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.
Showing posts with label Medicine. Show all posts
Showing posts with label Medicine. Show all posts
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...
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.
Friday, 5 November 2010
Doctor doctor!
I finally got my houseman posting, and thank god it's in Selayang!! I spent the last 5 days in a 'kursus induksi' in Melaka, which was really fun! (believe it or not?) They put us up in this pretty decent hotel and fed us 6 times a day. 3 of my friends from KMB where there so we had plenty of time to catch up over shisha and lots of coffee. What fun. Melaka was quite different from what I remembered it to be. It was spotless. The river was so clean you could see fish swimming in it! What a lovely place!
Today, I took out my stethoscope from it's dusty box for the first time in 4 months. Looking at it made me think of how much medicine I have already forgotten. What would I do if someone collapses on my ward? Hopefully, I won't be hiding in a cupboard somewhere.
At the moment, I am feeling quite nervous about Monday! I don't really know what to expect because I've never really done a proper clinical attachment in Malaysia, but hopefully, I'm prepared for the worst. I am prepared to surrender my social life for at least a month till I get into the swing of things. I know there are going to be 16-hour days and 30-hour calls, some scolding and that I'm going to be exhausted. But I hope it doesn't break my spirit. I really hope I enjoy working and don't cause any harm to anyone.
I must now fill out countless forms (of which one needs to be stamped by an Oaths Commisioner!) and pack my suitcase. Hopefully I'll have time to report some experiences along the way!
Today, I took out my stethoscope from it's dusty box for the first time in 4 months. Looking at it made me think of how much medicine I have already forgotten. What would I do if someone collapses on my ward? Hopefully, I won't be hiding in a cupboard somewhere.
At the moment, I am feeling quite nervous about Monday! I don't really know what to expect because I've never really done a proper clinical attachment in Malaysia, but hopefully, I'm prepared for the worst. I am prepared to surrender my social life for at least a month till I get into the swing of things. I know there are going to be 16-hour days and 30-hour calls, some scolding and that I'm going to be exhausted. But I hope it doesn't break my spirit. I really hope I enjoy working and don't cause any harm to anyone.
I must now fill out countless forms (of which one needs to be stamped by an Oaths Commisioner!) and pack my suitcase. Hopefully I'll have time to report some experiences along the way!
Sunday, 28 September 2008
Life goes on!
I PASSED!!! And its great to be back! Now leaving all that crap behind me,
I'm on neurology at The London at the moment and am enjoying every bit of it! Ophthalmology week was great and I'M SO BUYING AN OPHTHALMOSCOPE!!! Oh what fun
Anyway, I'm back on my Music Presidential throne and am working my ass of for it! Can't wait! Despite the usual problems (low on brass, NO OBOE!, no harp) I'm glad to say that things are looking up this year! Many new members signed up at the freshers fair, and a 3rd of them violinists!! and a new cellist and a HORN!!! omg Just incredible, horns are SO rare. But we still don't have trombones...
Anyway, nowadays I'm losing sleep due to excitement! I keep thinking of that first rehearsal that just has to be perfect! First impressions last you see, so i don't want to scare off the new members.
And I just LOVE our choice of repertoire!
-Mussorgsky: Prelude to Khovanshchina
-Khachaturian: Masquerade Suite
-Eric Coates: London Suite
It's gonna be good!
I'm on neurology at The London at the moment and am enjoying every bit of it! Ophthalmology week was great and I'M SO BUYING AN OPHTHALMOSCOPE!!! Oh what fun
Anyway, I'm back on my Music Presidential throne and am working my ass of for it! Can't wait! Despite the usual problems (low on brass, NO OBOE!, no harp) I'm glad to say that things are looking up this year! Many new members signed up at the freshers fair, and a 3rd of them violinists!! and a new cellist and a HORN!!! omg Just incredible, horns are SO rare. But we still don't have trombones...
Anyway, nowadays I'm losing sleep due to excitement! I keep thinking of that first rehearsal that just has to be perfect! First impressions last you see, so i don't want to scare off the new members.
And I just LOVE our choice of repertoire!
-Mussorgsky: Prelude to Khovanshchina
-Khachaturian: Masquerade Suite
-Eric Coates: London Suite
It's gonna be good!
Saturday, 19 July 2008
Acceptance
The results have finally sank in.
For hours yesterday, I kept checking if the name on the slip wasn't mine. I kept saying "I can't believe I failed! ME?? ME??" over and over and over again. So memalukan! Lose face only. Ceh
Kept picturing that moment opening that wretched envelope.
Well, there's a first time for everything!
Now, I'm looking forward to going home. And am gonna kick the resits in the arse when I'm back!
And my neck is really stiff now. So bye
For hours yesterday, I kept checking if the name on the slip wasn't mine. I kept saying "I can't believe I failed! ME?? ME??" over and over and over again. So memalukan! Lose face only. Ceh
Kept picturing that moment opening that wretched envelope.
Well, there's a first time for everything!
Now, I'm looking forward to going home. And am gonna kick the resits in the arse when I'm back!
And my neck is really stiff now. So bye
MBBS Part 3 Exams
BL 3rd year medics had 2 painful weeks of exams starting the 30th of June. Most people found them horrifying but i thought they were ok, save for the 5 minute OSCEs! I couldn't have screwed up more in them!
Recollection of the OSCEs
Paper Bii (5 minute stations)
Lost of Weight History
COPD history station
Oxygen therapy
Male catheterisation
Results
-Failed paper B (osces) by one station!! Fuk
-Was such a shock to find out. Like being struck by lightning....
Oh crap- resits
Bye bye summer!
Recollection of the OSCEs
Paper Bii (5 minute stations)
Lost of Weight History
- thought i did well in this
- established that the patient has lost weight, has tremors, palpitations, anxiety, irritability and heat intolerance
- has family history of thyroid disease and vitiligo i think
- diagnosis: hyperthyroidism due to Graves disease
- patient was annoyed due to reaction post flucloxacillin i think
- established all the symptoms post Abx
- established previous reaction with penicillin
- explained that she's allergic to penicillin and should move on to another antibiotic
- at the end of the station, Dr Epstein asked me: "Did you get the money?" I was so puzzled! What money? So I said "No, I didn't." Then he said, "To buy the double bass?" Then it clicked that he was asking about the orchestra, something completely unrelated to the station! Buat aku panic je
- what more to say?
COPD history station
- I thought I was doing well and asking about everything there is to ask about sputum (colour, amount, blood, smell)
- but at the end of the 5 minutes, I saw the examiner marking a whole column of 'N's instead of 'A's (with the most bored and annoyed look on her face)
- fuck
- went to the station and saw the fake arm, so started saying to the examiner: "I would ask the patient's name and identifiers such as date of birth..." and she stopped me and asked me to talk to the fake arm
- so I did, and it felt weird! Hello Mr Smith, would it be ok for me to stab you and bleed you?
- Didnt get the blood from the Antecubital fossa. bodoh
- Second attempt was panicky but got blood
- Should've passed i thought
Oxygen therapy
- man comes in with Status Asthmaticus
- pick and explain the best method of oxygen delivery
- I went for highest flow venturi mask (but i think i should've said non-rebreathing bag)
- saw a woman patient and thought: " wow i didn't expect to have real breasts to examine"
- then after i got consent etc she took of her blouse and was wearing strap on fake breasts!
- the right nipple was missing, but since the instructions said only examine the left breast, I didn't even comment on that (should've said "obvious ulceration to the right nipple!")
- examiner smiled, so i thought it was ok
- young woman with watery non bloody diarrhoea 2 weeks post eating undercooked chicken at a barbecue
- she was worried about cancer! what?
- I completely ruled out cancer and told her she most likely has infective gastroenteritis probably due to Salmonella
- young man (30 years old) with excrutiatingly painful ureteric colic and haematuria
- from the history i took, i diagnosed nephrolithiasis and told the patient it's common
- he was worried about bone cancer, and i stupidly ruled it out without even giving it much thought. trying to be too clever
- must've failed this one
Male catheterisation
- the minute I saw this, I started laughing incredulously: the last time i ever did such a thing was PPD which is bloody months ago!!!!
- stumbled the whole way and the examiner literally told me what to do
Results
-Failed paper B (osces) by one station!! Fuk
-Was such a shock to find out. Like being struck by lightning....
Oh crap- resits
Bye bye summer!
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