So my friends and I were going through our patient's charts before the rounds as per usual. We were reading through the notes for this baby girl with congenital glaucoma (totally blind in both eyes - poor thing) who was referred to us because she fell off her cot and hit her head (to rule out cerebral concussion / bleed).
The documentation of the event went like this:
"baby alleged fell from bed when no bady there
mother and father in bathroom together at that time
PPK and staff nurse heard sound of the thing fell down
went to bedside when hear baby cry"
Oh my god!!!!
You are an MO for god's sake! Did you learn English from the toilet store? Imagine if this goes to court. What an embarrassment.
Monday, 20 June 2011
Scientist with a vibrator
So I was on-call in the pit and I had to see this 70+ year old man who was referred for an abdominal mass. He used to be a scientist, so the history came pouring out without much difficulty (in fact, I had difficulty stopping him sometimes!)
So he told me he noticed a lump in his lower abdomen a few months ago, and it didn't really bother him because he didn't have any gastrointestinal symptoms.
He was determined to prove that it was extraluminal, so he took a "strong vibrator" and exerted strong pressure on the mass and managed to "detach it from the serosa". He suffered excruciating pain for a few days but it subsided without treatment.
He was also very sure that it was benign (without any laboratory / radiological evidence) and so he delayed his presentation to us.
Geez...
So he told me he noticed a lump in his lower abdomen a few months ago, and it didn't really bother him because he didn't have any gastrointestinal symptoms.
He was determined to prove that it was extraluminal, so he took a "strong vibrator" and exerted strong pressure on the mass and managed to "detach it from the serosa". He suffered excruciating pain for a few days but it subsided without treatment.
He was also very sure that it was benign (without any laboratory / radiological evidence) and so he delayed his presentation to us.
Geez...
Wednesday, 8 June 2011
Object of Desire
I have an obsession that sits at the back of my mind at all times. And no matter what I do, I can't stop thinking about it. That sexy beast. What is it? A BMW 3 series!!!
And of course, I want a manual one. A car that I can have complete control of. That feeling of accurate gear shifting! Ah.... it makes my hair stand, it sends chills down my spine, it causes tingling on my insides.
The lovely leather seats, the beautiful wood trims, the very precise electronics. Ah....
The feeling of power when it surges forward on command. You can feel it inside you. It causes ripples of excitement. It causes your heart to beat a little faster. And your pupils constrict as you go on to the next gear. And your mouth gets just a little dry.
Oh how I dream and dream. One day, you shall be mine. And one day, I will afford you.
You'll see
And of course, I want a manual one. A car that I can have complete control of. That feeling of accurate gear shifting! Ah.... it makes my hair stand, it sends chills down my spine, it causes tingling on my insides.
The lovely leather seats, the beautiful wood trims, the very precise electronics. Ah....
The feeling of power when it surges forward on command. You can feel it inside you. It causes ripples of excitement. It causes your heart to beat a little faster. And your pupils constrict as you go on to the next gear. And your mouth gets just a little dry.
Oh how I dream and dream. One day, you shall be mine. And one day, I will afford you.
You'll see
Friday, 13 May 2011
5 months later
So here I am, 5 months into my housemanship. I just got off a god-awful call (involving a lot of faecal incontinence, unstable patients and non-stop admissions to the point of ward overflow and only about an hour of shut eye) and yet I find myself rather sleepless.
Not counting the first month of the job, life has been ok. The hours aren't too bad (unless I'm on call) and I do manage to fit in a social life after 5PM. But of course it is a pain to have to wake up at 5.30am on a daily basis to pre-round patients. The calls can be brutal i.e. 36 hours of working without a drop of sleep. My first on call was particularly overwhelming. I remember being excessively nervous and clueless. I was pacing the ward with sweaty palms and trying to deal with all the handovers from the ward doctors. As I was trying to learn about the patients in the acute cubicle, a relative asks me about her aunty's progress. Bearing in mind that I didn't work in the female ward during the day, I had no clue what her aunty had. I told her to wait by the bed and I'll tell her stuff later on if I have time, and she walked off with a dissatisfied expression. And while I was still getting to know the patients, 3 new admissions come in towards the acute beds. So I thought to myself, 3 admissions is ok. I'll just clerk them one after another and call the MO when I'm done. After I finish my first clerking, the MO rocks up unexpectedly and asks me to present all 3 cases. At this point I was just panicking a little because I new a telling off was very near. The MO gets annoyed at me and says 'Elias you're so slow! You can't be this disorganised when you're on call!' and she storms off and tells me to be ready the next time she comes. While I'm trying to get through these admissions, the nurses harrass me endlessly about patients with high BP or blood glucose readings and of patients who need new IV cannulae. Not to mention, the relative I was taking about earlier approaches me again and says that she really needs to know what is going on with her aunt. At this time, 2 other new admissions come in. Feeling very flustered, I tell her to go back to her aunty's bed and I try to power through all the admissions. Not much later, I get 3 more admissions and I'm totally running around like a headless chicken at this point. The MO shows up again and gets annoyed and starts seeing the admissions by herself. More relatives of the same patient approach me and ask me what was wrong with their aunt/grandmother. And they had very worried looks on their face, so I finally ask them, "what's concerning you?". One of them tells me "our grandmother is not responsive", and I stupidly walk to the MO and ask her, why is that patient not responding. She totally freaks and yells "She's not responding??? How long has this been happening??!!" The relative tells us "3 hours". The MO yells "DID IT NOT ENTER YOUR BRAIN TO INFORM ME THAT A PATIENT IS NOT RESPONSIVE????!!!" At this point, I'm in total panic and I run to the patient. Her airway was patent but she did look as if she was gasping for air. I quickly assess her and gave her a GCS of 3. I shout for help and get the cardiac monitor to the room. Her oxygen saturations were low. I get an ABG done: it was bad. Her pH was 6.9!! She was in respiratory collapse. The MO and I start bagging her, and soon after, we lose her pulse and we frantically start CPR. We referred to anaesthesia quickly to get her intubated. And all the while, I'm running in and out of her room feeling very guilty that I ignored the relatives for so long. We manage to stabilise her. Her saturations became 100% and her haemodynamics were stable. I then learn that she has a severe case of pulmonary TB. She collapses 2 more times and we manage to stabilise her. At this point I tell the relatives that we have stabilised the patient and she will hopefully be alright if we get on top of her TB. I did stress however that her TB was very serious.
The time was now 2am. I go to see one of the new admissions, an 80 year old lady with a stroke. She lost consciousness at home and was then noted to have facial drooping and hemiparesis by her grandchildren. They were all surrounding her and looking very grim. They bombard me with questions and all I could say was "the next 24 hours is critical. She may die. But if she survives this, the recovery process will be slow"
I finally charted for all the new admissions, inserted all the required cannulae and felt that I was on top of things for once. I check on the lady with TB many times to ensure that she was ok. At around 3am, I was informed that her saturations dropped yet again, so I start bagging again. I call the MO and we both witness another collapse! But like before, we manage to stabilise her and the MO leaves. (She tells me "Don't let her out of your sight!")
I finally sit down (feeling extremely exhausted) when one of the nurses comes to me and says "you better take a look at the lady with the stroke. She seems a little.... odd". "Odd in what way?" I say. "Well, she's not breathing...". I run towards her in a panic. She wasn't breathing. There was no pulse. But she was still warm. Her pupils were dilated. The nurses told me to just call the MO and pronounce the death. But I couldn't. I got the emergency trolley over. She was in asystole. I start CPR. I give some adrenaline and atropine. I get some electrical activity on the cardiac monitor and I'm like "Yes!!". The MO shows up and says, "you didn't have to do CPR, you could have just pronounced the death, the electrical activity is not a heart beat, it's just the drugs". True enough, she was still pulseless, and she was now cold and blue. We pronounce the death after 30 minutes of CPR. I called the relatives to hospital. They were hysterical. They were wailing away. Some of them fainted. At this point, another patient (a 58 year old woman with metastatic ovarian cancer) desaturates and starts gasping. I run to her and to my relief, there is a 'Do Not Resuscitate' order by the bed. Between all this excitement, I was running around the whole ward taking blood and correcting electrolytes (not to mention the endless blood cultures!). 7am comes and the ward doctors start showing up to the war zone that I was in. I summarise my call to them succinctly: 8 admissions, 3 collapses, 2 deaths. The call was over. (note: I did not eat breakfast, lunch or dinner that day)
I then rush over to the male ward (where I work) and pre-round my patients as fast as I could. The consultant turns up and does rounds. I then discovered my ability to sleep while standing up. Throughout the round. I was falling in and out of sleep and I did not hear most of the plans. My colleagues had to cover for me. I manage to squeeze in lunch and I fall asleep on the table. I then struggle to stay awake for the rest of the day. After I finished all my work (around 7PM), starving and exhausted, I walked over to my hostel room. I lay on my bed and I instantaneously collapsed in my dirty work clothes and only wake up the next morning at 6am for another unforgiving day at work.
Of course, with experience, my efficiency improved vastly and I was able to squeeze in 2-3 hours of sleep per call.
But what I did not expect (stupidly? maybe) is the huge responsibilities that come with this job. I have learnt that even the smallest mistake can have the most serious implications on a person's life. I have personally seen instances where not remembering to do a simple blood test on a deteriorating patient, or going with a knee-jerk reaction to deal with a problem (something as simple as even running fluids) can rapidly lead to death.
We don't realise the amount of responsibility we have until something bad happens, after which, it is usually too late, and we have to live with the mistake we made. These mistakes change you. They eat up a part of your soul, and you're constantly haunted by them. But they are forever burnt into your memory, and the best that you can do is to never repeat it.
Because of this, I noticed that senior doctors are always so careful and meticulous with patients, unlike their reckless young counterparts. And because they've seen the consequences before, they are hard on us for the smallest of mistakes. And at times, we fail to see the reason why they berate us publicly for forgetting to start aspirin on an IHD patient or not starting an I/O chart for a nil by mouth patient. But I remind myself that it's because they're scared for their patients and that it angers them that we are so blaze about things. This thought helps me a lot if I get scolded/humiliated!
I sometimes question this life commitment I've made. It's going to be many more years of exhausting calls and constant scrutiny. And things are most certainly going to get harder before they get any easier, as I progress and take on more and more responsibility. I see my colleagues around me going through the same struggles of trying to stay committed to their choices. And more often than not, I witness them breaking down and I can only hope that we all stay positive despite how horrible things can get at times in the hospital. This is certainly not a job for the weak hearted.
Not counting the first month of the job, life has been ok. The hours aren't too bad (unless I'm on call) and I do manage to fit in a social life after 5PM. But of course it is a pain to have to wake up at 5.30am on a daily basis to pre-round patients. The calls can be brutal i.e. 36 hours of working without a drop of sleep. My first on call was particularly overwhelming. I remember being excessively nervous and clueless. I was pacing the ward with sweaty palms and trying to deal with all the handovers from the ward doctors. As I was trying to learn about the patients in the acute cubicle, a relative asks me about her aunty's progress. Bearing in mind that I didn't work in the female ward during the day, I had no clue what her aunty had. I told her to wait by the bed and I'll tell her stuff later on if I have time, and she walked off with a dissatisfied expression. And while I was still getting to know the patients, 3 new admissions come in towards the acute beds. So I thought to myself, 3 admissions is ok. I'll just clerk them one after another and call the MO when I'm done. After I finish my first clerking, the MO rocks up unexpectedly and asks me to present all 3 cases. At this point I was just panicking a little because I new a telling off was very near. The MO gets annoyed at me and says 'Elias you're so slow! You can't be this disorganised when you're on call!' and she storms off and tells me to be ready the next time she comes. While I'm trying to get through these admissions, the nurses harrass me endlessly about patients with high BP or blood glucose readings and of patients who need new IV cannulae. Not to mention, the relative I was taking about earlier approaches me again and says that she really needs to know what is going on with her aunt. At this time, 2 other new admissions come in. Feeling very flustered, I tell her to go back to her aunty's bed and I try to power through all the admissions. Not much later, I get 3 more admissions and I'm totally running around like a headless chicken at this point. The MO shows up again and gets annoyed and starts seeing the admissions by herself. More relatives of the same patient approach me and ask me what was wrong with their aunt/grandmother. And they had very worried looks on their face, so I finally ask them, "what's concerning you?". One of them tells me "our grandmother is not responsive", and I stupidly walk to the MO and ask her, why is that patient not responding. She totally freaks and yells "She's not responding??? How long has this been happening??!!" The relative tells us "3 hours". The MO yells "DID IT NOT ENTER YOUR BRAIN TO INFORM ME THAT A PATIENT IS NOT RESPONSIVE????!!!" At this point, I'm in total panic and I run to the patient. Her airway was patent but she did look as if she was gasping for air. I quickly assess her and gave her a GCS of 3. I shout for help and get the cardiac monitor to the room. Her oxygen saturations were low. I get an ABG done: it was bad. Her pH was 6.9!! She was in respiratory collapse. The MO and I start bagging her, and soon after, we lose her pulse and we frantically start CPR. We referred to anaesthesia quickly to get her intubated. And all the while, I'm running in and out of her room feeling very guilty that I ignored the relatives for so long. We manage to stabilise her. Her saturations became 100% and her haemodynamics were stable. I then learn that she has a severe case of pulmonary TB. She collapses 2 more times and we manage to stabilise her. At this point I tell the relatives that we have stabilised the patient and she will hopefully be alright if we get on top of her TB. I did stress however that her TB was very serious.
The time was now 2am. I go to see one of the new admissions, an 80 year old lady with a stroke. She lost consciousness at home and was then noted to have facial drooping and hemiparesis by her grandchildren. They were all surrounding her and looking very grim. They bombard me with questions and all I could say was "the next 24 hours is critical. She may die. But if she survives this, the recovery process will be slow"
I finally charted for all the new admissions, inserted all the required cannulae and felt that I was on top of things for once. I check on the lady with TB many times to ensure that she was ok. At around 3am, I was informed that her saturations dropped yet again, so I start bagging again. I call the MO and we both witness another collapse! But like before, we manage to stabilise her and the MO leaves. (She tells me "Don't let her out of your sight!")
I finally sit down (feeling extremely exhausted) when one of the nurses comes to me and says "you better take a look at the lady with the stroke. She seems a little.... odd". "Odd in what way?" I say. "Well, she's not breathing...". I run towards her in a panic. She wasn't breathing. There was no pulse. But she was still warm. Her pupils were dilated. The nurses told me to just call the MO and pronounce the death. But I couldn't. I got the emergency trolley over. She was in asystole. I start CPR. I give some adrenaline and atropine. I get some electrical activity on the cardiac monitor and I'm like "Yes!!". The MO shows up and says, "you didn't have to do CPR, you could have just pronounced the death, the electrical activity is not a heart beat, it's just the drugs". True enough, she was still pulseless, and she was now cold and blue. We pronounce the death after 30 minutes of CPR. I called the relatives to hospital. They were hysterical. They were wailing away. Some of them fainted. At this point, another patient (a 58 year old woman with metastatic ovarian cancer) desaturates and starts gasping. I run to her and to my relief, there is a 'Do Not Resuscitate' order by the bed. Between all this excitement, I was running around the whole ward taking blood and correcting electrolytes (not to mention the endless blood cultures!). 7am comes and the ward doctors start showing up to the war zone that I was in. I summarise my call to them succinctly: 8 admissions, 3 collapses, 2 deaths. The call was over. (note: I did not eat breakfast, lunch or dinner that day)
I then rush over to the male ward (where I work) and pre-round my patients as fast as I could. The consultant turns up and does rounds. I then discovered my ability to sleep while standing up. Throughout the round. I was falling in and out of sleep and I did not hear most of the plans. My colleagues had to cover for me. I manage to squeeze in lunch and I fall asleep on the table. I then struggle to stay awake for the rest of the day. After I finished all my work (around 7PM), starving and exhausted, I walked over to my hostel room. I lay on my bed and I instantaneously collapsed in my dirty work clothes and only wake up the next morning at 6am for another unforgiving day at work.
Of course, with experience, my efficiency improved vastly and I was able to squeeze in 2-3 hours of sleep per call.
But what I did not expect (stupidly? maybe) is the huge responsibilities that come with this job. I have learnt that even the smallest mistake can have the most serious implications on a person's life. I have personally seen instances where not remembering to do a simple blood test on a deteriorating patient, or going with a knee-jerk reaction to deal with a problem (something as simple as even running fluids) can rapidly lead to death.
We don't realise the amount of responsibility we have until something bad happens, after which, it is usually too late, and we have to live with the mistake we made. These mistakes change you. They eat up a part of your soul, and you're constantly haunted by them. But they are forever burnt into your memory, and the best that you can do is to never repeat it.
Because of this, I noticed that senior doctors are always so careful and meticulous with patients, unlike their reckless young counterparts. And because they've seen the consequences before, they are hard on us for the smallest of mistakes. And at times, we fail to see the reason why they berate us publicly for forgetting to start aspirin on an IHD patient or not starting an I/O chart for a nil by mouth patient. But I remind myself that it's because they're scared for their patients and that it angers them that we are so blaze about things. This thought helps me a lot if I get scolded/humiliated!
I sometimes question this life commitment I've made. It's going to be many more years of exhausting calls and constant scrutiny. And things are most certainly going to get harder before they get any easier, as I progress and take on more and more responsibility. I see my colleagues around me going through the same struggles of trying to stay committed to their choices. And more often than not, I witness them breaking down and I can only hope that we all stay positive despite how horrible things can get at times in the hospital. This is certainly not a job for the weak hearted.
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