Take a Bow and Exit Stage Left

In just one more day, my temporary stay at the ED will finally come to an official end. I still remember the first day we started out here in the department, my friend and I were already counting the days until we leave. For some reason, we felt something amiss that we were already looking forward to finishing up this posting.

Thought I’d put up some of the remaining pics I’ve taken since this will probably be my last thoughts about ED.
As I went back and read some of the posts I’ve written, it struck me that there was one word which I had repeatedly used throughout – interesting. Just the right word to sum it all. Interesting. The really good part about ED is the never-ending challenges of diagnosing patient after patient, and quickly too, in order to provide the most effective treatment to ease the patient’s anxiety and pain and to alleviate the symptoms of the disease in which they present.

I’ve seen many, many, many patients since being in ED and I bring away oh-so-many memories and stories of which I will remember and cherish for quite a long time. Real life stories from real people facing real problems.

Our trusty ultrasound machine fondly known as Maya. Ah.. I’ve had many good and ‘eye-opening’ sessions with her. These times I will definitely miss.

I told my supervisors on the day of my final assessment that I have learnt to be a better doctor because of ED. I ‘graduate’ from there knowing what it really is like to be among community people coming for various medical needs and critical situations – unlike those in the wards where the emergency has passed.

Charcoal pills – all of the pills shown here are to be swallowed by those who, in their brief moment of irrationality, ingested poison – be it in the form of panadol, sleeping pills, detergents, insecticides, etc

I have learnt and am so much more aware of the weapons in which I possess are powerful enough to treat, also powerful enough to kill. Even water can be poisonous to some. I now know what ED is like on a terribly busy Friday/Saturday night and an extremely hectic Monday morning. My advice: Don’t be a part of that craze!

Two super enthusiastic doctors who were on duty from the semi-critical zone came by the resus zone where I was on duty that night, just to view some X-rays on our light-box.
Apparently ours was clearer. Look at how intently they examine the film up-close… and on the table too!! lol…

I’ve witnessed the unfortunate who never made it past the golden hour… the young, the old, those who left behind grieving parents and distraught children. I’ve spoken to those whom we thought were living their last hours, but miraculously picked up. I’ve been a part of a wonderful team who resuscitated a patient who entered in not breathing and no pulse, but leaving our zone with a beating heart.

Those were taken from the CT scan films of a young man in his twenties who probably was involved in a road traffic accident. Yup. You guessed it. That’s some serious skull fractures with bleeding within the brain.

I have seen those who mistreated our emergency department for trivial and small medical matters which could have been seen in an ordinary clinic.

I’ve talked to people who are simply clueless about the illness in which they suffer for years.. and some, who would simply refuse to do anything more about it than to have their illness treated when at its worst.

Our little asthma bay. To some doctors, it’s known as a potential for a disaster. Not all who come here are asthmatics.

I have had patients whose medical problems still left us clueless even up to the point of admitting them up to the wards. There are some who are like puzzles where the doctors at ED will simply have difficulty knowing and solving because of the need to ‘dispose’ them to the wards quickly before a clogged up line starts forming… and believe me, it can be so clogged up, we can even term the place ‘like a pasar malam’. I remember one horridly busy day. The resus bell never seem to stop ringing. People just kept pouring in for the worst of emergencies.

See the many tiny needles within the facial tissues? I’ve been told that this was a common practice among some older woman to ’prevent sagging’. This woman was in her 70s. Never knew that.

I’ve seen many foreigners who with bleeding wounds and broken bones would just walk away from the hospital because they simply cannot afford the treatment which they need most.
I’ve witnessed deliveries of babies of whom their mothers never knew they were pregnant in the first place.

Another X-Ray showing evidences of TB (Tuberculosis)

I step out of this department more grateful for the work of the doctors and other medical staff who are on duty practically at the front doors of the hospital. After working hours after hours in this area of the hospital that never sleeps, I can fully appreciate the hard labour they put in to serve, not just the people as patients, but they in turn, served other departments in many unseen but vital ways.

Thanks, ED.

I was a little bored while working at the wee hours of one night shift. I try to walk around to keep myself awake at night.. or I might just snooze off in front of the patient!

Reflections by the waters

Way too long. I’ve been gone for waaaayy too long. Well, it feels like I have. Believe or not, I do miss blogging, although I don’t seem to do it as often as I should.

The past few weeks have been pretty eventful. From work to some private reflections on life and all there is to it. So here’s an update for those who desperately (lol!) want to know the on-goings of my little life.

I’m done working at ED! Yay! It’s about time and am looking forward to moving on to the next. Bring it on! It would be quite unusual to be referred to as a 4th poster cuz if we were to follow the old system, I would have already been known as a HO-MO AND working locums would be legal. Oh, the joys of working as a HO for 2 years.
(BTW, I DON’T do locums… not while I’m still under training. I don’t even trust myself to treat anyone properly on my own yet)

Will probably blog more about ED and my final thoughts on the posting as whole tomorrow before I step into a new world on Tuesday. Word goes that it probably will be O&G. Argh, the joys of child-bearing (and all there is to it…)

I ABSOLUTELY LOVE THE BEACH!!

Was blessed with a short break at church camp last week and we went to Port Dickson for a few night’s stay. It’s been a few years since I’ve basked in that beach. I’ve left that place with a conclusion. If there’s anything I could wish for, I’d definitely go for beach-front property. I could just spend hours sitting in the sand, getting my feet soaked by the waves and watching the horizons. It is there that I’ve made the deepest and most personal meditations where there is completely no distractions. It is there where I feel God is nearest. I have spoken the most intimate words at the beach. It was an amazing experience. Ah, and also the joys of burning in the sun and getting a tan.

Stumbled upon some really cute twitter pics from Smashing Magazine. They were simply too cute that I just had to borrow them to decorate my blog.

I thought this was most adorable.
Look at its little tongue sticking out.

So yup. I’ve officially put up a “Follow me on Twitter” link to the right. So if you’re a twitterer and would like to follow me, you’ll see the tiny blue bird on the right. Although I haven’t quite been twittering recently, I will try to as often as I can remember.

I guess that’s all I have to say for now. Hopefully more up tomorrow.

PB ends

on bittersweet tragically haunting scenes.

To finally think that it has finally come to an end, after all that chasing and solving and escaping and fighting, it’s now no more.

There is a nice sigh of relief for all of them that they are now all free – for some more free than the others.

I wished that the ending was a little nicer though with a “and they ALL lived happily ever after” moment. Guess these writers just love to torture the fans.

Sigh.

Clubbing

 

lol. No. Not talking about late night dancing and drinks. Although this did happen late Saturday night. A man came in because he accidentally slit his wrist.. but I could not take my eyes off his fingers.

It was gross clubbing of his fingers.. and his toes. Story goes that he started developing it since he was 13 years old. He was born a healthy child with no congenital heart diseases. When his mother was admitted into the ward weeks ago, the specialists during their rounds noted his fingers and suggested for further investigations. Turns out he is disease-free.. which is odd. Because clubbing usually is a sign for several diseases and if you’re curious to know, read it on Wikipedia.

Spoke to him about what life is like having such oddly shaped fingers. He does have difficulty eating with his hands, he can’t pick up fine small objects from flat surfaces and even trimming his nails are a hassle. Poor guy.

Some dynamics have changed in ED recently. Firstly are the oncalls we’re required to do. Instead of the three shifts in two days stunt we had to perform twice a week, which I wrote of before… now we have to do four in two days… and still no day offs for post-call. FOUR shifts in two days… that means, morning shift, afternoon shift, night shift, immediately followed by the morning shift after. According to our auditing people, we aren’t fulfilling enough hours to claim our oncall money (speaking of which, I have not received ANY money for my crazy oncalls I’ve done since stepping into ED because of all this nonsensical queries! ) We fought for a short break during one of those shifts because there was absolutely no way we could survive four shifts in a row! So in the mercy of our bosses, we were granted a short break from 5pm to 9pm, after which we were required to report back for duty. Now that’s not so short a break for me, given that I have to drive home, in the after-hours jam, reach home, just in time for some dinner, a shower and I’m off to work again. No more nap time as before.

We have more house-officers in ED now. Think our latest number is 24 now? Which is great. We have at least 2 in yellow and resus. Can’t add more numbers in the green zone rooms because of the lack of space. Yes, in some ways the load has lightened up a lot. But also for some reason, the number of patients have increased significantly in the recent months too. Recession I suppose… or is there really? Still see malls bustling of people shopping and buying.

I’m feeling poor. lol.

ED in the limelight

It was a piece of news which rocked our department. The false accusations hurled at our faces angered us… though it wasn’t quite made to us at that time, we all felt insulted.

Had I not been assigned to the medical standby team to oversee an event graced by the First Lady, I would have been seated in the next room. So I wasn’t there when it happened, in fact, I first found out about it through the radio on Monday morning, and only learning later at work that it happened in my very own ED. My dear colleagues were the poor victims of the vicious verbal assault.

The first newspaper report: April 27, 2009

Here: Our Minister defending us

Mind you, he did not knock the door. He barged in and practically created a scene out of the prescription given to the university student (which naturally means that his ‘victim’ was already seen by the doctor).

Why were the patients at the waiting area not seen?

First, one must understand the principle of triaging patients. Critical patients who desperately need emergency medical care will be sent to the resuscitation zone immediately by our triager in the front of our department. Likewise for the semi-critical cases – to the yellow zone. Almost cold cases or stable ones, where patients come in for bruises, small cuts and bumps and all those very minor problems (which make up a whole lot of our patients everyday) will be sent to the green zone as they are healthy enough to wait and healthy enough to walk in through the doors to see the doctor for treatment.

There were only three patients waiting. If you’ve worked in our ED, you would easily noticed that a patient often comes with a huge entourage of concerned family members. Sometimes it gets irritating when the entire family wants to squeeze in the tiny room with the patient already on a wheelchair to give their input on the situation. Back to my point, patients come with family… which made up even more of the numbers sitting at the waiting area.

Now if you were also a doctor working at the ED, the last thing you want is having 20 patients waiting outside to see you and the last thing you want to do is to do your own ‘personal stuff’ and have those patients wait outside.
Delaying our time to see them would:
1. mean not being able to see all the cases coming in during our shift time… and that means going home late. Who would want that?
2. make our patients impatient and they come in with a grump and humph about waiting outside for so long. Of course, they’re always blind to the other hundreds of patients waiting outside and that we work on first come first serve basis (but there are exceptions). More often than not, we’re made to skip lunch (if working morning shift) until three or skip dinner (if working the afternoon). Of course nobody would know how hard the doctors are working behind the closed doors.. sometimes not even having the time to go to the loo. Of course nobody sees the complicated cases that come through our door, needing Xrays and blood tests and ECGs done because they have multiple diseases or very deep laceration wounds.

Of course nobody sees, but one fine day, some deputy guy barges in the door on a relatively free Sunday morning (most early Sundays people sleep in and don’t come as early as they would on Mondays as those are the days they want to run away from working and they want their MCs) and happens to find one doctor glancing at the newspaper left behind by the patient. Why weren’t they seeing cases when there are three outside, you ask? Because their cards were still at the registration counter. There were no patient cards in the box of the consultation rooms.. how were the doctors expected to see them then?

He made very awful and extremely false statements about the people who work hardest to keep our society healthy. Many of us forgo sleep at least twice a week, work very odd hours and receive lower salaries than our counterparts in other career fields because this is our passion. But if we were to be accused falsely for being lazy, then the accuser has horridly breached the line.

Try working in our ED for a day… then you’d know how it really is like. Don’t dishonour the group of people who have served the people most.

PS: Try looking up his blog. I didn’t want to link it here. No sign of apologies at all. Sad.

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.

More than a thousand words

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.