A Reason To Be Happy

In a way, today felt like Deepavali.

Finally, our ward received a new stock of syringes and gloves etc.

In the beginning, we lacked sterile gloves.

Then non-sterile gloves.

For the past few days, you would be lucky if you can find any gloves at all!!

It has been more than a month since we had 10cc syringe.

Let me tell you why you need 10cc syringe.

When a patient is admitted to the ward, here are a few basic investigations:

1. FBC - 2cc

2. RP/LFT - 1cc

3. RBS - 1 to 2 cc

4. PT/INR - 2cc

Which comes to 7 cc.

So, how do you use a 5cc syringe to take the blood?

2 choices - prick the patient twice, or you use a 5cc syringe and take the blood and then remove the syringe from the needle and in place put in another syringe (don't take the needle off from the patient). The first way, the patient will hate you, the 2nd way, you are at a risk of needle prick injury - so, which would you choose?

Branulas are hard to get too - someone made the wrong orders and certain wards have this horrible branula which is SO hard to use!

Tegaderm - another almost extinct thing - nowadays we just use plaster.

Thankfully, today we received our stock.

I really felt happy to see the PPK pushing the trolly full of stuff today.

Anyway, quote of the day, by Dr. LYF - "Only 2 things in life is certain - death and income tax".

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?!!!!

I NEED A Ventilator

Yesterday, a lady had severe pre-eclampsia, a condition, during pregnancy, which could lead to eclampsia (manifested mainly by seizures) and so had to be delivered as soon as possible.

Her baby was a premature, only 1kg, and so will require a ventilator after birth.
There are no available ventilators in Ipoh Hospital.
So we called outside, from the near hospitals to the further ones.
Finally, we managed to get one in Selayang, and so the baby went all the way to Selayang during the first few hours of life.

Today, another lady. She had bleeding placenta previa, a life threathening condition, and so, had to be delivered as soon as possible.
Estimated fetal weight - 1.8kg.
We tried as many hospitals as we could.
All the way from Perlis, right down to Johor.
Ventilators were either in use, or have already been booked.
There were none that we could book.

In the end, the caesar had to be done.
The paed's team were told to standby.
NICU Ipoh was informed.

The baby was born.
2.6kg!
The baby had to be admitted (for observation I guess), but did not require a ventilator.
Thank God for that!

But just imagine if that is not what happened.
What if the baby needed a ventilator?
Do we wean off another baby from his/her ventilator?
Or do we try all the hospitals again in hope that a ventilator has just become available?
Isn't it sad that we don't have enough ventilators?

Such a scenario is not an isolated one.
It happens many times in a week.
What would you do if that were your child?
Pray and hope that there is a ventilator available?
I guess that is the only way..

Sick Of H1N1

Recently, H1N1 has been quite a hot topic.
Everyone, everywhere is talking about the latest morbidity and mortality statistics.

All of a sudden, everyone is wearing masks.
The emergency rooms (and I'm sure that the outpatient department) is crowded with people who think they have H1N1.
People are demanding for tests and medications.

I just don't get it.
I don't know how many times the government has told that not everyone needs treatment.
Only if you are in the high risk group, you will be given treatment.
If not, all you have to do is quarantine your self.
Why do all this people have to crowd the A&E like that?

The other day, at 12am, the A&E waiting area and the locum room waiting area was full of people.
Come on la...it's not like you develop flu at night..if you MUST seek treatment, why can't you come earlier? Why so late at night? Because your work is more important?

Dear people, the mask you wear - it is NOT impermeable to viruses.
If you really want to avoid the flu, stay at home, rest.
If you don't have to go the hospital, then don't.
I still see people bringing their barely-1-year-old children to the hospital to visit sick relatives.
Is that necessary?
Don't they realize that hospitals are the homes for all the viruses and bacterias of the world?
Why do you think so many people fall sick IN the hospital?

Yes, I know people died of H1N1.
Yes, I know you are worried that you might get the infection.
But going to the hospital whenever you get the flu is not the solution.
If you are really unwell, by all means, go to the hospital.
If all you have is flu and a slight fever, stay at home, drink lots of water, do whatever it is you do when you had the flu before H1N1.

One thing you can do, and should do is avoid spreading the infection to others, which means minimal contact with other people. Just because you have an infection doesn't mean another person has to have it too, right?

I'm sure 1Malaysia doesn't mean every catching the same infection at the same time, right?