Archive for Housemanship
{ May 4, 2010 @ 10:06 pm }
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{ Faith, Health, Hospital, Housemanship, Medicine, Personal, Religion, Work }
{ Tags: Blogs, Faith, HO, Hospital, Houseman, Medicine, Personal, Religion } · { }
A 30 year old vietnamese, working in a wood factory presented to A@E with alleged industrial injury. His left hand got stuck in a wood cutting machine, while working. Post-trauma, no LOC, no nausea and vomiting, no headache. But c/o left hand bleeding with severe pain and deformity. O/E, the left hand was totally crushed. 1st and 2nd finger totally gone and not viable. 3rd to 5th fingers viability questionable. Case was attended by Medical officer with me in the A@E itself. Patient’s BP was intially low, probably due to excessive bleeding, but then later responded to fluid resus. About 5 pints of Gelafundin was run.
This patient will need a hand microsurgery, which is not available in this hospital. He has to be referred to a hand microsurgeon which is about 3 hours journey from here. But another problem, since this patient is not a malaysian, a deposit of at least RM3000 is needed prior to surgery. My MO then consulted his employer regarding this option. As we expected, his employer is not keen to pay RM3000 for him, instead ask us to do wat we can for him.
So we planned a wound washout, wound debridement, K-wire insertion, and toilet and suturing under emergency GA, Keep In View Below Ankle Amputation if the 3rd to 5th fingers are not viable. consulted bout patient and his wife regarding this, and they signed the consent form.
So MO and me went in the surgery. Fortunately, his 3rd to 5th fingers were viable. So we did a wound washout, wound debridement, K-wire insertion and Toilet and suturing under GA. Patient was stable thoughout admission and discharge after 4 days.
Pre-surgery
Post-surgery
I do wonder, will he ever get back to work…. Will his employer give him any compensation…. the life of foreign worker in Malaysia is really a sad case…. Many more are like him….
One little mistake and he lost 2 fingers…. Thinking of this, sometimes I just give thanks to God for whatever I has. Having a full function limbs is already a blessing from God…
{ March 25, 2010 @ 11:57 pm }
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{ Housemanship, Medical studies, Medicine }
{ Tags: Blogs, Food, HO, Houseman, Medical studies, Medicine, Personal, Relationships, Travel } · { }
{ March 12, 2010 @ 11:37 pm }
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{ Christianity, Church, Faith, Health, Hospital, Housemanship, Medicine, Personal, Religion }
{ Tags: Academics, Blogs, Campus, Hospital, Houseman, Medicine, Personal, Relationships, Religion, Spiritual Life, USMKK } · { }
8 months into housemanship, 16 more months to go… Im counting days of being a houseman in a beloved country called Malaysia… Housemanship is only once in a lifetime, many ppl says we should learn as much as possible during housemanship… I do wonder… Hav I been learning enough the past 8 months? Still seems so much is lacking within me.
Im currently in a new posting, a very much different posting than the previous 2 ones. The previous 2 ones was really a very hectic and busy ones. They really drained me of my adrenaline… And now I really feel so tired and ‘malas’ already…
Here in this posting, I got more time for sports and social. Got to play badminton and futsal more often. Get to spend more time socialising with friends. I feel much ‘younger’ now… Really miss those days in USMKK where sports is an everyday thing to me…
But the past 8 months of hectic life has also drained me of my spiritual life. I oso now feeling tired and ‘malas’ spiritually. Tried to pray sometimes but really difficult to concentrate… Tried to read the bible but my eyes gets heavy in a short while. I need God’s love to overwhelm me again, that I will continue to desire Him more and more…
{ March 5, 2010 @ 7:07 pm }
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{ Christianity, Church, Faith, Health, Hospital, Housemanship, Medical studies, Personal, Religion, Testimony }
{ Tags: Blogs, Christianity, Faith, Faithfulness, HO, Hospital, House Calls, Houseman, Life, Medicine, Religion, Spiritual Life, Trials } · { }
If you were to look outside on a dark, stormy day, would you think the sun had disappeared, just because you couldn’t see it? Of course not.
Yet, some of you may be beside yourselves tonight because you’ve failed the Lord so badly you can’t imagine Him still being faithful to you. “After all,” you reason, “we reap what we sow. I’ve hit hard times and haven’t sown anything, so I guess I can’t expect anything from the Lord. I don’t know if I’ll ever pull out of this rut.”
But, as valid as God’s principle of reaping and sowing is, there’s another part of His Word, even more powerful, which says, “If we are faithless…He remains true (faithful to His Word and His righteous character), for He cannot deny Himself…He will surely be gracious to you at the sound of your cry; when He hears it, He will answer you” (II Timothy 2:13 and Isaiah 30:19, AMP).
So, tonight, rest securely in the knowledge that there is nothing you can do to diminish His faithfulness to you, even if you haven’t been faithful to Him! Believe that He will be gracious to you at the sound of your cry. When He hears it He will answer you! He understands the circumstances of your life and wants to help you draw close to Him again!
{ February 26, 2010 @ 10:56 pm }
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{ Faith, Hospital, Housemanship, Medical studies, Medicine, Personal, Work }
{ Tags: Blogs, HO, Hospital, Houseman, Life, Malaysia, Occupation, Personal, Trials } · { }
Finally I completed this tough scary posting. In a posting where HO are fully responsible of every single details of a patient, I have been experiencing sleepless nights and nightmares of my patients collapsing in the middle of night. This is where some seniors take the chance to bully the HOs. But I do salute some who does the opposite and stand up for the HOs.
Im so thankful to God for helping me through this posting. For his grace and mercy in keeping my patients alive and well despite my poor knowledge and incompetence. But through this 4 months, I did get to really learn to become a safe and independent doctor.
Today, im in a new posting. A place where we fix and manage bones and muscles. But im getting lazier and lazier since completed my previous posting. Feel like drained of motivation and strength. Guess I used too much of it during the past 4 months. Haih….
Pray that i wil gain back my motivation and strength. 16 more months to go in housemanship….
{ February 26, 2010 @ 2:06 pm }
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{ Hospital, Housemanship }
{ Tags: Blogs, God, HO, Job, Love, Passion, Pressure, Relationships, Religion, Work } · { }
Pressures from work can weigh on your soul in the middle of the night like a wet blanket. Has your work become dreary? Is it taking you twice as long to do things than it used to? Has the striving to get somewhere become too much?
One dark, stormy night, the twelve apostles were together in the same boat. There they were, out on the sea of Galilee trying to get to Capernaum, but Jesus was not with them. They were left to struggle with the storms of nature on their own, and quite frankly, they were not getting very far.
Suddenly an amazing thing happened: “…they saw Jesus walking on the sea and drawing near the boat; and they were afraid. But He said to them, “It is I; do not be afraid.” Then they willingly received Him into the boat,, and immediately the boat was at the land where they were going” (John 6:19-21, NKJV).
When Jesus, the God of love, joined the endeavor, they immediately got to their destination! This story gives us a major insight as to what love can do for any project. When love is involved, time flies; work is accomplished with grace and ease. Pray for love of your work! Pray for Jesus, the power of Love Himself, to get into your “boat” and lead you through.
{ February 3, 2010 @ 5:08 am }
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{ Hospital, Housemanship, Medical studies, Medicine, Personal }
{ Tags: Academics, Blogs, God, HO, Hospital, Houseman, Life, Malaysia, Medical studies, Medicine, Personal, Testimony } · { }
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…
{ January 28, 2010 @ 10:31 pm }
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{ Academics, Faith, Hospital, Housemanship, Medicine, Personal, Testimony }
{ Tags: Academics, Blogs, Faith, God, HO, Hospital, Houseman, Malaysia, Medical studies, Medicine, Personal, Testimony } · { }
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….
{ January 25, 2010 @ 8:22 pm }
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{ Hospital, Housemanship, Medicine, Personal }
{ Tags: Blogs, HO, Hospital, Houseman, Medicine, Personal, Photos } · { }
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!!!
{ January 23, 2010 @ 7:58 pm }
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{ 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…
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