My head’s just bursting with things to write. There’s so many issues which I’d like to address, so many matters to talk about.
If only I had the time to sit down and write, without feeling the need to sleep.
But here’s what I can leave behind for now.
Guess what’s the problem in the picture. It’s pretty obvious.
Will write more soon. Stay tuned.
For the first time in a long time, I woke up this morning actually believing it was a weekend. It didn’t take more than a minute for me to realize it really was a working day (I didn’t care what weekday!) and that I was late and had slept through both my alarms (I have an alarm clock AND my phone set to ring at different times just in case I couldn’t be roused by one)… or maybe in my slumber I unconsciously snoozed both of them? I don’t know. This has happened before…definitely, but it has been quite awhile.
Practically jumping out of my bed and getting ready for my near dead life, it didn’t help that my mom commented that I should think about reasoning out the crazy hours with my superiors (coming straight out of Orthopaedics, these are crazy hours in comparison indeed). I could only mumble that there is nothing much that I could do about the situation. I had just ended a three-shift-in-two-day stint which comprised of a morning (8am to 3pm) and night (10pm to 8am) on the first day, immediately followed by an afternoon (3pm to 10pm) the next day, forcing a few hours of nap in my system between shifts (if I could even force any… my body’s losing its sleep wake cycle orientation!). I was scheduled to restart another of the crazy cycle again today. In fact, both my parents were commenting about my working hours today at dinner… it’s all in the name of housemanship, I guess. Since when labour laws were ever on our side anyway?
Dashing out the door, I thought thankfully that it’s the start of the school holidays, which means there may be less cars on the road… or so I could only hope. Technically by the time I left home, the supposedly ‘missing in action’ cars on the road would have arrived at school anyway… so it really didn’t make much of a difference. Great…
Don’t get me wrong, A&E posting can be quite fun with the right perspective and attitude (of course, it’s also important that you need the right people to work with too) but it’s the hours that really bogs one down. With no difference in the working hours between a weekday and a weekend, one could really start to forget what day of the week it is… unlike in other maybe more luxurious postings, where the one only has to work up till noon on a weekend. The number of the patients pretty much is the same on any day of the week, we still have to dress all formal on weekends, so really, there isn’t much of a visual indicator to remind us of the joyous weekends. (Of course, seeing colleagues from the other departments comfortably in their jeans on Saturdays and Sundays do help somewhat!)
Been seeing quite a lot of ‘interesting’ cases in the numerous time I’ve spent in that emergency department. Think I’ve only got time to share one here. This… a patient of my friend’s. I just happened to stop by the room and saw the case.
Poor young lady while wearing her solid jade ring accidentally whacked her hand on her steel bed frame. Finger with ring started to swell and cause her pain. Finger was so swollen she couldn’t even take the ring out of her finger… yes, she tried soap and butter. It was a compartment syndrome just waiting to happen. Even our MAs couldn’t break that never-ending circle with one of their equipments. They eventually did with bigger pliers, so I heard. Not sure if it’s clear enough here in this photo, but you can see a fracture line in one of the bones on that finger. The second bone from top – the middle phalanx.
Alrighty… gotta go get ready to start the next shift of the day 
Have you ever felt so frustrated with the things going on around you that all you want to do is just cut off all the strings that hold you to the ground and escape?
I do. Perhaps that’s my way of handling situations that make me uncomfortable – y’know the fight or flight response. That’s me. Flight.
A lot of things are happening which in a mix is pretty difficult to handle. Stuff at home and work, things going around with friends.. and even those who aren’t quite friends. Argh.
Right now, I just need to think of place to run to.
It’s quite saddening, actually.
Wikipedia (my favorite reference 
) writes compassion as:
a profound human emotion prompted by the pain of others. More vigorous than empathy, the feeling commonly gives rise to an active desire to alleviate another’s suffering.
Two scenarios on the same day. Two responses descriptively exemplifying two opposite ends of that one word we call compassion.
Of the many patients I saw that day, there was one different man who walked through the door. My MO with me had gone for her lunch break… and so I continued to pick up the patient’s cards for the next consult. Opening the trauma labelled file, the words that stood out than the rest was “Under PSY follow up at HKL”. Now normally I try to stay away from all the psychiatric cases. They’re too complicated for me. I wasn’t exactly sure what to get from them other than knowing the trouble they have caused in society, what psychotic symptoms they were experiencing, then look into any injuries they may have had in their flare up. Most of the time, the proper diagnosing and management comes from the psychiatry MOs who will have to review them all over again but in greater detail.
So I braced myself. Calling his number in, an Indian man in his 50s came in. He had a plaster on his head and on his arms. In his rage and frustration that morning, he had taken a light bulb and hit his own head with it, then tried hurting himself. He lives in a welfare home and they had taken him to the hospital for treatment. Amazingly none of the home’s representatives walked in with him. He was left alone in the waiting area. He had ran out of his anti-psychotics and all he wanted was medicine. He stuttered a lot and repeated himself many times. When asked about his auditory hallucinations, he described hearing many voices, each of a different language and he looked very disturbed about it. Occasionally he would stand up and walk around in the room to further prove his point. I had to stand up and stand near the door, ready to run out of the room in case he had gotten a little bit too aggressive. But he wasn’t. He could be easily coaxed into sitting down and talking properly. He clearly needed his regular meds and this very much warrants an admission in the ward. After checking on his wounds which were thankfully very very superficial (for a light bulb smash!), I asked him nicely to wait outside while I call the psychiatry MO to come and see him to prescribe him his meds.
I called the MO. She said to lock him in the isolation room – a room which we have at the end of our small corridor to temporarily house aggressive schizophrenic patients. This was more for the security and safety of the other patients. I replied that this man was not aggressive and I personally did not think he needed to be isolated in that small room. In fact I was thinking that locking him in that room might further aggravate him into announcing that he was mentally abnormal. MO quickly ended the conversation saying she will come later to see the patient. ‘Later’ being the keyword. As I was talking to my other patients after him, he kept coming in the door asking for his meds. All I could do was reassure him that I have called the appropriate doctor and she will be here soon to see him. In fact, just to be sure I would not get by butt burned, I had asked other staff members whether my patient needs to be kept in the room. All their replies were the same. If he is not aggressive and harmful towards others, he need not be there.
When she did arrive much MUCH later, he was no where to be found. He was gone. In her own frustration, she quite loudly exclaimed, “See? I TOLD you he should be isolated. Now he’s gone and no where to be found.” I honestly felt quite bad he had left, but I still firmly believed that it was not right at all to isolate a non-aggressive, relatively calmer man, even though he was a schizophrenic. How would you feel if you were made to go and wait in an empty cold room like that when you had done nothing bad to others? She walked away with a humph.
Much later on, I called another patient number. A woman in her 40s wheeled a man in his 50s into the room. Both of his legs have been amputated up to his thighs. His wheelchair looked old and was falling apart. Under his bum, on the chair was a cardboard and under the cardboard were some clothes. What an odd way to keep things, I thought. Now here is a story to tell.
She is a single lady working with a charity organization and was having lunch in Ampang. She sounded like a very well educated woman and seems like she had some medical background. She used to be a nurse. She met him on the streets, on his wheelchair and it looked like he was having chest pain. He does not have a home and was living off his wheelchair. He had ran away from the government welfare home for reasons I don’t think I should disclose here. She took him into her house for the night so she could take him to the hospital for treatment. He was a diabetic in need of insulin, but he had lost his injection pen. When I tried to ask him questions, he would only speak in words, mostly grunting to acknowledge the pain. He was not in a good state of health at all. She requested that he be admitted to sort his health and medication out while she would go to her boss who also started a home for the homeless to see if she could put this man into their care. My heart just melted and the story felt like a breath of fresh air in such a cold society. Good Samaritans like this actually exist!
While she went to sort his registration for admission, I took a few peeks at the man just to make sure he was okay. He fell asleep comfortably on his chair! The only times I can sleep upright on a chair is when I’m on-call and when there are no beds around and I need an hour or two of sleep. She was such a thoughtful and friendly lady who clearly showed much compassion to those who are suffering around her, even to strangers.
How many of us would actually do something like that? For once, it reflected back upon me and I felt ashamed. Which of us would go out of our way to make other people’s lives better? I know I hadn’t.
Until I received my first opportunity this morning. As I walked out of the Emergency Department to leave after my night shift was over, I was stopped by one of our security guards. She asked me if I had an anatomy book for students. This woman is a widow, has a daughter who is studying nursing and she can’t afford to buy her daughter the book she needs. I promised her that I will look through my books to find if I have any and pass it on to her. All I could was smile as I walked to my car. This is the beginning of many opportunities. I will do my part as a doctor in a community so much in need of compassion and unconditional love. Sort of like that movie “Pay It Forward”.
Now time to go look in my boxes before I head back out for my afternoon shift…
I wouldn’t say that I’m ecstatic working in the A&E Dept. Some days have been good, some days not so good. But I will say that it has been interesting. Quite an eye-opener to the work and service the A&E provides to filter the patients warded into the hospital for further care. Makes one a little more appreciative of their work and really, the skills they need to acquire to know practically everything there is to know about the human body. What more in HKL, the national referral centre.
A lot of things are unpredictable here in the A&E so one has to be on his/her toes ready all the time. For one, the workload’s unpredictable. Let me give an example, last Tuesday there was a torrential rainfall resulting in massive traffic jams practically everywhere in KL and even more so in the roads around HKL. I was stationed in the Red (Resus) Zone and there were practically no patients coming in for hours. The yellow and green zones were quiet that evening too, simply because nobody could get in or out of the hospital grounds because of the flood and jams.
The patients and cases coming in are very unpredictable. Everything under the sun comes in for treatment. On that same day, I visited the yellow zone and there was a young girl who came in almost paralyzed like after she has a whole body muscle cramp. She was practically on the bed, only able to blink her eyes. She couldn’t respond to us when we asked her to, she couldn’t even move her muscles at all. We know quite well that she could hear and understand us because she had tears rolling down her eyes when we spoke to her. We did all the test that we can in the A&E side and tried cracking our heads for her diagnosis before the neuromedical team came and took over the case. Now this is the part that I find a little lacking in the A&E. We will never know the true definite diagnosis of the patient. Our job really is the receive patients, stabilize them as much as we can diagnose at the first hours of their arrival and send them where they most need to be – either back home, or under observation, or to be warded for proper treatment. I wished I would know what was wrong with that young lady.. I guess I will have to ask the doctor in charge that day.
The things these patients tell you or ask of you can be very unpredictable. The stories they tell, the requests they make, the excuses they give. Amazingly funny. Sometimes eyebrow raising.. sometimes there are very sad stories too. Today, there was a young lady who came in with both her eyes extremely red and swollen. She claimed that her brother was sniffing/smoking drugs and had accidentally blown the ash/smoke into her eyes. From the examination, there were some very serious damage to her eyes. She had a chemical injury caused by alkaline substances (which is worse than being injured by acid). Best of all, she was very comfortable. She was laying down, very quiet and not complaining much. We suspected she could be high on some of the drugs. More probing later on finally revealed that this mother of 2 young girls was also involved in the drug-high session. Sigh.
Alright. I’m almost late. Gotta get ready to go in for another of the many night shifts. It’s a red resus night… with the specialist on call who has extremely unpredictable mood swings. Sigh.
*I secretly took this picture. If the HOD finds out, I might be decapitated*
‘Twas just like any other weekend in the Resus(citation) Zone. It felt like a quiet morning, everybody was just getting ready to start the day… and then there it was. The three bell rings. It was almost as if they signalled the clock turning eight.
Patient with SOB (Shortness Of Breath). Not long after that, patient with malaena, then another with seizure, followed by a few more also with seizures, and the list continues.
The interesting bit about working in the A&E of HKL is that you get the information of riots or disasters early, like the landslide in Bukit Antarabangsa. This time my specialist received a phone call from the police. There was a riot in Brickfields and they needed us to be on medical standby, in case the injured needed urgent treatment. It was only later on did we find out that it was one of the Hindraf protests. Thankfully none of them were serious enough to come to my zone, although one of them eventually did. He had to because he had a serious reaction to the meds he took for his injury.
It was pretty much non-stop for the whole shift – with referrals also coming in from Malacca, Seremban and even Ipoh.
Almost towards the end of the shift, this really interesting case came in. (I apologize for the jargon. I’ll try to keep it as simple as possible)
A 41 year old Bangladesh man, with diabetes and defaulted his medications for 4 days, came in with acute and severe SOB. He had right sided pleuritic chest pain. OK. That’s pretty much the history you can get before you start intervening and treating his acute state. Examination: Thin man. Sweating. Respiratory rate about 30. Chest examination: Reduced breath sounds on the right side. Coarse creps on the left. Hyper-resonance on the right.
Once we gave him the high flow mask. Proceeded with further history when he was a little more comfortable. He’s been coughing for 2 months. He has lost a considerable amount of weight. He isn’t sure whether he has contact with TB patients.
Take an X-Ray. What do you see? This.
Now we have a dilemma. It’s TB complicated by pneumothorax. Not just that, notice the streak in his upper right lung. That could be some loculations right there.
Now how do we solve this? A pneumothorax naturally calls for a chest tube drainage, but given this special case, inserting the tube will not help. Why? Notice the positions of the loculations. That’s pretty much where we’d puncture the tube it and if the loculations has cause some compartmentalization in his pleura, you’re pretty much only draining the air from the upper zones. Further more, the tube may facilitate spreading the infections to other areas which we do not want.
So, to tube him or not? He definitely needs the air drained. Look at the deviated trachea. The pneumothorax has pushed the trachea and heart towards the left side. But how? The tube won’t help.
The story ends with my specialist planning to use a needle to aspirate the air from the 5th or the 6th intercostal space. I wasn’t there to witness it – I needed to get home to rest before starting the night shift. I was already staying back an hour to see the updates of this case. Don’t quite know what they did exactly then. I should’ve asked.
Yeah, working in A&E may be quite exciting in that sense – fresh cases, treating them in their most acute and where time matters most. Today, A&E posting didn’t feel so nice like it did. Some people in the department are such a pain. There isn’t that nicey feeling of working well when you’ve got ‘colleagues’ like that around who manipulates and be painful. I wish there was some meds to make them go away.
Ugh.
