Thursday, October 28, 2010


This is so what I really am in need of at the moment...

I will try to have The Lightweight this time. Of course, with the hope that I won't loose it. Perhaps I will have to chain it to me so not anyone can simply borrow it without returning this precious requirement to the owner.

Wednesday, October 27, 2010


I was wrong when I told you I was unfortunate not to be able to join the ACLS course. Apparently, Allah has planned better for me. Yesterday morning after the passing over session, when I was already mentally prepared to do my first shift at the red zone, I was told that the big boss wants me to join the course too. Hence, my morning shift was canceled.

So, total of three days of ACLS course. Yesterday, we only reviewed the basic and advanced life support algorhythm. Thanks to the recent BLS course, it did helped avoiding sleepy lectures on the first day. It is true that you learn more on what you already knew.

Today, the more complicated advanced cardiopulmonary life support was introduced. It is very useful, I'm sure. But I fell asleep on the afternoon lectures that I feel so guilty for the nice consultants giving the talks. I'm sure they could see me pretty clear with my eyes closed - how couldn't they when I was literally sitting right at the front seat? My eyelids just went too heavy and floppy. But thank god, I was wide awake during the last two lectures by the big boss - but, how wouldn't I when the big boss always gave me questions to answer?

Tomorrow will be the assessment day. MCQ and megacode i.e. practical session test. Teamwork today in the megacode practice was not satisfactory, my CPR was not the best, and I was failing myself with not sticking to what I was supposed to act as. I just hope I won't fail others tomorrow. Of course there's no need to worry about being a team leader as I was made into the last time - due to the fact that most other participants are either MOs from this hospital or from other health centers. Only five HOs are joining the course entirely and all are the new HOs in the department. People have been telling us how lucky we are, even the junior casualty MOs just had a chance to join the course, not the senior HOs too of course, so let alone new HOs finishing off their tagging. All five of us, we are not even officially start working as in charge at the department, but already been given the great chance of participation.

But this won't be good if it is going to create an issue, aye? Somemore, I was supposed to off tag for 2 days already, and I've been made off yesterday, and guess what? I just received a call from the HO leader - and he just rearranged so I don't have to work tonight (I'm supposed to work night shift today), so that I can study for the MCQ tomorrow. How nice! But seriously, I am starting to worry more if this is really going to make the issue worse. There have been queries at the background of why we get to go and why not others, you see. Very understandable as I might have queried the same too had I been long enough at casualty. I know this sounds selfish and I feel partly guilty about it, but how on earth exactly should I respond anyway - I am so not gonna let the opportunity off, you only get this once in a blue moon.

Headache with that. Headache with the numerous factitious algorhythmic lectures today. Headache with learning those guidelines, knowing that the latest ones are already on their way out, knowing that I will still need to learn the new ones later on. Let me just rest a bit for a while then maybe tonight I should really use the night off given to really study the nearly one centimeter thick ACLS guideline book, as that would have been what my pay is for, for today.

Monday, October 25, 2010


Today marks the two weeks of life at casualty. And some previous friendly M.O.s who saw me there today still thought I was there to see surgical cases. No, they are totally wrong.

I am going to officially work, starting tomorrow, a.m. shift at RED zone. First day in charge and already in red. Great. Preferrable than green still. Expectable cases - those with poor GCS or any candidates for intubation, those with chest pain, severe asthma or COPD exacerbations, severe trauma etc. Basically red is for severe cases needing very urgent and prompt treatment, yellow is semi-critical i.e. for those who are not as severe, but not as stable and green is for stable patients. So red for tomorrow. More things to learn, most likely typical cases, easier to discuss with M.O.s. Sounds daunting, but I think I like red. Or maybe I should be careful with my sayings coz tomorrow I might not like it at all.

I managed to intubate a patient today, but the one thing that made my day was that I managed to insert a short line CVP via internal jugular vein on the first attempt, under ultrasound guidance of course. It was my second try after the failed attempt on my first day tagging, remember? Lucky try today more than anything, but thanks to friends who were helping with the equipments. I love teamwork. More precisely, I love teamwork with people I can work with.

Anyhow, I bravely asked for an early leave from the nice M.O. so instead of still being at the hospital at this moment, probably glancing surreptitiously at the watch, hoping that 10.30pm will arrive soon enough - here I am, my fingers dancing on the keyboard, writing an entry to the blog. I left around 720pm after completed my Maghrib prayer. What a great day. Only later to realise how unlucky I am because the department will be having an ACLS course tomorrow, and apparently all the taggers are attending the 'what sound to be useful' course. Since I am already off tag tomorrow, I won't be able to join them, how unfortunate. I just thought I still need to work up on my very basic knowledge on life support, especially when it has something to do with ECG. Medical posting seems so long ago that all the details are no longer well stored in the brain.

So tomorrow it is. First day in charge. Morning shift. Red zone. Double shift the next day, then night off, something to look forward to. Hoping that everything will go well. Hoping to be given strength and good state of mind.

Friday, October 22, 2010


Today, I am officially off tag again. Another four days of tagging then I will formally considered start working, blending myself in the shift system at casualty. Almost there. It will not make much difference, I think. The jobs are the same, tagging or not. Less responsibility in tagging I suppose. The best part is that I won't have to work double shifts everyday like in the tagging period. There will be days I will only be working from 0730 to 1530. Plans are already pouring in my thought - one of them is to go and get a new pair of spectacles.

Too many things happened, but I can hardly recall what to share now. Not that I learned much new things. The one big lesson I have learned so far is how much I forget and not knowing my things. How shallow my knowledge is. There are just too much to learn. Even simple stuff that you practise everyday like the content of normal saline and hartmann solution. Worst, by knowing more, you will realise how much you still don't know. It is very upsetting, but life is a learning process anyway.

Yesterday I took diclofenac for my toothache, only then to realise that I am allergic to it. Itchiness and rashes started after nearly two hours taking it. Almost had my eyes swollen as I used to with ibuprofen, feels throat closing off. Self pre treated myself with IV hydrocortisone stat. Very scared to go to sleep yesterday, just in case my airway would suddenly collapse but I fell asleep easily anyway, thanks to piriton and tiring day. Weird, I can definitely tolerate ponstan, but maybe I should start avoiding any other NSAIDS now.

10 days in casualty and I still haven't got a chance to insert a chest tube or intubate a patient yet. I don't mind much about the latter, as I have done it in previous postings, but chest tube? It is one of my aims in casualty. I won't let myself do it the first time in a district hospital, without any supervision. Having myself alone to be responsible for it. Please let there be a chance. There's no more medical/surgical posting to find one. Unlikely needed in ortho or paeds, the upcoming postings.

11th day of tagging (off today, though, a very unproductive day regretfully). Had I known only two taggers are off on saturday, I would have come to work today and off on Saturday too. A quite tiring week that one night I could barely sleep for my legs were aching, not knowing what posture or position I should have slept in. But anyway, glad that I am almost there, although doubtful that I am competent enough to 'work' at casualty.

Sunday, October 17, 2010


I was looking for 'the hidden six' in secondary survey and found these slides - very good slides that I thought worth sharing it here. (read: good slides for medical personnel)

Saturday, October 16, 2010


Today is the 5th day at casualty, but I am officially off tagging today. A&E is generous enough to allow two days off during the tagging weeks.

I have not been productive enough here. Feel like moving at a really slow pace, which does not sound right as I AM actually in the EMERGENCY department. Still blurr with where all the stuff are. And not that familiar yet with the staff and system. Using the new H.I.S system makes things rather slow too. FYI, we have now started using the computer system, so every clerking and progress at casualty needs typing in the system. Still in phase 1, started since August but at least in ward, only the discharge summary needs keying in, clerking using the computer is optional. Phase 2 is coming up this November, which is next month already! Can hardly imagine how the phase 2 is going to drag the serving times.

Yesterday I merely clerked 5 cases. Prepared myself to go for ambulance call, but never had a chance to do so. Two days ago, I attended a Basic Life Support course which finished at 5pm. It just reminded me of how much I detest doing chest compressions, I got out of breath even before completing the first complete cycle. And hey, what is wrong with counting slowly and only made the final five counts loud at the end - even with this, I still get breathless, let alone counting from 1 to 30 for 5 times with the simultaneous chest compression with each count. Worst, the Boss randomly picked on me to be the leader of the first megacode scene. It was a wrong decision to step on the right hand side of the mannikin and started CPR myself, when I was supposed to be giving instructions to my colleagues. To count, compress the hard mannikin's chest, think of what to do next and give the relevant instructions at the same time (plus knowing it was only an act) was just NOT feasible! I should have gone to do the bagging, then it would have been easier to think and instruct. I failed the megacode, I can totally see it at my boss' face.

Went to green zone on my second night tagging. It is the zone where all the stable patients will be coded in to. There is always a long list of patients there. Patients who are unstable or in agony are triaged in yellow and red zones. That night I was made aware that I won't be a good GP. Too many patients to see, sitting at the desk asking questions, sometimes made the patients lie on the bed for proper examinations, having to include all the differential diagnoses into account which can be so wide - these just don't 'entertain' me much. I'd prefer delivering a baby and making a mother happy. Or doing procedures. Or resuscitating patients despite how breathless I can be.

Anyway, I am off today, planning to do some readings which has not started yet, hopefully will be carried on after attending my colleague's newborn's aqiqah.

Tuesday, October 12, 2010


Today is the first day of tagging at emergency department. The concept of tagging is as usual, you go as early as 7am and get back home at 10.30pm (thanks to DG who just made this official). But the environment is totally different, of course. The most obvious one, there are no wards. Meaning no ward round. There is one small observation room, just enough to place four patients at once, but that does not need a rushed morning round as in my previous postings.

I arrived at the department at 7.15am today as the passing over session at casualty starts at 730am, wearing a pair of black court shoes, having already been warned by a friend to wear dark coloured proper footwear - I sort of aware of the shoe rules two years back when I was doing my elective there. Then I was chased off to go and get the formal letter telling I have passed surgical and allowed to move on to the next posting. I went to SOPD for the letter and saw my favourite Miss there, and undecidedly asked her again whether I really passed my viva the other day, as I knew I did very badly in the viva session I wish I turn back time to do it all over again. Worst, I feel so ashamed to see Miss, having not been able to answer her questions to standard. I am sure she expected more. She gave me her cute smile "yes Afifah, you passed". Good. But still feeling so ashamed.

But anyway, came back to casualty with that piece of precious paper, and I felt like every eyes were on me. Unplanned, I introduced myself to break the silence. Right after that and after a few further questions about previous postings etc, I was told to attend a BLS (basic life support) course on Thursday and an MCQ session today! Goodness gracious, first day of new life, and an MCQ is something that is out of expectation, seriously.

Time runs very quick in the morning. I happily and confidently volunteered to insert a central venous line via the IJC, ultrasound guided - it was a failed attempt though, the specialist took it over from me and easily passed it through. Then get myself out for a brief lunch, hurried back and clerked a paeds case before attending the CME & MCQ. It was my first paeds case I clerked after the posting in final year which was probably 3 years back by now. So horrible, I do not know how exactly I am going to survive paediatrics as my 6th posting.

Attended CME on cardiac arryhtmia. Suddenly being reminded of those wavy lines, which if they go flat, every lay people would also understand that it means the heart stops pumping. In medical term, we call these lines ECG (echocardiogram). They might be easy to read at some points but interpretations can be quite mean, and I can hardly recall all those medical management learned in medical posting for those haywire lines. One thing I should start focussing on. To make things worse, there was this one specialist who really do fancy asking questions to taggers - I have already been given a homework on how to do a carotid massage.

Then the MCQ begun. 25 questions, each with 5 true or false statement in 30 minutes. Some are surgical based questions eg trauma management, not too bad as I just came out of that rotation, but paeds based? Not so helpful. I answered them quickly (as this was only meant for a baseline pre-posting mark, I supposed) so I could go out to perform my Zuhur prayer before the discussion started. When I came back, half of the questions were already discussed, upset as I wanted to know the answers! It might come out again on my real exam to pass the posting, you see. The miracle is, I passed. Just borderline pass, though. But better than expected. It does not mean anything though as I will still need to pass another MCQ in 2 months time. Or even worse, as they would expect that after 2 months duration, the marks should have gone higher. Huh.

It was nearly five. Then was pretty much helping other H.Os and M.Os, it si quite good around here. This is where I see quite a great teamwork. Whenever a patient passed through those double door, someone will go and clerk, others will go and set IV line, take blood, fill up forms and call the relative for registration. I think this is what I like about casualty so far, although I think I myself was not that useful to others - I kept wasting time when people asked me to get something, I just do not know where things are! And I am not practised to be well aware of those who still need blood takings done etc. Briefly, still disorientated to how it works here but slowly getting there. There are cases like MI, UGIB that ended up with intubation but I think the most horrible case that I saw today was a thirteen year old schoolboy who came with a nail stucked in his right sole. Please watch where you step on. Please. Oh, I should have captured a photo of it, some of my colleagues did.

10.30pm sharp, and they started chasing me out of casualty. It was the time to go back (so good they all!). Tomorrow, there will be an audit done in our department and I am supposed to read on the four main CPGs - dengue fever, NSTEMI, asthma and DKA but here I am, for whatever reason, feeling so eager to write while searching for the answers to my new homework - I guess, starting to write again in the last few days has fueled my interest in writing again.

Saturday, October 09, 2010


It has been long since the last time I wrote.

It was a year ago when I started my very first posting in the O&G department, the subject I used to like when I was a student doctor. Yet another two days mark the one year of my working life. It has not been the most productive year. Yes I am working, but I just do not feel me being as active and sincere in what I am doing as I used to. Moaning is like a must in daily life. I hate it, trying so very hard to control myself but it is just inevitable. I wonder where has all the passion gone?

O&G and medical. The worst has passed. Surgery has been quite an enjoyable posting, especially when I was given a chance to perform appendicectomy by the nicest MO - it has been a turning point, I used not to enjoy the posting before - but now, I would not mind if being called back as an M.O. Provided my favourite Miss and HOD are still there. Logbook signed up and sent. Presentation done despite the rush after being cancelled and having to make a rearrangement. Viva is coming up tomorrow. I am hoping for an easy pass but those previous viva questions that came across me ears sound very tough, questions like what the expected results of FNAC and biopsy in breast/thyroid disease are (which I still have not been looking for the answers), so I will just pray for the best. I do not mind if they are going to extend me, provided they put me in SOPD and no oncalls for the 3 months extension time. And another appendicectomy! These sound great that I might ask for an extension myself, but why would I , if I do not have to?

Off for another two days before the next posting in the emergency department, starting Tuesday (provided I passed the viva). When I was in my first posting, every H.O. were saying A&E is the best posting in terms of the working time - they have their postcall day off you see. So like in the UK. But the new shift system does not sound as great as before, and worst, there has been complaints about it. No comment on my behalf now. Wait and see when I myself be in that department. In the meantime, I will free myself from thinking about hospital and enjoy the less than 72 hours of holiday. At home. So true, there is no place like home.