for their jonah-ness. In other words, they attract patients like how shit attract flies. Whenever they are on call, you can be rest assured that they will fill up your ward with acutely ill patients that will at least stay in your ward for days.

Well, the nurses might give you a two-cents worth advice on what to do in order to have a good night call. So far I haven't found any of them to be really useful, but then having a floral bath before you're on call does make you smell good. Wearing bland colour clothings too have not proven to be effective as well, but getting blood stain son your white pants will give you a hard time to wash them off.

Anyway, my next call is will be this coming Tuesday. Let's hope it's a good call. :)

Snobbish bastards

2009-01-19T06:58:00.000-08:00

I get very annoyed when people starts to exert pressure onto me with their status or their backstairs influence. I just despise them. Period.

"I'm Datin XYZ and I know your consultant Dr. ABC, so I demand this this this that that that bla bla bla..."

" Are you acquainted with Dr. MCD, he's this pengarah in this hospital and he's my mom's uncle's cousin's grandson's son-in-law?"

"I am your hospital Pengarah's neighbour so bla bla bla bla bla bla..."

Here's another encounter I had with another pain in the arse.

Some 16 year old kid got admitted into A&E for a fracture over his right femur and so while we were waiting for his X-Rays, some idiot barged into the Yellow Zone and asked for me.

Idiot: Hi. I am Mr. Capatti. This kid is my neighbour and I happen to know Dr KFC Singh.

Me: So. There's no Dr. KFC Singh here in this department. Maybe you should find him somewhere else.

Idiot: He is an orthopaedic specialist in this hospital actually. I've called him already and he said he will be here shortly.

Me: I have never heard of any Dr. KFC Singh in orthopaedics before. Anyway, if he's here I don't mind talking to him.

Idiot: So, can you see my neighbour first?

Me: I have already attended to him and we're waiting for his X-rays. Could you please wait outside as I have other patients to see to, and you won't be doing much help standing here.

After 10 minutes, this so-called Dr. KFC Singh appeared and he was just an orthopedic MO. Having informed him about this case and as expected he asked us to inform him when the X-rays were done.

After 20 more minutes, the X-rays came back together with the idiot.

Idiot: Have you reviewed the X-rays yet, doctor? Can you please call Dr. KFC Singh to tell him that the x-rays are back?

Me: (pissed off) Am I the doctor here or are you the doctor here? I know what I should do and you don't have to keep on giving me instructions. Please wait outside or I'll have someone escort you out!

And he's not even some bloody Datuk or a Tan Sri!