Just Keep Knocking

Sorry folks. Got feedback that the link to my new blog isn't working. Checked it again and again...and it seems to be working fine. Gee, how long does it take for a new domain name to "propagate" through the Internet?

Moved!

It's A Doc's Life has moved.

If I'm on your blogroll, kindly update my link !

Gate Crasher

I will be gate-crashing an intensive care conference in Kuala Lumpur tomorrow.

A physician in the midst of anaesthesiologists and intensivists. I hope I won't be singled out for my ineptitude in all things ventilator-related.

Blogging shall resume in 3 days' time.

Innovative Patient

Spotted in my ward : One lady's fierce determination to ensure that her IV cannula stay firmly in place.

Her request to have her plaster reinforced must have fallen on deaf ears.

Shameful.

Very Irritating Person?

V.I.P.

What it means to me :

• patient with acute myocardial infarction - needs my immediate attention and antifibrinolytic therapy STAT. Time is myocardium
• patient with respiratory failure - needs my immediate attention and early anaesthetic assessment for consideration of assisted ventilation
• patient with upper gastrointestinal bleed - needs my immediate attention and judicious fluid resuscitation while we arrange for means to stop the hemorrhage
• patient with a sudden deterioration in GCS - needs my immediate attention and assessment for need for airway protection while measures are underway to determine its cause
• patient with cardiac arrest - you know what he/she needs

What it doesn't mean to me :

• high-ranking government officer who walked in (or chauffeured in, whatever) with fever for 3 days, but stable
  
• relative of some MP who has mild abdominal discomfort
• some Datin with moderately high BP but asymptomatic
• resident orthopedic surgeon's neighbour who has diarrhoea

Can't we just do our job? Your order of importance is dictated by the nature of your medical condition, not your status. Don't pry me away from a patient who deserves my attention more just because you are an "important" person who happens to have a trivial medical problem.

Did I just commit professional suicide? Maybe. Not that I have any political aspiration anyway.

I took an oath to be fair and just to my patients, and I intend to honour it.

Everyday Hero #2

I cannot possibly do for one and not the other.

This is beginning to appear contrived, but I really do have something to say about the first man in my life.

I have a cool dad. Not cool in the fashionable, hip, tech-savvy sense, but cool in the way he raises his children. He's conservative, yes, but not in a you're-not-wearing-that-out sort of way. I remember a childhood peppered with humour, lots of story-telling, and even more books. He hurt more when I grazed my knees, cooked us horribly bland food when we had acute gastroenteritis, ferried us to various school meets, sports outings and tuition classes, and remained very supportive of our choices in life. He's dependable, reliable and kind.

Some say we came out of the same mould. So dad, I'm proud be your girl. Hope you're proud of me too .

Happy Father's Day!

(This time I'm posting at the right time.)

*Image courtesy of www.donnabellas.com

R.I.P.

Sucky, sucky, sucky.

3 mortalities. Thought by now I should be accustomed to deaths, but yesterday's just felt particularly sucky.

Man in his 60s, single, survived by a brother. COD : Advanced colon carcinoma. Did he even have his chance at a meaningful life?

Man in his 30s, mentally-challenged, welfare home resident. COD : Diabetic ketoacidosis and septicemic shock. Survived by no one. I stared at his I.C. and felt depressed that his demise probably meant nothing to anybody.

Man in his 50s, heavy smoker, survived by one son. COD : Acute myocardial infarction with cardiogenic shock. Another boy has just become newly orphaned.

As for me, I was worn out, physically and emotionally.

And the curtain closes on a chapter in my professional life.

*COD = cause of death

August 2002 And Everything After

14 June 2007.

I am on call today. It's my last call as a medical officer, since I started in August 2002. For many nights in the last 5 years I have had to spend nights alone in the hospital (mostly awake), walked along empty deserted corridors and entered spooky elevators in ungodly hours of the day, had uninspiring (to put it kindly) on-call meals provided by the kitchen, dragged myself out of bed to attend to patients who had a knack of "collapsing" the moment you fell asleep, and braved temperatures of Artic proportion in the very, very cold emergency unit in Sarawak General Hospital.

It's a lonely business, what we do. When the world is sleeping, you are up, thrust into a position to make life and death decisions. There have been s****y calls, when bad outcomes transpire despite all that you do; there have also been rewarding moments, when your action makes a difference (with a little divine intervention).

I shall miss escorting patients in the short journey from casualty to CCU most, where I would surmount all my strength and push open the CCU doors to allow the trolley through - a moment time and time again I would liken to Aragon pushing open the door in Edoras in his return from near-death (Return Of The King). A little fantasy-diversion wouldn't hurt!

And my on-call attire...my trusty black top from Isetan I had worn on most of my calls, is starting to fray. Even the backpack I carry to store my personal effects has a small tear near the strap. It's time they retired, having served me well over the years.

Strange, somehow I don't feel like I'm moving forward to a better phase. Now s**t begins!

Blackout!

What a night!

The lights went out on me last night. It wasn't personal. I heard the whole of Seremban had a power outage too.

And lives were disrupted, plans foiled. Hair left semi-dry, recipe for frizz. Laundry pile gaining critical altitude, deferred yet another trip to the washing machine. Navigation around the house aided by the faint glow from my mobile phone screen, with a high risk of rolling down the stairs and sustaining a head injury (and we wouldn't have been able to find the car keys to take me to the hospital). Blog not updated...at risk of losing its readership?

So what's a man and a woman to do?

I played Quadra Pop - a pathetic underwater theme Tetris rip-off which is strangely addictive - on my mobile phone, while hubby fell promptly asleep beside me.

Yes, many a generation have been conceived in darkness, but it simply had no amorous effect on 2 very tired people!

Unclear On The Concept

Some patients can be so unbelievably clueless. Some examples :

• Man walks in, sits down, says HI and then asks, "Doc, what's my BP today?" Wait, I haven't checked!
• Woman, told that she's just been diagnosed to have diabetes mellitus from her blood test, exclaims incredulously, "You didn't even check my urine! How do you know for sure?" (Can I propose that the misnomer kencing manis be banned?)
• Man, told that he has renal impairment, asks, "Which one? The left or right kidney?"
• Woman, a hypertensive on treatment, pleased that her blood pressure has returned to normal, asks hopefully, "So am I cured? Can I stop my medications?"

A former consultant of mine was of the conviction that no one should ever be admitted for hypoglycemia. If ever, he was adamant that it was the medical practitioner's fault. I remember an exchange during a grand ward round when we were house officers in the medical ward.

Consultant : Why is this lady here?

HO : Hypoglycemia.

Consultant : You are not answering my question. Why is this lady here?

We were dumbstruck, but really, his point was that no patient would develop hypoglycemia if we took the trouble to educate our patients.

HO : We have counselled her on multiple occasions, but she just doesn't understand.

Consultant : You don't need a high IQ to comprehend these instructions, just common sense. And she can't be so stupid.

(Turned to patient) Makcik, apa itu Proton Saga?

Patient : Tak tahu lah!

This has now been immortalised in our memories as the "Proton Saga Story". The point is, patient education is extremely important, but on many occasions, all your advice and instructions fall on deaf ears or get deflected by a thick cranium.

Well, we do try anyway.

Newly Added : Blogroll

Technology is a beautiful thing (yes, the geek in me has spoken!). Over the last few weeks I have reconnected with some people from my past, with a little help from blogging.

YLTan aka DocPerineum (it's obvious what he does, doesn't it?) is a former colleague from the Land of The Hornbill; he also lived in the room across from ours in the HO quarters. He is a budding photographer when not dealing with matters of the nether regions.

Dr Flora maintains a witty blog that tells of funny patients and even funnier medical personnel in Sarawak General Hospital, hence it's no surprise her blog is called Laughter, The Best Medicine. We have never actually worked together in the same department, but have braved heights, leeches, the open sea and endless boring lectures in our induction course.

Medic Fang was a classmate in medical school. Known for spouting the best straight-faced one-liners, he continues this tradition in Medic Diary, with his funny insight into matters both medical and non-medical (like movies!). He was actually part of my husband's group of Heroes Of Might And Magic fanatics fans - they had marathon sessions lasting well into the wee hours of the morning, and called themselves by nicknames.

I have hence added a blogroll - of blogs by people I know and those that I stalk visit often. Now, when do you think a class mate from secondary school will drop by and say HI?

Organised Chaos

This is a copycat act following a rash of posts featuring doctors' worktops/desks in the MMR.




This is where I spend most of my waking hours at home - where I have toiled for my membership exam, spent countless hours in the quest to better my own Bejeweled scores, edited scores of photos, and blogged. Most of the time with my husband next to me playing real-time strategy games.

There's a Pfizer year planner for 2006 (!), stacks of review articles yet to be read, a notebook that's perpetually glued to the table top, some water bottles that have been there for weeks, my MRCP scroll still in its case, a dummy Symbicort turbuhaler and a handy DIY stationery organiser from IKEA (where "miscellaneous" objects go).

It's messy but functional. That's why it's called organised chaos.

LULU II

This is another LULU moment.

We bought tickets to see Shrek 3 and to our surprise the movie projected on the screen was Pirates of The Carribean 3, which we had already seen! The guy at the ticket counter must have been day dreaming - we asked for Shrek, but he sold us tickets for Pirates instead. Our fault too for not checking the tickets before leaving the counter.

Oh well, we didn't mind sitting through another 3 hours of swashbuckling action. When the credits rolled, people streamed out of the cinema while my husband and I stayed behind, knowing that there's extra footage midway through the credits, having missed it the first time. We felt so smug!

Then again, who's the bigger lulu? Probably us!

Painful

What a day.

I sat for a "competency assessment" (otherwise known as the PTK) today, which in spite of what it's called, does little to measure my ability as a physician. It is however a prerequisite to a promotion and pay rise, and so we poor civil servants have little choice but to force-feed our brains with facts that are irrelevant in our practice.

And so for the past 3 nights I had been grudgingly poring through information I know will slip through my brain once it's been regurgitated in the exam hall. It's called cramming, which is disdainful. I must say though it's one of the least stressful exams I have ever had to prepare for, which leads me to the conclusion that life is indeed blissful when one has absolutely no expectation (you might call it ignorance).

I am glad it's over, but I'm left nursing a migraine and an extremely sore right upper limb (from 5 hours and a half of furious writing). I need analgesia.

The hazards of exams...study, anyone?

Little Kathmandu II

I ran the tuberculosis contact screening clinic today. A woman brought in a van-load of Nepalis, all of whom had the misfortune of having shared a hostel room with a co-worker infected with tuberculosis.

Hah! Another outbreak of Nepalis!

There were altogether 11 of them. My job was simple - take a targeted history and perform a quick examination, and review the chest x-ray and sputum results. These smart guys took the opportunity to complain about their headaches, body aches, skin rashes and constipation! Pretty soon I felt like I was running a polyclinic. By the fourth patient, I had to tell them that I was just a "TB doctor"! Health care should not be this compartmentalized, but I had tonnes of other patients to see.

Sigh. I hate to turn patients away, especially these gentle Nepalis.

A Step Forward

After umpteenth months, the powers that be have decided that I am "ready" to assume specialist responsibilities.

It's life as usual, except for a certain awkwardness in doing ward rounds with people who were once your colleagues of same rank (and with whom you sometimes b***h about some specialists over lunch). What is really wonderful though is the fact that my signature carries a great deal more weight now. Imagine, I can now prescribe amlodipine for my mother-in-law without having to beg for a specialist's signature!

Some genius told me, "Membership has its privileges".

I couldn't agree more!

Welcome Back!

Hubby's back in the hospital for his final 2 years of postgraduate surgical training.

It's surreal. Not having to drive myself to work. Constantly feeling for the car key in my pocket and not finding it there, and feeling a few ounces lighter. Having a consistent lunch buddy. Being able to go have lunch outside, then leaving it to him to deal with the stress of finding a car park space later.

Welcome back. You have been missed, by me and the staff alike.

The Transformers

My brothers and I loved Transformers (probably under heavy influence of a cousin whom my second brother worshipped). I think the appeal lies in the humanisation of the bots, and how good versus evil is played out. That good always triumphs, against great odds.

I saw the first animated movie. When Optimus Prime "died", we fought back tears.

Perceptor: I fear the wounds are... fatal.

Daniel: [long pause] Prime, you can't die.

Optimus Prime: Do not grieve. Soon I shall be one with the matrix.

Hot Rod: Prime.

Optimus Prime: Ultra Magnus, it is to you, old friend, I shall pass the matrix of leadership as it was passed to me.

Ultra Magnus: But Prime, I'm - I'm just a soldier. I - I'm not worthy.

Optimus Prime: Nor was I. But one day, an Autobot shall rise from our ranks, and use the power of the matrix to light our darkest hour.
[opens his chest to reveal the matrix. Removes it and begins to hand it over to Ultra Magnus]

Optimus Prime: Until that day, till all are one.
[Matrix starts to fall to the ground. Hot Rod catches it, gives it to Ultra Magnus. Ultra Magnus inserts it inside. Prime dies]

And when the Autobots seemed to be headed for a certain doom, Rodimus Prime saved the day.

Rodimus Prime: This is the end of the road, Galvatron.
[throws Galvatron through Unicron's hull and opens the Matrix]

Rodimus Prime: Now light our darkest hour!

The place blew up. And the soundtrack played. What a moment!

Michael Bay, please don't disappoint us.

Flushed Away

Spotted in one of the cleanest and least known, least frequented (explains the "clean") wash rooms in the hospital.

Well-placed message, but do you see what I see? Is it what I think it is?

*The sign says don't forget to flush

I Wonder

I've had some memorable patients in my days in Kuching. I sometimes wonder if they are still around, whether they won their battles....or had succumbed.

M was a young lady who had never smoked a cigarette in her life. At age 32 years, she was diagnosed to have stage IV lung carcinoma. One of the first chest drain insertions I performed was on her, which she bravely tolerated. Her husband brought me fresh tiger prawns from the village - I think they lived in my freezer for months. She was lost to follow-up subsequently. I wonder if her last weeks or months were good.

J was another young lady diagnosed to have multiple sclerosis. It was heart-wrenching to watch her disability progress. Each time her ward stay became longer; soon it felt like she'd never left the ward at all. My colleague and I chipped in to buy her an AM/FM radio to ease the boredom of being confined to her bed 24-7. It broke my heart when her young son came to visit and took the radio home with him. I wonder if you're in a better place now, J.

Mr B had bronchial asthma, initially cared for by a GP who put him on years of long-term oral corticosteroids. His asthma control was atrocious. He was a regular at the emergency department - on most of my on-call days he was certainly there. I wonder if he is still steroid-dependant?

Finally, an adolescent with Type I diabetes mellitus, who had recurrent episodes of diabetic ketoacidosis. His presentation was classic - he'd walk in, looking a little dehydrated, breathing a little rapidly, and he'd say, "Doc, I think I have DKA"! A blood gas analysis always confirmed his acidotic state. He'd survived each one. I wonder if he'd run out of "luck" some day.

I wonder if I'd still see some of these folks when I return to Kuching.