Tuesday, July 26, 2011


I was reading this one article that I accidentally found upon googling for articles on the yet to implement shift system for all housemen in Malaysia. Hilariously irritable. I repeat, irritable.

No offence to the nurses, my near 2 years experience have exposed me those who are unexpectedly of cannot-make-it calibre, as what the blogger named it. Go on, have a read:

DOCTOR, DOCTOR! by Home of the Manx (I think the blogger is a psychiatrist)

The head nurse of my main ward was slightly upset when I told her my opinion that some nurses of certain wards are of cannot-make-it calibre. But it’s true. The ones in my main ward are generally OK despite being relative greenhorns. They have an acceptable average level of intelligence, integrity and diligence, with an outstanding one here and there. On the other hand, some staff in other wards really make me want to bang my head against the wall. I tell myself that there is no point in sacrificing my noggin like that. If I used their heads to smack the wall instead, the building would crumble.


(Phone rings)

Me: Hello.

Nurse: Hello, Dr. Katie. This is staff from Long-Stay Ward Pee-A-Lot. Do you think you could come and conduct an urgent multidisciplinary ward round with the medical officer, nursing staff and pharmacist? This afternoon?

Me: (thinks: that would be the equivalent of chartering an emergency jet plane to buy groceries for tonight’s dinner) Huh? Why?

Nurse: We want to convert all the patients on Valiant tablets to Valiant syrup.

Me: Huh? Why?

Nurse: Because we had one patient who nearly choked on a Valiant tablet.

Me: Oh? When? No one told me.

Nurse: Last year, before this ward came under you…

Me: (moment of disorientation – this is late July, right?) Okayyyy…

Nurse: … so there was an enquiry, and now we have to think of ways to prevent further near-choking incidents, so I thought we should change his Valiant tablets to syrup form. Then I thought we should also convert everybody on Valiant tablets to syrup. That’s fifteen patients. That’s why we need you to do a multidisciplinary round for everyone to institute the changes.

Me: Whoa, wait wait. This patient who nearly choked – was he only on Valiant tablets?

Nurse: No, he’s also on Fluent tablets, Hallucinate tablets, Chlorophyll tablets, Di…

Me: Uhhh… so you’re telling me that putting him on Valiant syrup plus ten other tablets will prevent him from choking on tablets?

Nurse: Well, it was Valiant that he nearly choked on.

Me: And the other fourteen patients? I suppose they’re on lots of other meds too? For which there is no syrup form?

Nurse: Yeah…

Me: So how does converting them to Valiant syrup make sense?

Nurse: Well, true, it doesn’t… but there was an enquiry. We have to do something!

Me: (sighs) OK, fine. If there HAS to be a change, I have no objection to this one patient being converted to syrup form. Leave the other patients alone. No multidisciplinary round. Just get the medical officer to convert the Valiant to syrup form at the same dose.

Then came the clincher.

Nurse: But Dr. Katie, Valiant syrup is very expensive, you know. Are you sure you want this patient to be on syrup instead of tablets?

Good grief. No amount of bonus is gonna compensate me for the brain cells that died during this conversation.

My very shallow experience so far has enlightened me of how unbelievable nurses could be and of how much the nurses' works has shifted to become part of the junior doctors' jobs, because we (junior doctors) have apparently become the glut.

One example of mine:

One hectic night in a surgical based ward, a patient was having a problem to pass out urine post op (which is not uncommon) and another patient who has low GCS due to intracranial haemorrhage ran amok in ward. Not to mention there were another few cases who I had not yet fully clerked after seeing them shortly with my MO - at least the diagnoses and plans were already there. I was left alone in ward as another HO oncall in the ward had long gone into the OT to assist the surgeries.

Before handling the latter patient, I have requested the nurses who were chatting at the counter (and was probably finishing off their very important report which copied every plans by doctors) to prepare the catheter set for the former patient.

After the amok patient been taken care of, I upsettingly found that the set were not ready yet. To make it quick, I prepared it myself and pushed the trolley to the patient's bed myself, passing through the nurses who were too busy chatting or probably gossiping. Then I had to pull the at least 2 screens to secure the patient to his own privacy - there were no curtains in the ward you see.

And to make it worse, it was a male ward and I was completely aware that I was much in need of a chaperone for those kinds of procedures - but like that ever happened in this hospital anyway. Surprisingly in Malaysia or maybe just in this hospital where the chaperone appears in every single introductory papers to be signed off by new doctors entering a new ward, having a chaperone practically were made compulsory only if you are a male doctor having intimate procedure done on a female patient. Other than that, it is definitely not widely practised here.

So I shouted out that I needed a chaperone, in which later on as expected, nobody came to chaperone - let alone if I asked them to assist me. Again to make it quick, I just proceeded with the procedure but it was not as easy as expected. I needed a smaller sized catheter and hence shouted for another help.

Me (shouting): Akak, tolong bowok cbd size 12 se (nurse, can I have a size 12 catheter please?)

After twice or thrice shout out, a nurse came with the wanted catheter and she placed it on the trolley next to me who were all sterile.

Me: Thanks... (before I could finish off with asking for another favour to open the catheter packing up into the sterile set, off she went to the other two nurses at counter)

SPEECHLESS. That was all I remember. I was completely speechless! Hello, it was a only a common sense for you to open it up, d*** you.

Luckily my MO (who was quite new in this hospital at time) passed by and he nicely helped with the favour I was about to ask and chaperoned me until I finished off my procedure, asking during that while 'what are the nurses doing leaving you alone here?'

Exactly. So what do they do? Obviously we need more doctors to compensate for those jobs that previously not done by doctors. So why complain of the glut?

Anyway, having said that, there are some nurses who I love so much and I think these are the nurses that achieve the same standard as those in the UK. If there are awards I can give to the best nurses, I will definitely pass them to these two nurses I have met in my career so far - 1st one in renal male ward who would call you to clerk a new patient who needed a peritoneal dialysis at 3am in the morning and by the time you reach the ward, everything has already been prepared, and when you were doing the procedure she was closed to you so you do not have to shout to ask for favours (I know nurses have tasks to do too, not that I always wanted her to be on my side even though that is what u get in the UK), and when you finished off the procedure she would take care of the other sets after you thrown away the sharps as she knew your phone just cannot go silence for a while and there were other patients you need to see and take care of.

And another one I met in ortho ward who would call you to clerk a case and by the time you need sedation and analgesic for a close manual reduction, he said it was already prepared as he already anticipated it. Prepared as in already diluted, mind you.

Seriously, thinking about these two particular nurses made me want to cry, thanking God for still making them exist in my current world. How I wish things are different, but who am I to change things?