DOCTORING THE DOCTOR

I was planning for at least a decent day off during the 'week off' for raya haji, but due to shortage of H.O. that was not made possible. But my wish was finally granted, after I got this horrible self diagnosed AGE (acute gastroenteritis).

I actually went to hospital for my morning shift on Friday, only to find out that I was too dizzy to stand up (I even get my brother to send me to the hospital), probably due to the loss of fluid via vomiting and diarrhoea. I hesitated before decided to finally take the two days of MC that the Big Boss offered me. My hydration was actually fair (a very bias judgement I have to say, as I was assessing myself), so I refused IV drip in the first place, but after two bouts of vomiting I succumbed to the correct decision of having a cannula inside my vein - and it did feel painful when the Hartmann solution ran through the small pink cannula into my left radial vein (is there?) to compensate for my loss.

Diarrhoea became worse when I got home that I literally did nothing just because I was incapable of doing things or to think, because I was too tired and dizzy running from bed to toilet, and vice versa. The next morning I woke up, pulse rate was still tachycardic, but I was feeling much better - then only I could think up straight - I was probably already in second stage of hypovolaemic shock. I called my friend, and let her brought me in anohter couple of IV drips. Today I feel much better, and ready for works, and surely in a much more empathic mode.

*Left - modified IV drip stand at home; Right - adik Aqil my doctor*

The Big Boss asked me why did I refuse admission, which I didn't because on Friday morning there was exactly no indication for admission (Friday night's condition was a good enough inditation though) - but so true, the worse patients to serve are the staff, simply because we know how it works.

I might as well sign an A.O.R anyway should I require admission, why should I be warded when the rest of the family is at home? Still the granted two days off at home was not that meaningful because all I did was sleeping and sleeping, all day long. And I miss a day out with friends who came around from Kelantan, as well as a friend's wedding. The least bit that made it worth it was that I managed to read almost five chapters of Harry Potter and The Deathly Hallows after feeling a bit better, after completing those IVD and tolerating orally.

The sad thing is, I am left with only 6 days off for another 3months in this posting, and that is only if it is permitted. Yes, for us H.O, MC is deducted. Counted in. Exactly why we bother so much about getting ones. Explains the reason why we still work despite having a one week suffering of unresolved fever, seeing those who came with a few hours fever without taking antipyretics.

The good thing is, now it reminds me how bad an IV line could torture your nerves, I will try to be more empathy as I used to once upon a time when I was a medical student.

EID MUBARAK

THE BIG BOSS

Some people missing in action in working time, is not a peculiar subject for me anymore. People coming in late for the ward rounds in the morning, or go back so early and leave the burden of the ward works to the others, also sounds so familiar. I can go on and put in complaints, and the list will be endless. Including things about my own self, like how I feel how slow I can be at times. But complaining alone won't achieve anything. Feedback like those in today's handovers is more likely to cause improvements, complaints won't.

I like my Big Boss, he is so far the most responsible H.O.D. I have met. He has this weird 'flight of ideas' speech when we were presenting cases or during the handover sessions, but he is very thoughtful and he does take good care of the staffs and the department; about things that should be in its right place. No one is allowed to come late. Which is good. I dislike punctuality too, even though I have always been rushing to work - but to my defense, that is only so that I arrive on time. I can list up ten reasons how coming in late for ward rounds will cause your punctual colleague to suffer. Of course, there are exceptions to being a few minutes late, but if it is a habit, it is something that hardly changes.

Back to the Big Boss. He knows what is going on in the department. Absconded staffs, nonfunctioning computer system that delay things, absconded patients, issues with other departments...etc. People who were missing in action and those staffs who weren't helpful were also warned today, so hopefully things will get easier and quicker for me. I love those nurses who were so helpful and not just bossing around, scolding doctors (read: housemen) because they have to do jobs. I love the former I would bake cakes for them. If I have the time and energy =)

Anyway, feedbacks like these, discussed in today's handovers are more likely to cause improvements, complaints won't. When I said feedback, I mean complaints made to and done by people who are able to do the changes for the better, and not just merely complaint to friends, who are at the lowest position like yours.

Attempt to get help from the supervisor was to no avail the last time, and even when we ran out of the lab forms yesterday, nothing very helpful was done about it. If the Big Boss is not in his current position right now, I wonder if adrenaline will always be enough in the emergency department.

Malaysia and good feedback system, is still a long way to go. The last time I put in suggestion in a suggestion box, a few weeks (or months) later, the box was gone. When my medical boss lodged an incident reporting to improve some systems, which I seconded, he got an incident reporting attack as if he was doing that out of arrogance.

Reminds me to how Newcastle University library answers NICELY to all the suggestions sent, oh how good the system is.

Same goes with the politics. But not going into that topic tonight, too tired I need some good sleep right now. And the conclusion is I like my Big Boss. Taraa...

OF ALL THE FEELING

I feel I lack that feel that I used to have
I don't exactly know how to describe it
Maybe one day I will be able to
But for now
It is just upsetting
I want my old self back
And the gratitude I used to show
I miss my old life
This working life is just.... not working
As how I wanted it to be
As how I imagined it to be
The soul feels empty
That surely needs a refill
And all traced back to the One

THE GREEN FEVER

I was working at green zone this morning, and most of the cases I have seen today were those with fever. Here goes some conversations:


SCENE 1

Me: Bakpe mari?
Patient: Demam doktor
Me: Bile start demam?
Patient: Bangun tidur tadi
Me: (glancing at the watch which showed 1030am) Ooo...baru 4jam laa lebih kurang?
Patient: Lebih kurang gitu aa
Me: Amik panadol doh ke?
Patient: Dok pon. Buleh ke gitu?
Me: ????


SCENE 2

Me: Mokcik, bakpe mari hari ni?
Patient: Demam doktor
Me: Ooo, berape hari doh?
Patient: Lima hari doh
Me: Lagi ade masalah lain ke?
Patient: Ade...batuk-batuk doktor
Me: Ooo, berape lame doh batuk?
Patient: Lame doh doktor
Me: Ye la, berape lame?
Patient: Lame sangat doh doktor
Me: Mokcik, (again, with all the patience) lame tu, berapa lame? Seminggu, sebulan, setahun?
Patient: (sengih) Lame doh, mokcik dok pindoh rumoh anok mokcik lagi mase tuh
Me: ?????? (and how on earth would she expect me to know when did she move to other house?)


SCENE 3

Me: Bakpe mari hari ni?
Patient: Rase pening aa doktor. Hawe2 nok demam ade gok. Tadi daroh saye tinggi
Me: Ooo...kad takdok lagi ni, doktahu lok tekanan daroh awok berape (assuming it was the BP he was talking about). Saya panggil je dulu sebab takut ramai lok beratur kekgi. Berape tekanan daroh awok td?
Patient: 146 gitu aa
Me: Hok atas ke bowoh?
Patient: Hok mule2
Me: Ooo dokla tinggi sangat
Patient: Tapi memang tinggi tadi doktor!
Me: Dakpe, kekgi sapa kad kite tengok

(after noted his diastolic BP was more than 90 for four times, and him having symptoms of hypertension with a high haematocrite and viral illness symptoms, he was advised for admission)

Me: Awok kene masuk ward ni, tekanan daroh memang tinggi, apstu kite takut denggi jugok
Patient: Hah? Dok payoh la doktor, saya rehat kat rumoh je laa. Doktor wi ubat je ke saya
Me: Doh awok siap kelabu mate lagi, tu tanda2 tekanan daroh tinggi. Dohla mude lagi dapat doh. Kene cek betul2 ni. Lagi daroh awok dok comel sgt, takut denggi. Ade due sebab doh ni saye nok suruh awok masuk ward
Patient: Dok payoh laa doktor. Bagi ubat je laa
Me: ??? (tadi die jugok yg beriye kate tekanan daroh tinggi, pening dok berenti)
Lucky he finally took the advice for admission, if not I myself would go hypertensive.


SCENE 4

Me: Ye dik, bakpe mari ari ni?
Patient: Sakit perut doktor
Me: Sakit kat mane...bla2
Patient: Sakit kat beloh ni...bla2
Me: Ade demam dok?
Patient: Semalam rase macam ye, tapi tadi misi kat depan tu kate saye takdok demam pon
Me: Tuh hok die cek, die dokleh rase awok demam ke dok. Awok sendiri rasa hawe2 demam dok, dik?
Patient: Doktau laa saye. Takdok la kot
Me: (susoh nguh ikut ke misi pulok doh)


How I wish history taking can be much easier...

THE CUTE TOM

This is not the exact reason why I am giving my thought to having an iPhone, more specific the iphone 4. Should I, or should I not?

But seriously, the Talking Tom is so cute and funny it made me laugh.

ps: I practically did part of a chest tube insertion today, I was only assisting, but did actually managed to put a finger on top of somebody's parietal pleura. How exciting is that? Just joking =) At least next time I will have to do it on my own, I have some ideas about it.

SHIFT VS ONCALL SYSTEM

For those who would like to know our working time as houseman, this posting will enlighten you in general of how it works. It might be different with different hospitals or postings.

I am working pm shift today. We have three shifts per day at casualty. Morning or AM shift starts at 0800 and finishes at 1530. Afternoon/evening or PM shift from 1530 to 2230 and night or ON shift from 2230 until 0800 next morning. But every weekdays' morning starts at 0730 with the handovers, and usually the morning people will start the shift at 0730 then.

In general , everyday we are entitled to work for at least one shift. There are days where we will be working double shift, which means we work in the AM and ON shift. And the next day, those who worked the night shift at the red or yellow zones MAY be entitled for a night off - meaning they don't have to go to work the next day, but those in green zone, still has to come for a PM shift the next day. This is how it works here.

Even if we have a night off, we will still be coming for CME (continuous medical education) presentations for our learning purposes on the night off day, and every weekdays, regardless of us in the PM shift, still has to come sharp at 0730 just for the handovers. I don't mind that seriously, as it forces me not to prolonged my sleep too much, like today (because it's a weekend, and hence no handovers). Plus, sometimes there are so much to learn at the handovers. The HOD (head of department) really likes to ask questions, and I think that is how I learn much. Even though most of the time, I was not even close to answering the questions.

I think I'd prefer the oncall system better, but maybe it won't work well in casualty because the patients are non-stop, and you will most likely be exhausted after the formal working hours. At least with double shifts, you get to go back for a while before continue with the night shift. But still, so tiring.

For those who had no idea how oncalls work in other departments, this is how it works - your working hours starts as usual from 8am to 5pm, but you come as early as 7am or earlier for your morning rounds. If you are not oncall, you go back after 5pm only if you finish your job that are not supposed to be burdened on the oncall people. Say you have too many jobs in the ward, you might only goback after 10pm. If you are oncall, then your oncall time starts at 5pm until 8am the next day. Then you continue working, until 5pm the next day, or later if too many tasks need to be done, as mentioned before.

Let me give you the example of one of my tiring schedules with the oncall system. It was when I was in medical posting, at times where the total medical housemen was 17 and we have four main wards to cover, not to mention the clinic and other periphery wards, also the H1N1 breakout at time. I had a few EOD (every other day) calls that month. I came to work at 645am, carried on with the sleepless night with the oncall, then I only went back at 1030pm the next day after the all sorts of procedure done. Then next day I came back at 645am for the morning rounds, and was oncall again, only to be back around 10pm the next day.

Dear my beloved Damia me niece who always keep mentioning that all I do at home is sleeping, if only you could understand this, you won't blame me for coming home and sleep for sleeping is the best rest, after the long working hours with those sleepless nights. In medical. But please note that, not all days were like this anyway, especially in different posting.

Anyway, back to casualty. Only the 4th and above poster housemen are allowed to enter the department, so we won't get any new freshies here. The total of housemen in the department is reducing. Therefore, holidays are out of questions these days. Both my brothers' family are coming home for the upcoming eid (raya haji), and no holidays are allowed during the days they are back here. Now, these are the days I resent becoming a doctor.

I just pray that I will manage to apply a straight four days off I need in December, as I have already paid such a big amount for something I have long wish done. I give you a clue:

But I wonder if I had enough stamina for the much awaited event.

THE LOST COURTESY

Today I was so upset and greatly reminded of the World of Courtesy ranking, produced by Reader's Digest four years ago. According to the ranking, which might not be accurate at all, Kuala Lumpur i.e. Malaysia is ranked the third least courteous country out of 35 cities of different countries included in the RD's global courtesy test.



A sudden regret fulfilled me for a while - I am not sure whether it was a regret of being a Malaysian, or being surrounded by majority of non courteous people where you cannot make a difference. Or a regret of not staying and work in the UK , and not even applied for a job there. Whatever it is, I feel guilty for having this regret, but it surely does bring back nice memories and life back in the UK, where everything seemed so easy and approachable. And the courtesy was at its most. I have been to most of the European countries and I think UK is still the best at courtesy.

Let me go through and see the differences:

In buildings with doors

UK
I was walking 5-10 steps behind someone before reaching to a double door, and that someone I never knew would turn back to see if anyone was at the back, smile and keep the door opened until I reached the door, that sometimes I had to walk really fast to not make them wait for too long.

Here
I was walking just behind someone's bum, even worse someone that I know who realised I was right behind them, and we were just about to enter a door with him/her right in front of me, and then....'bamm'. The door shut. Right in front of my face.


When you are in need a favour

UK
People would ask politely, with the nice "Do you mind....." or "can you help me with....." at the start and the magic word PLEASE at the end. Even when the favour asker was a specialist asking for some help from a medical student. And help is at your tip of finger, especially if the favour you are asking is totally the responsibility of the person you are asking the favour from.

Here
If you ask for a favour nicely, there is the slightest chance of you being entertained quickly and nicely. Even if sometimes it is supposed to be their job. Most of the time you have to ask them three times then either do it yourself or start shouting and complaining (then people will complain about you to the boss). Believe me, giving instructions, or telling people to do something with a raised voice gets the attention better. I have this one colleague who always give instructions instead of asking properly, and 'favour' done as instructed.

Hey, what is wrong with being courteous? Maybe they like instructions better.


At the workplace

UK
If a doctor needs to perform a procedure, a nurse will be around (we call them dirty nurse) so to help us keep sterile while they can get things for us. Even when I was a medical student, I get my own dirty nurse to insert a catheter.

Here
Me (in sterile condition needing another catheter of different size as I failed to insert two different sizes that I already prepared myself together with the catheterisation set) : Akak, boleh tak tolong amik CBD saiz 12 tak? Tolong eh kak, tengah sterile ni. Translate: Miss, can you please get me another size of catheter, size 12 please, I am currently steriled (shouting at 3am to the ***** who was gossiping at the counter, who were supposed to prepare the set after nicely being asked, twice.

***** (went to get the catheter that I asked for): Nah. Translate: Here you go (putting it on the trolley, without even bother to empty the sterile catheter into the sterile area, then went back to gossiping).

Don't I deserve a chaperone, even if you don't want to help me preapring the stuff or be my dirty nurse?

*ooops, I think this is a complaint already aye?

On the road

UK
I am not a good driver, but driving in the UK was way much easier. Imagine you were turning right at a T junction or you were changing lanes. Even if it was not too busy, they will flash their headlights to mean that "you go on. I will slow down for you".

After you give way to people, they will flash their headlight twice implying "thanks", and not enough with that, they will put up the hand, mumbling thanks, again to show their gratitude. And you will put your hand up, mumbling "you're welcome, glad to help".

Here
If somebody flashes the headlights, it means "It's my road. Don't you dare take over. I am speeding, can't you see?" I don't even dare to flash my lights to give way if I see someone is coming out of a junction I am turning into, just in case they misunderstand. So you see, there's no room to be courteous. You just cannot be humble on the road.

I was not in rush and let those from the front to pass first at the guard at entrance of my house, and I hardly get a hand showing thanks. Don't bother the lights.

And when I was grateful that people waited for me to pass the guard and put up my hand of gratitude, they just stared. Oh how I miss the courtesy of driving in the UK.


At the parking lots

UK
Disabled parking lots are really meant for the DISABLED. And the disabled people do come out and enjoy their life even if they have to use wheelchair to move. The buses are even properly designed for them so they can travel easier.

Here
SOOO many disabled people (parking for the disabled are always, always full), but I think most disabled people are usually stucked at their house and the only place they usually visit is the hospital.


And the ones below.... I cut and paste from Iris' blog, a good friend at the university, who is currently working in Selangor and just entered O&G department:

In encouraging labour
England
Midwife: Come on, push. Good girl. Push. You can do it. Push. You're doing very well. Just bear down. No, you're pushing the wrong way. Bear down. Push. Yes, gooood girl. You're doing reeeally well.
Here
MO: Push, push, push, push, PUSHHH. What are you doing? You're not pushing! You want the baby to die? If something wrong with the baby, it's on you. Push. Do you understand ar? How many times I must tell you?? EYYY, don't push to your face..see, flushed already.. haiya... DON'T LIFT UP YOUR BUTTOCKKKK!!

On the welfare of the juniors
England
During handovers amongs specialists and senior doctors, there are always cups of tea that you can have...with some biscuits..someone might bring their homemade cake to share. And I was only a medical student then. And the cups of tea flow endlessly. From 3rd year to final year. Made for you. By nurses.
Here
The Biggest Stitch: (On the suggestion to increase the number of beds for oncall house officers to sleep on) Actually I don't think housemen should sleep at all. It's good enough if you can sleep straight up in a chair. Or bring your own camping gear and camp in the parking lot. You think oncalls are for sleeping?? During my time............ etc.

Ego
England
When you gave the wrong answer to a pretty basic question:
Consultant: No, I don't think so. Try again.
Here
When you gave the right answer to a pretty basic question:
Specialist: [stare at you after your answer] Some more?
Me: Erm.. can't think anymore
Specialist: [to colleague] Read out your list of answers (prepared beforehand)
Colleagues: bla bla including the answer I gave earlier
Specialist: Why didn't you say that answer?
Me: I did!
Colleague: She did.
Others: Yeah. She did.
Specialist: No, I didn't hear it. Oh no, it's because I caught you cheating. You shouldn't be spoonfed. That's why I didn't count that answer.
Me: ????

*LOL on the labour room situation* She is in Selangor and exactly the same words are being used, I can imagine. Can you see, it is happening not only at my place, but also at other city. I bet if you go to the north, or south or West of Malaysia, in general, the situation would most likely be the same. Oh how encouraging we are!

I won't deny that I am also losing the courtesy, I wish I won't. And I blame the environment. Tell me, am I guilty for missing UK so much?