Music and me

It’s been such a long time since I’ve just spent some good hours with my piano. The last was probably way before I started ED posting, and only until recently was I finally able to touch those keys again and play…. and only to find out how much of my skills have rusted.

It was the thing to do when I felt stressed. When I was angry, I would play loud Chopin music and literally feel much better after that. I love the way piano sings (under talented hands, of course).

It was nice to finally play and sing and pretend to be Sara Bareilles, or Mandy Moore, or Mariah Carey. Only for my ears to hear, obviously

At this moment, I absolutely love David Cook’s “I Don’t Wanna Miss A Thing” and “Here without You” by 3 doors down. These songs have been stuck in my head for some many days now.. and it would have been perfect if David Cook sang them to me… Heehee. Siggghhh..

Currently listening to: Here Without You
by 3 Doors Down – Away From The Sun

The story of my night

We need more hospitals
…actually, we need more hospitals that work for the people.

We need more doctors
…ones who are free to make right choices for the people.

Let me give a real life example.
While working through my shift last night, I had a 40something year old Chinese lady who walked in my room. She looked extremely pale and very lethargic. She slumped on her chair as she spoke to me. Her hair didn’t look real…it was too large for her head. She came in complaining of severe abdominal discomfort and she handed me a letter. She has stage IV gastric cancer with evidence of metastases into her lungs and liver. Diagnosed in a nearby private hospital and she has completed 6 doses of chemotherapy. She had requested to her doctor to change her treatment in a government hospital. Why? Her money’s running out. This is not an unusual situation. I’ve had to manage many many patients who had to turn to government funded hospital because our private doctors have sucked all the patients’ money from their pockets. Anyway, back to the story. This lady’s discomfort is probably coming from the enlarging cancer and the liver. I could easily feel it in her abdomen. Hard. Deadly pieces of mass probably from the mets in her liver. She needed an admission to manage her pain (which is a cornerstone of cancer treatment). She was almost in tears as she begged me to admit her in the wards. I’ve never had a patient grab hold of my hand during consultation before..but she did. She was desperate.

Naturally, this would fall under the oncology department’s responsibility. She has already been given an appointment date at that clinic at the end of this month, but she couldn’t wait until then. The pain’s disturbing her sleep. It was half past 4 in the wee hours of the morning. I called the oncology doctor on call. He couldn’t admit her into the onco wards. Why? Because they have not open her own personal oncology patient file yet. I was stunned. Just because she lacked a piece of paper, they would not admit a patient who already has been diagnosed with nothing else but cancer!

I had no choice but to call another primary team to admit her into their care first then proceed to refer her case to the oncology department from their own ward. Stupid long twisted road to get to the same destination… but that was the only do-able thing left to do. Her kind of cancer fell under the surgical team’s. I called the doctor on call. I hear the reluctance in her voice. But she agreed to come down to the ED to see the patient anyway. As expected, she too, wouldn’t admit the lady into her surgical ward. Apparently they don’t admit patients in their ward just for pain management. Obviously I knew that! They only take in patients who can be treated with some surgical procedure. Patients like her who need pain management are usually admitted into the oncology ward… who is not accepting her because she has no file.

I’m not bad talking about this doctor. I understand her situation as well. She is restricted to set of rules made by her boss that there is only a certain set of criteria that must be met before admitting patients into her wards. I’ve seen them workout patients very thoroughly first before even considering to admit. Having surgeons breathing fire down your neck isn’t the best thing to experience. But here in our hands, we have a lady (with a known cancer, mind you) in pain who is stuck between nowhere because of the red tape drawn to protect everybody’s own bum. What did she do? Discharge the patient back home with pain meds. Now here’s a pointer for those of you who thinking you might come to the ED for some illness someday. We can’t discharge patients with any pain meds stronger than sodium diclofenac (an NSAIDs). Those meds probably fall under the moderate pain control group. It’s like trickling a small stream of water in a blazing fire to put it out. It’s not as bad as sprinkling water, but it won’t help… as much.

In the same time, I do understand why some of these red tapes were drawn as well. Our wards are crowded. It’s ridiculous how people just love to flock to HKL. In fact, earlier on last night, we had a staff announcing that the female medical wards are already full and that we had to be judicious with our admissions. Not that we’re not, but the sieve has been made thicker. I heard that patients were already only on chairs.. they’ve ran out of canvas beds.

Why is it this way, you ask?
ONE: There is this generalized mindset among society that treatment in HKL is reliable and that it works. Because they’ve been so used to coming to HKL, it was the only place they could think of going to. Because the medicine in HKL works. Because they were born in this hospital. Because it’s cheaper than UMMC or HUKM.
TWO: Because the newer high-tech hospitals have been programmed into a system whereby they will not take in anymore patients than they can keep. The computer system will not allow them to do so. So any excess patients that appear at their doorstep when they have reached their maximum patients in ward, will be sent to none other than HKL where we still work with pen, paper and computers which are still only in black and white.

That’s why our wards are full. That’s why many lines are drawn about admitting patients. That’s why some patients like this lady have no where else to go but to suffer back home with her little pain meds and wait for the end of the month so she can see the oncology clinic proper and have her file opened.

I had to return back to her bed where she was resting to talk out what was decided by the doctors on call. She was feeling better because we had injected her with some high powered analgesia. I could sense the disappointment in her. I wished there was something more that  could do. I wrote another referral letter to Oncology requesting for them to consider bringing her appointment date forward. Since she was in the area, I asked her to bring it to the Onco Building once office hours began. Told her to cross her fingers that the letter might do some magic… and I bade her goodbye.

I wished there was something we could do to make all of this better. I wished we wouldn’t have crowded, unhealthy wards. I wished things were not so difficult for simple matters.

We need hospitals unparalyzed by a rigid technology system. We need hospitals, not even the partially private ones.

And that must begin with doctors who care and see what’s it like at ground zero and most of all, are empowered to do something about it.

ED

I’ve contemplated for sometime about whether I should continue writing what I really felt like penning down yesterday. A part of me felt that if I did, I might tarnish the image of ED when a part of me knows that there’s so much more to ED than just these not-so-great experiences.

What happened today finally launched it to the pages of my blog.

I’ve never felt more taken advantage of until after being in ED. It is to a point of being absolutely ridiculous how SOME (mind you, only a handful) speak as though they could never function fully without the help of house-officers around. And ALL I could think in my mind is that they were able to function before without us, it should be no different than it is today. Fine. Maybe more patients have showed up at our doors… but to sink so much to the point of almost helplessness? Surely that can’t be!

Of all the times where I almost felt like crying at work, two out of the three have happened when I was in ED. (The first occurred when I was in Orthopaedics when some bossy MO from Anaes comes saying the most insulting things just because my consultant wants to use the OT for an emergency op). How do I even begin to explain why I felt that way, what happened to make me feel so vulnerable emotionally…it’s difficult to. But usually I feel so when I personally believed I did no wrong but was simply accused of doing so. Yesterday I had to wheel a patient from my zone to the resuscitation zone. She was having an anaphylactic episode. All I did was walk beside the bed until we parked her into a cubicle. Now once we were there, I watched as the staff quickly put on her the necessary basic steps to resuscitation… oxygen, cardiac monitor, pulse oxymetry, etc etc. In the same time, I was passing over the story to my fellow colleague house officer, when out of the blue, the MO comes storming in the cubicle and raises her voice, questioning me why I had not passed the case over to her. I was stunned. It was unexpected and I had not even left the resus zone, how could she say that of me? How could she quickly jumped into conclusion that I was not going to pass the case over to her? Was she expecting me to run to her-highness’ lair at the counter to present the case whilst leaving my patient to be handled by the staff themselves? Perhaps she wanted that. I don’t know. I stumbled through the case presentation – clearly I wasn’t even thinking of what I was saying. As I went back to the counter to write what I had gathered from the patient, I had to literally blink back my forming tears. Yes, I’m a cry-baby. But I really felt like I did no wrong. I don’t know. that’s just me.

The message rang truer than ever when I received a text this morning from an MO about swallowing the pill and just persevering through this rotation. (Thanks Doc!) I really thought that was what I had to do for the remainder of the posting. Just suck it up and get myself out of trouble. (Although it looks like the opposite is about to happen… I am going back for night shift later to find out how much of deep poop I’m in, regarding some patient from the morning shift! UGH!).

However, not all negatives are said about ED. There are many other MOs who are friendly and more than willing to teach and help out. There are just some who well, are more concerned about getting their bums fire-free. Sigh.

I’m running out of time.. gotta really head back to the hospital now. I need to start hitting the books again too…. now I’ve got an mid-posting assessment to face up with end of the week. Sigh…

UGH!

I’m sorry that the past few days of pondering hard about what’s best to write did not lead me to actually causing my fingers to type on the keyboard… but today’s sudden surge of sheer frustration did make me type vigorously indeed.

I am sick and tired of all of this nonsense.

There I said it.

I am sick and tired of the pompous hypocrites with whom I see everyday. I cannot stand some who are just plain LAZY bullies, who would rather let patients wait longer outside so they don’t have to see them. I completely dislike those who just won’t use their brains for a little bit more but rather subject others to be admitted because that’s the easiest way out, and rather laze around and have others do their job for them. I will not take it when someone bosses me around unreasonably ridiculously and expects me to do what they say because they are given the post they were given. I do not like those who check out their salary (from my own tax money!) but are not seen working in the scenes. I cannot stand people who lie – when asked something, but answered a whole different fake story. I am frustrated at those who cheat others for their own pleasure and happiness. It makes me cringe to be among parasites who suck the blood out of you so that they prosper. I am very much disappointed that some would rather betray the closer ties of relationship for another.

I could go on and on and on..
The more I do, the more nauseating it actually is.

Running away sounds really good right now. Actually, come to think of it, people are everywhere so that I need to run away to a people-less place… which is non-existent. Unless it’s Antartica or the middle of the Sahara Desert.

I was so tempted to say, “How about not seeing the lights of tomorrow’s day?” but I know by saying that would sound a lot of loud alarms and sirens, causing unnecessary panic.

Don’t worry. It won’t happen.

I’m off to work for the night.