For the sake of blogging….
Its kinda getting late, almost 11pm already. I better finish up this post and go to sleep fast. In this depart, we need to sleep early, in order to wake up in time and start our morn rounds at 6am. I began to feel ‘old’ recently. Sleeping early….
The condition in really challenging our patience. Imagine, its already almost 1 week, there was not a single pink branulla or opsite in the whole ward. I wonder what is the sisters doing. Is it the whole hospital is running low of branulla stock or is it plain laziness??? I dont understand. But this problem of low stock of equipments in the ward is really really making our job difficult and stressful.
Imagine, a patient came in with high grade fever associated with cough and SOB… We need to take blood C&S before starting antibiotics. If we start antibiotics without taking any culture, boss is gonna give us a ‘piece of his/her mind!’. But the whole ward, bottle for blood C&S NOT AVAILABLE! Geram betul…. Sometimes I just feel like knocking my head on the wall.
But what to do, this is part and parcel of being a houseman. Getting frustrated and irritated for things that are within our control… I seriously need the grace of God to keep me steady and cool in the midst of all this nonsense…
‘Traumatic PD’
I was oncall last 2 days. Tat was an eventful call, cuz i oncall with a ‘Jonah’ MO. That was this patient, referred from a peripheral hospital. 60 year old malay lady, known case of diabetes melitus, hypertension, congestive cardiac failure and chronic kidney disease. She complain of right abdominal pain with vomiting and diarrhea. The working diagnosis was, 1) Sepsis secondary to ? source, TRO Pneumonia, 2) Acute kidney injury on chronic kidney disease, 3) Underlying DM, HPT, Chronic kidney disease, Congestive Cardiac Failure. She was having spiking temperature with urea about 44.0 and ABG of metabolic acidosis.
Patient was attended by MO oncall in A&E. He then call me thru the ward and asked me to trace the PT/INR and then to do a Peritoneal Dialysis(PD) for this patient after reviewing the PT/INR. PT/INR results came back normal and I was requested to PD this patient.
So then I did the PD for this patient. I inserted the PD cathether into her abdomen. She complain of abdominal pain. Managed to run in 1 litre of hypertonic fluid. But when I tried the outflow, initially came out clear fluid, but then came out about 50-100cc of turbid, yellowish fluid with some whitish material. Being afraid of perforating her bowel, I quickly alerted the MO oncall.
MO came and see this patient. After looking at the PD fluid, he said ‘Its shit!!! And U r in deep shit!!!’ Then he said ‘Initially we planned this patient for maximum medical management, but now that u have perforated her bowels, we have to HD this patient!!!’ Now that he has tonnes of work to do, he was kinda irritated with wat I has done.
We then referred this patient to surgical, TRO Perforated viscus. Also refer to GA for Haemodialysis via femoral catheter. I got myself into writing referral the referral letters.
The following day, the surgical team came to review this patient, their impression was, TRO perforated viscua. They then planned this patient for exploratory laparotomy. Patient’s condition was optimised and then she went for exploratory laparotomy.
But, thanks to God’s wondrous grace. Post op diagnosis was appendicular abscess and pus collection over right illiac fossa. Bowel was normal!!! Patient was actually having sepsis secondary to appendicular abscess. and the turbid yellow fluid during my PD insertion was the pus discharge from the appendicular abscess.
I dunno whether I will be requested to present a morbidity review on this. But Im glad that, my so-called ‘Traumatic PD’ lead to the correct diagnosis. She is currently in ICU. Pray that she will walk out healthy….
Pay Day!
Today I get my monthly pay. Today is also the day I completed 7 months as a houseman. Another 17 more months to go, everyday seems an agony…. Although we are considered highly pay, compared to other government servants, we are actually overworked, ill-treated. If i were to divide my monthly salary with the hours we put to work, it comes to about RM6-8 per hour…
With this, I understand, why sometimes governments servants tend to be slow in their service. Our government servants’ pay is much much lower compared to us. The staff nurses and ppks, they are really overworked and underpaid. And this really affect patient’s care. Imagine, 1 staff nurse take care of 8-12 patients at one go. With the small congested hot wards, I do understand why it tends to get very irritating, and annoying sometimes.
This morning, when i came to ward. No spirits, no swabs available!!! How to take blood? Even the EDTA bottles for FBC blood taking also out of stock!!! The excuses that the staff nurses gave was, there was too many dengue patients, so all the EDTA bottles were used up for their 4-6 hourly FBC. But there was only 2 dengue patients in the whole ward!!! I just feel like bursting… But wat to do, just bear with it lar… Its common to get frustrated and irritated during housemanship, but its the matter how do we deal with it. Whether we gonna start shouting, or be patient and request for help.
Tomorrow Im oncall again…. Haih…. Hope for a smooth call with stable patients!!!
Maximum Medical Management
January 23, 2010
Filed under Hospital, Housemanship, Medical studies, Medicine, Personal, Testimony
Tags: Academics, Blogs, Faith, HO, Houseman, Medical studies, Medicine, Personal, Spiritual Life
Maximum medical management! This is a word that is not rare. I wonder who created this term. Some patients admitted with severely ill condition, sometimes our boss will say ‘This patient is for maximum medical management’. It simply means that patient is not for active resuscication should he ever collapse. For this group of unfortunate patients, should they ever collapse, we still resuscitate them. But we don’t intubate them. Mostly, its grave prognosis.
Usually its the elderly, known case of carcinoma and with multiple illness will be in the group ‘maximum medical management’. But the word maximum medical management means maximum. So their management should be maximized. Sometimes I noticed, their management is not maximized. Kinda disappointing….
Just finished my evening rounds. Here, we housemans do our rounds twice a day including saturday and sunday, which is actually good for patients, but not good for us. Cuz we dont get weekends off. Actually they shud just allow us to do rounds once a day on weekends. I tot of suggesting tis to Boss, but who am I. Im just the ‘know-nothing’ houseman. Boss surely gonna shut me off and give me a piece of her mind… Hahaha! Nevermind, take it as something tat is beneficial for our patients…
Living up our mistakes…
January 18, 2010
Filed under Hospital, Housemanship, Medical studies, Medicine, Personal, Testimony, University
Tags: Blogs, Campus Life, Exams, HO, Hospital, Houseman, Medical studies, Medicine, Personal, Spiritual Life, Testimony, USM
Surviving as houseman simply means surviving our mistakes. Lets admit it, no one is perfect. But, when we see a dr for treatment, we expect perfect treatment. Of course, because it involves our life.
But, the fact is, doctors also make mistakes. Commonly most of a doctor’s mistakes will be during his/her housemanship days. In this department, when our seniors found out our mistakes, they will come after us like a hungry lions. So if one of us makes a mistake, we will be in deep ‘misery’. One of my colleagues even slept in the hospital room, even she wasnt oncall. Cause she was too worried that she might make any mistakes. She change her ward shortly after that. Cant blame her oso, cuz the MO in charge of that particular ward has too high expectation on HO. Man… I hope they dun post me in that particular ward. All the patients inside there were unstable and can collapse anytime.
I remembered how I made a big mistake during my final year pro exam. In the long case, I made a wrong diagnosis. It almost cost me that whole exam. By God’s grace, I narrowly passed my Pro 3 exam. I was so worried that I didnt even went to hear the result announcement… If I didnt make it during that Pro exam, I may have not started my housemanship yet, and the little one in my family may have not started his therapy yet. Although we are still struggling with him now, but still I thank God, at least now after I started working, our family has started to move somewhere…
Its so so late dy, and I need to get an early sleep again. Hopefully I get a ‘bedsore’ call this wednesday….
Keeping the hope.
January 14, 2010
Filed under Hospital, Housemanship, National
Tags: Hospital, Houseman, Malaysia, Medicine, Personal, Spiritual Life, Testimony
Today, one of my patient fell from her bed. She is a diabetic patient with multiple organ damage, and her left was once amputated for diabetic ulcer. The bed barriers wasnt up, and she was trying to reach something from her bag, when she just slipped and fall from her bed. A loud bang, and what i saw was, she lying on the floor. Quickly me and my colleagues get her up to her bed.
I was very furious with the staff nurse in charge. Feel like giving her a piece of my mind, but then I decided to hold back. What that has happened already happened, and we cant turn back time. Quickly I assessed my patient. She well orientated to time, place and person. GCS full, no headache, no vomiting and no blurring of vision. I put her on GCS chart and vital sign monitoring and ordered for skull X-ray and Cervical X-ray. Really hope she will stay alive…
I passed over to the HO oncall. I just hope nothing happens tonight. Although it isnt my fault, but they will still hold me responsible for whatever that happens. This is how this department works. HO are responsible for whatever mistakes and errors that happened in the ward, eventhough its not their mistakes.
I hope God will keep me strong in the midst of all this troubles, and hardships. Each day problems remind us of his wondrous grace.
On ambulance call.
Last sunday was the first day I ever buy and read a newspaper during my days as houseman. the 1st news that caught my mind, was those irresponsible arson attacks. It was speculated that, those arson attacks followed when the High Court ruling allow use of ‘Allah’ to describe the Christian God. Well, as this is really really a very very sensitive issue, I shall not comment further. But those involved in those arson attacks are really jeopardising our social and national harmony.
Today, Im on ambulance call. Basically ambulance call is a passive call. We just wait for phone calls from hospital if there is any patient that need to be send to tertiary hospitals. Mostly patients sent from our hospital are those intra-cranial bleed (ICB) patients, where they will need neurosurgical intervention. There wasnt any neurosurgical specialist in our hospitals, so every patients with ICB, will be referred to the tertiary centre. And the journey from our hospital to that tertiary centre will take about 1.5-2.0 hours. Some patients will be intubated, so imagine, we have to ambubag them about 2 hours. By the time we arrive there, our hands will turned numb…
Ambulance calls sometimes can be interesting, but as for me, I prefer that, no patients tonight to be sent over, and I can have a good sleep. Cant stand the feeling of post-call…
Grateful
January 10, 2010
Filed under Christianity, Church, Faith, Hospital, Housemanship, Medical studies, Medicine, Personal
Tags: Blogs, Christ, Christianity, Hospital, Medical studies, Medicine, Personal, Religion, Spiritual Life
Today, I just got the news. A sister of my fren has passed away of stroke. Life sometimes can be so unpredictable. Someone we loved can be perfectly well today and then collapse in a split second. Good ppl die of serious illness. Hard to say whether will we breathe the next breath.We shud learn to appreciate those ppl around us. We never know, will we ever see them again…
I used to complain a lot bout being a houseman, complain about our workload and how we are treated. But now I realised, in the midst of us feeling that we are ill-treated, and bullied, there are many more unfortunate ppl around us. People who are sick, unwell and chronically in pain! People who have no source of help in their illness. They just relied on us, government doctors and nurses to cure them. Many end their life in hospital, which mostly is not the intended one.
I learned to count my blessings. Although being treated like slaves, get scolded like nobody business, I still thankful… At least I didnt have end stage renal failure or decompensated heart failure. People call me doctor and I still get my pay every month. I dun need to lie in the hospital for a long time… having to wait for the busy nurses to attend my needs. Being a christian and knowing that I’m saved is already the greatest blessing ever.
Its getting late, and my eyes are getting heavy. Tomorrow will be another challenging day. Keep in heart, we are blessed!
Believing without seeing
January 4, 2010
Filed under Christianity, Faith, Hospital, Housemanship, Medicine, Personal, Religion
Tags: Christ, Hospital, Houseman, Medicine, Personal, Spiritual Life, Testimony
Another day has gone. Today there was this patient, 55 malay lady, known case of diabetes mellitus and hypertension, came in with generalized swelling or what we call it, anarsarca. She has persistent high urea with metablolic acidosis.
I was requested by MO to insert a CVP long line. Imagine all her hands were swollen and edematous. How am I gonna insert a CVP long line through her cubital veins. CVP is a catheter that we use to monitor patient’s heart, to keep them from getting overloaded. Usually we keep the CVP reading between 5cm-10cm. Since then, I kept on asking myself, wil I be able to insert that CVP long line??? How many times will I be poking her???
But no choice, MO’s order has to be obeyed, otherwise we will getting some nice bashing… So I prepared the patients and my equipments to set the CVP long line. I could feel a vein on her lateral part of left arm. Poked there twice, failed!!! Then no more visible or palpable veins (Her arms were edematous!) I made a short prayer, please God, let me get the venous line….
Then I insert one new branulla blindly into the medial part of her cubital fossa. Saw some blood backflow, quickly I flushed in my heparinized saline and insert the CVP long line. Thank God it went in. Thats the time where I felt, whenever I lost confidence in myself, God is my faith and confidence. I didn’t knew that, such a simple thing as CVP long line could remind me of putting my faith and hope in God.
Faith means believing without seeing. It comes when we read God’s word and believe in it. Blessed are those who have not seen and yet believe. (John 20:29) We are the blessed generation cause we believe in Christ even without seeing him. He is the Alpha and Omega of our faith.
Post-call…
Post-call…. One experience that every houseman dreads. U just so disorientated, dizzy and tired. Today is my post-call day. I do prefer oncalls on fridays and saturdays, cuz the following day is a weekend, and i will be able to get a good rest on those days. Sometimes i felt RM100 per call for houseman is just too little…
This morn, me in my post-call look, do my usual morning rounds. There was this bedridden lady with pneumonia. She is on Ryle tube feeding. Here I saw her husband, with one sided stroke, still faithfully feeding his wife every 3 hours with nourishing fluid. Such a faithful husband. After feeding her, he took a tissue and wipe clean her mouth. She has multiple diseases with complications and currently is on max medical management, which means not for intubation. And her faithful husband frequentl does tepid sponging for her. He popped a question for me, ‘How is she doing?’. Her condition has always been the same, and she may collapse anytime. But i just answered him ‘Her fever is improving’. Couldnt find the right words at that time. Wonder whether does he believes in Christ o not… I do hope I wil have the opportunity to share my faith with him.
