Patients and Patience

Visiting hours is the worst time to review or take blood from patients.
When you ask the patient a question, the relative will help with the answer.
All of a sudden, you get a heap of complaints, sometimes not from the patients, but from the relatives.

Today, a friend of mine wanted to take blood for a dengue patient,
When he pricked the patient, her daughter was the one 'tsk'-ing in pain (don't know how else to put it).
Won't you find that disturbing?

Another short story - I was reviewing a patient.
I was just going through her previous notes before I started asking her questions when another lady by her side suddenly asked me something (I forgot the question). I answered and continued with my work.

All of a sudden, this lady asks me, u are doctor...and I told my name.
Then, she told me, "I am Dato' XYZ".
I thought, "So?"
Does she think I am going to treat her differently just because she is a Dato'?
Do I have to go around and introduce myself with a Doctor in front?
Come on!
It's not like you were born with it...so why introduce yourself with it?

However, this I MUST say...people do treat you differently based on your profession.
Teachers get respect.
Policemen/policewomen are feared.
Doctors are ...I don't know.
All I know, when I am wearing my labcoat, more people tend to look at me and smile at me compared to when I am not wearing my labcoat.

I just have one message to everyone out there - when/if you are a patient, please remember this few things :
1 - tell us your complaints, no problem, but please, don't go on and on and on! Keep it short and informative.
2- please do not change your answers. There have been many times when when I ask a patient a question, and when the MO or specialist ask the same question, the answer changes. The diagnosis depends on your answer. You give a different answer, the specialist says we didn't get a proper history!
3- please remember that you being in the ward means more work for us - extra 1 person to review, extra 1 person to take blood from, extra one bed occupied. If it were up to us, we would dischage everyone and keep the hospital empty. I am getting SICK of people who tell us that we like keeping them in the ward and not discharging them.
4- if you are given medication, please that them at home. Don't not take your medication, don't default your follow up. In the end, you are the one who is going to suffer - and when you are readmitted for your non-compliance, we will not be as nice to you as we previously are because you simply REFUSE to listen to us!

That's all for now, can't think of anything else.
Stay healthy!

Disappointed!

Today, for the first time, I got very very frustrated and disappointed with a patient because she was SO DUMB!

I have had patients who can't speak Malay or English.
I have had patients whom seem to be too blur to understand what you say and make you repeat your question many times.
I have never scolded them, never criticized them (at least notto their faces), although I don't understand how anyone can call themselves a Malaysian, and live in Malaysia and not know Malay.

But this patient was just too much.

She is a known case of TB, supposedly completed treatment about 6 years ago.
Came due to cough and SOB (shortness of breath).
X-ray looked really bad - is it the TB again, is it a cancer?
We were not sure - so we decided to get it reported.

I went for reporting - the radiologist wanted her old x-rays to compare with before commenting on the latest x-ray.

I went back to the ward and told the staff nurse to trace her old notes.
The thing is, old notes of 6 years ago is not easy to find.
They told me to call the chet clinic - I did.
The person in the chest clinic said that notes more than 3 years old will be at the record office.

I called the record office, and they said they have her records.
But, they asked me, why don't you want the latest notes?
I was dumbfounded.
Latest notes? She was admitted recently?
Then I told them to just send whatever they can up to the ward.

Guess what - she was admitted twice this year.
The first time was in April - she was admitted for a month, and the 2nd time was an elective admission for bronchoscopy.
The X-ray finding was about the same as what we found this time.

I just went through her old notes randomly - she has had CT abdomen and lungs, she has had a BMA (bone marrow aspiration) done, she has had a bronchoscopy done, she had had a skeletal survey done (basically x-ray of her whole body).
How can she neglect to tell us about all these?
What the &*%$@

Then I went to her and asked her - were you admitted earlier this year?
Then she says yes.
Then her grandchild says yes.
Come on!
How can you forget to mention this when you first came in?

When she was discharged previously, she was given an appointment to follow up in our clinic - claims she didn't come because she lost her appointment later.
ARGH!!!!!!!
What can you do with such people?!!!!

Housemanship and Complaints

The truth is, we (housemen) have it easy.
Are you surprised that I said that?
Do you think I am crazy?

Think about it - right now, we have about 30-40 HOs per department.
It used to be about 10 last time (by last time, I am talking about 5 years ago).

Nowadays we have about 4-5 HOs per ward - it used to be 1-2 HO per ward.

We have an average of 6-8 calls per month.
Used to be 15 calls per month.

Our pay is higher than before.
Our allowances are more.
And yet, we complain.

Why?
Because it is human nature.

Do you think that we compare ourselves with what the HOs went through last time?
Of course not!

We compare our working hours with those who do a 9am-5pm, 5 day job.
We compare our pay with our friends who are working in different countries or who are doing different jobs.
We compare our call claims with those who get paid per hour - like staff in factories.

And when we compare like that, yes, we are at a loss.
We don't get to sleep late on weekends.
We don't get to take MCs.
We get paid (for oncalls) at a rate of about RM6 per hour on weekends.

I have done my fair share of complainings.

My theory - if life is tough, you learn to cope with it.
E.g - in O&G, when you do the maternity call, you cover the 1st Mat, 2nd&3rd Mat, the high risk ward and also ward 14. When at one point there was a so-called shortage of HOs, only 1 person was oncall to cover all these wards; when there were more HOs, then 2 people did the oncall.
I did 5 maternity calls by myself, and I coped - I did whatever was necessary. Yes, I had to run up and down doing stuff, but I did it. And then I did many other calls with a partner - and again, we managed to do whatever was necessary. We didn't have to hurry that much, that was the only difference.

I guess, as HO, nowadays we tend to take things easy, because we have it easier.
Yes, we are in a way pampered.
Yes, I know we do less work that what the HOs did previously.
Yes, we have more free time.
Yes, we get to go out, get to have a life.

But please, don't blame us for it.
We didn't ask for thousands of us to graduate at the same time.
We were just lucky, I guess - or unlucky, since there are many things that we don't get to learn because of the huge number of us.

What's my point?
I don't know.
As usual, I am just writing whatever is running through my head - and now I seem to be hanging in the middle of nowhere.
*sigh*
(makes you wish you never een started reading it, right?)

I think it's about time I stopped writing.

Am I going to stop complaining?
No.
I am a houseman.
I HAVE to complaint.
That is what we are supposed to do.
:P

Rantings

Dear Diary,

Today, I feel....alone.
And it's because I am alone.
It's not too bad a thing..I used to love being alone.
I used to enjoy having the whole house to myself.
What changed?
I have no idea.

Yes, I read a story book, a really nice one, one I really enjoyed.
I browsed through facebook.
I played farmville.
I even went to work and went for a wedding after work.
But I still feel empty.
Something is missing.

I really feel like talking, having a good chat, but then whom to talk to?
Somehow, today everyone has something going on.
It's not like I am blaming anyone, but it's how life is, huh?
At one point, it seems like you have no time to 'layan' everyone, and at another time it seems like no one has time to 'layan' you.

Sometimes, I really don't know what I want.
At times, I just want to be left alone. I want to be free to do whatever I want.
And sometimes, I just want to have something to do, something to keep me occupied.

Argh..what am I crapping?
Maybe all I need is sleep.
Maybe.

It's All About Sex

In the past 3 days, 3 different articles caught my attention in The Star.

This is the first one : It's in the genes.
Basically what it was trying to say was that if a couple has almost similar genes - a so-called biological match, then this means they will have better sex, less cheating, longer-lasting love and perhaps even healthier children.

A day after this article was published, a letter was written to The Star, titled 'we reap what we sow in a marriage'.
It was written by a guy, and this is part of what he said:

Having thus married, the maintenance of harmony in the home is entirely in the hands of the newlyweds, though it must be emphasised here that the wife plays a pivotal role in the joint effort for wedded bliss.

If a busy working wife is so preoccupied with her daily working schedule to such an extent that she inadvertently or otherwise neglects to attend to her husband’s natural carnal needs, the seeds of discord are sown in the matrimonial home, opening the doors to the free inflow of serious consequences.

Most husbands in the above situation, understandably, have little or no ability to withstand any wife-imposed sexual starvation and they are thus forced to seek their pleasures in the outside world where a variety of sexual services are readily available around-the-clock.

I have to admit, when I read this, I was pissed off. Does he actually mean what he said? Did he actually think before writing this crap? Is he blaming infidelity on women, because the women are not 'attending to their husband's natural carnal needs'?

Today, a reply to his letter was published, Your wife is not like your mother.

Obviously, it was written by a lady. She was, naturally, against what he said. If you are interested in what she had to say, please just click on the link, it's just a short letter.

Anyway, here is what I have to say.

Sometimes, guys just don't understand. It is easy for you guys. Study, graduate then work. Once you think you are ready, get married, have children. Then, you just continue working and plan on making more babies. No one is going to ask you to do anything else.

For the fairer sex, they have to do everything that the guys do. But at the same time, they are expected to do housework and cook and take care of their children. If a child's upbringing is not good, it is the mother's who get the blame first.

I am talking from my own personal experience. A party in my house - the children eat first, naturally. Then, either the women or men eat. Once the women eat, they clean up after themselves. But the guys, they just leave everything, sometimes they don't even wash their plates! Then, the guys continue chit-chatting or watching TV and the women have to clean up.

Come on guys - how many times have you taken a plate from a lady and washed it for her? How many times has a lady washed your plate from you?

If a lady doesn't cook at home, that is an issue. Has anyone questioned a guy why he doens't cook at home even though he has a kitchen? In fact, if a guy says he cooks, everyone says that the wife is a lucky lady. Why is it never vice versa?

All I am trying to say is, more things are expected from women compared to men. Most men don't lift a finger around the house. The lady of the house has to come back from work and do everything herself. At the end of the day, is she expected to be not tired? Is she expected to 'fulfill her husband's carnal needs'?

Guys, if you want it, work for it. Help her with her housework. Let her get some rest. Then maybe you can get some action - if you are still up for it, of course.

P/s I am just talking about guys in general - there are a handful who are nice, who do help around.

Medical, Here I Comes

It is very rare to get a 'chill' day in the labor room.
Something is always happening.
There is always something to do.

But that day was different.
There really wasn't anything to do.
Even the MO found it weird, but hey, enjoy the moment while it lasts, right?

So, there I was, trying to complete my log book.

Then, I saw my specialist walking in, with a nurse pushing a patient in a wheelchair into suite 1.
Now, suite 1 is our 'special' suite - we only put 'critical' patients in there - patients with severe PE (pre-eclampsia) or IE(impending eclampsia) or patient's with heart disease.

My friend immediately went into suite 1 to see what she can do and do the necessary.
Everyone who comes in will need blood investigations, so I started taking all the tubes necessary (I assumed that it was a PE case) for the blood tests.

I was about to enter the suite when I saw drops of blood on the flood. I stopped, went back to where we kept all the tubes and took another bottle, which was necessary for any patients who are bleeding.

2 others started setting branulas and taking blood.
1 pushed in the scan machine for the specialist.
I started filling up the blood forms.

Specialist scanned - confirmed an abruptio placenta (placenta separated from the uterus wall) and (as we would do in any emergency situation) we prepared for LSCS.

One HO ran for blood, one HO scrubbed in OT.
Baby was out in less than 10 minutes.
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Right now, I can't think of any more stories.
Tomorrow will be my last day in O&G.
I am going to start my medical posting.
As much as I hate tagging, hate starting a new department (it is like learning a new subject alltogether) I am glad I have not been extended.

EMERGENCY!

It was a busy day in the labor room.
All 8 suites were full.
There are 4 beds in the ABC - we even had to put patients in active labor there.

One MO was in the OT.
Another one was running around in the labor room.

Then, suite 7 had prolonged 2nd stage (basically, the baby was not coming out as fast as it was supposed to).

MO consulted specialist, decided for vacuum.
While the vacuum was being done for suite 7, one patient in ABC had fetal bradycardia.
MO was busy, told one of us to call the specialist.

Called specialist, specialist came over.
Suite 7 delivered by then.
Specialist decided that the patient in ABC should go for vacuum.
She started to prepare for vacuum, but we couldn't really get a CTG reading for the baby.

The ultrasound machine was pushed in.
The fetal heart rate was really slow.
Specialist decided then and there - LSCS NOW!

Preparations were made for LCSC (thank God the other LSCS in the OT was over).
Patient was pushed in as fast as possible.
Paeds team told to standby.
Baby was out in less than 5-10minutes I think.
Baby born crying.
Hurray!!

Came out to labor suite - suite 1 also had prolonged 2nd stage - another vacuum delivery.

That day, we had SO many deliveries that there were about 12 babies in the baby room at one time (usually we have about 4).
____________________________________________________________

It was 4am. I was oncall.

The CTG for patient in suite 7 showed some fetal deceleration (I think it was Type II).
My friend did everything that was necessary, but nothing worked.
And patient had some bleeding.

My MO was in the VE room.
I decided that we shouldn't wait for him to come in.
I tore off the CTG and went straight to him.

MO wasn't very worried, but he attended to patient.
Hmm..why was patient bleeding, he wondered out loud.

He did a VE.
His face changed.
2 words - cord prolapse (basically the umbilical cord has fallen out).
Everyone rushed to do whatever necessary - inflate bladder, raise buttock, prepare for LSCS.
I ran and called the other MO who was oncall.
Ran into OT.
Baby delivered within 5 minutes - not crying at first, but was eventually OK.

The Labor Room

O&G was not like the other postings.
There were more emergencies. More excitement.

It's because in the other 2 postings that I went through, Paeds and Ortho, all cases are screened in the A&E before they come to the ward. If the patient is unstable, they are stabilized before being sent to the ward.

In O&G, the labor room is our A&E. All pregnant ladies are sent there (very few are sent to the A&E). So, you see and play a part in managing emergencies in the labor room.

It's not to say that you see an emergency very often, but you see it enough.

There are some stories that I would like to share..these are the things I saw, my experiences. They are better stories, but then I wasn't part of it, so can't really tell those stories properly, so most probably won't be telling them.
(I will try my best to tell it as simple as possible, but am not going to explain everything (cos then it would take very long), so if you are curious enough, please google for it)
____________________________________________________

My MO was doing a Caesarean Section (LSCS) in the OT. Our specialist(S) was doing rounds in the labor room. S received a call and was on the phone, so I decided to go to the VE room (where we clerk patients before deciding whether to admit them to the labor room or to the ward or to discharge them) to see if there were any patients to clerk.

One lady was there, doing CTG (cardiotocography - to see the fetal heart activity). It was her 5th pregnancy, and she had already delivered 4 children via SVD (vaginal delivery). She came due to contraction pain.

I asked her all the questions I needed to ask, and then left her to finish the CTG (which takes about 20 minutes) and started writing down the clerking. She came after completing her CTG and looked quite uncomfortable, so I decided to do a VE first before proceeding with the clerking.

I did all the necessary examination and then did the VE (vaginal examination). I was shocked!! I felt a feet, and I could feel the whole feet. I panicked, and told my friend to call the MO.

I waited for my friend for what I felt like eternity. Then, I decided that I can't wait any longer. I told the lady to just lie down and not push and ran into the labor suite myself. Then I was told that there were no MOs around, only the S.

I went straight to the S, and told, Dr. L, there is a patient in the VE room, feet presentation. The S immediately came with me and attended to the patient. Confirming the presentation, she said prepare for LSCS (which mean you have to take her blood, set line, get the op consent and blood consent and send the booking slip).

But we only have one MOT. Dr. L decided that she would go into the OT to finish up the op that was going on so that this lady can be pushed in faster, before this baby decides to come out. At the same time, there was another emergency inside the labor room, a fetal distress. That makes it 2 LSCS waiting with one OT occupied.

The solution - fetal distress was sent to GOT (an ambulance will bring the patient to the main building for that) and feet presentation will go in after either of the LSCS (whether in MOT or GOT) is done.
________________________________________________________________

I didn't expect 1 story to be that long!
Although now, I feel it's not as exciting as when it was happening.
Will try a different story tomorrow.
Hopefully that will sound better once written down.
Good night!

Boob-Staring Is Good For You?

Spotted in The Star today..

HERE’s a simple “secret” to ensure longevity for men – stare at women’s breasts for 10 minutes a day to live an additional five years.

Both Sin Chew Daily and China Press reported that a German research published in the New England Journal of Medicine showed that men ogling at breasts for 10 minutes a day was equivalent to a 30-minute gym workout.

Sin Chew Daily reported yesterday that the team had spent five years researching 200 men.

Results showed that men who liked to stare at women’s breasts have lower blood pressure, suffer less cardiovascular disease and have slower heart beat.

The daily also quoted gerontologist Dr Karen Weatherby as saying that sexual desire ensured better blood circulation and led to better health.

However, it was reported that reporters had attempted to search the article in the journal’s website but failed. Thus, there were doubts whether there was indeed such an article in the journal.

______________________________________________________________

I guess all men can now cancel their gym membership and buy porn videos instead.

The Child In Me

I am not allowed to take more than 4 days off (including the weekend) at the end of my posting. Since I had an extra day to spare, I took today off.

As anyone who has a day off would do, I woke up only at 10am.

Wondering what to do (besides filling up my log book and cpd book and skt form - all of which I am yet to do), I decided to go to Jusco, just for window shopping.

Then I thought that today would be a good time to get myself a handbag and a pair of jeans - something I have meant to do for quite some time now. I expected Jusco to be empty, but was rather surprised to see that quite a number of people were there. It's the weekday - how come so many people have nothing else to do during weekdays?

Thankfully though, the crowd was not too bad and I went ahead with my mission. I walked in and out of many, many shops to no avail - couldn't find anything that I liked enough to buy. Just about then, I gave up.

Then I remembered that I have not yet bought my niece a birthday present (her birthday was ages ago) and decided to get her something.

I thought of getting her a pencil box with stationery, but another shop caught my attention. The shop had some interesting stuff, and I ended up buying some coloring like thingy from the shop for my niece.

But that was not all.
Suddenly, I felt like doing some 'art work' myself.

And so, here is what I bought for myself.


The end result :
Not too bad for a first timer, right? :P

p/s I am planning to give it to someone, the someone should be able to guess by now that it is for him/her.