Sudden Death

Again I haven't blogged here in awhile. Updates: I'm currently in Medical posting, it's already been about 2 months. So far I'm enjoying the posting quite a bit but the amount of death I'm seeing weekly. Today was another except that this was an unexpected one...

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A patient was admitted into female medical extension for acute flare of rheumatoid arthritis. In casualty she was given PCM, tramadol, morphine and fentanyl but none seem to have helped. She was still in severe pain on admission.

We brought my MO to see the patient first when she came in to start her rounds. We thought we'd get back to her later to solve her pain issues at the end.

"She won't die from the pain."

Whether she died from the pain or not I'm not too sure, but she did die today.

Halfway through the ward rounds, the staff nurse informed me that the patient was not breathing. She was right. I called my MO and we initiated resuscitation. Oh how there were so many inadequacies at the moment when every second counts.

1. No crash cart in the ward
2. Patient's only IV line was blue and not functioning
3. Oxygen thank was not by the bedside
4. We couldn't open the patient's jaw for intubation; temporomandibular RA

We couldn't manage to revive her after 30 minutes of trying. She passed away.

Our impression was drug overdose from the amount of opioids given to treat her pain. I'm more inclined to believe it was hypoglycemia as her DXT showed LO value. Later we found out that someone from the A&E sent her blood for dengue serology IgM which turned out to be positive. Did dengue kill her?

Whatever her cause of death, it came swiftly, unexpectedly. We were caught unaware and unprepared. Death is like that. It comes when nobody expects it. But we can still prepare. We all know how. It's only a matter of implementation.

Housemanship and Birding

Both are of the same age of about 1 year plus. While both are similar in age, there is a difference between the two.

Sabah has provided me the opportunity for me to travel and bird widely, gaining experience and skills in bird identification. Along the way I have met new people with similar interest. The 'sports' is already becoming an obsession. Every free time in the early morning or late evening is spent to bird. With the shift system applied to house officers, birding opportunities have become even more abundant. My lifer list is now nearly at 250.

What about being a doctor, my true 'career', the job where I should put my dedication in making myself a better doctor? This is my 4th posting. I will be moving to my 5th if my department lets me. After 1 year plus, working as a doctor, I must admit that my skills and knowledge are not on par or to the level which I am satisfied. Sure, during the months of work I have gained experience and knowledge but honestly it is still inadequate in my humble opinion. Sure the shift system has given me a lot of free time for myself and sleep, but in the long run, it has made me more calculative and pampered. Within weeks after the implementation of the shift system I have forgotten the lethargy accompanying a busy oncall and to work the next day til end of office hours. I am honestly ashamed with my MOs whom are still obligated and dedicated to continue their work even being post-call.

Shift system is not all that bad or for birding. Perhaps I should capitalize with the extra free hours. Some of the things possible now are:
- Study for MRCP, MRCS or other exams
- Attend OTs or minor OTs to gain more hands-on experience
- Attach to pediatric surgery activities, my supposedly main interest in medicine.
- Read more on my spiritual aspects of life and other non-medical (and birding) aspects.


So where is my direction in my life career? Birds or Human lives?

Failure to change now would only lead to the detriment of my future patients. Islam demands the best in our work. To be the best requires realization and hard work as well as tawakal. Not solely the latter.

Weekend Offs - Off

"Weekend off is a privilege, not a right"
Dr Suthagar, O&G Medical Officer (dunno why this quote stuck)

Orthopedics department was the latest department to have it's weekend off taken off following O&G, Pediatrics, Surgery (I'm not so sure about internal medicine). Reason given by Mr Nahulan, the Orthopedics head of department was that the replacing houseman (those covering patients on Sunday) could not perform well enough to present their cases. He feels that continuity is needed, in other words, the same houseman who had been taking care of the patient should be around to present the case when the MO or specialist does rounds.

It seems that the competence of housemen are in question. Despite having the numbers (even when halved, the current numbers still exceeded the amount of HOs that had to cover a ward a few years back) we still could not meet up to the expectation of our superiors. Why is that?

I refuse to believe that housemen are incompetent. Such labels are a disgrace after going through the trainings we had from high school to med school.

So what went wrong?

I believe it all comes back to attitude. I believe there is a lack of will for self-improvement. We took things for granted hoping that we could cover our tracks and hoping still that nobody finds out. There's no motivation performing better than what we could. As long as the job is done, nothing else matters.

Sadly this had to happen. With the weekend-offs gone, its back to 7 days a week work. No more early morning birding, no more over-time weekend sleep, no more weekend exercises, no more proper breakfast... In short, that's the end of 1 day of normal life.

The only thing to look forward to is that at least it's half day of work (although this might extend to the evening as in the case of O&G or if there happened to be additional unfinished work). At least its better than nothing.

I suppose we deserved what we got. Perhaps its for the best.

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Sometimes You Gotta Be Hard

Saw my MO scolding a kid today becaused he refused to cooperate for chemotherapy treatment through his central venous line (Hickman's catheter).

Kid's a 4 year old boy with acute promyelocytic leukemia. He was due for chemo which he didn't want to cooperate as he wanted to continue watching Masked rider or something like that. He got a scolding from my MO which he then cooperated.

My MO told me that as a kid patient he had 2 roles, one a the sick role, and as the kid role. The sick role deserves to be treated, but the kid role must be disciplined. I agree with him in a way. Kids when left to be treated like kings, even when they are sick will become spoiled and ironically become harder to cooperate for treatment. This is made worst when the parents pamper the child more.

I suppose life goes on even for the sick kid with cancer.

How much privelege would one get being sick then? Later for that...

Whining on Oncalls

Its weird that despite me always getting stressed up for oncalls, I'm known to take someone's call without any exchange, payment whatever. And I'd get this look, "You crazy? Are you sure? You don't wanna swap with my call?" "No, lar just give me the call only." I have to admit I was inspired by a certain senior back in my university for this type of behavior. Though people take advantage at times. But oh well.

Even with RM100 incentive per calls for housemen, people would rather be back at home and sleep. A rare luxury for me indeed nowadays.

Funny how I wish that my oncalls would be cold (though they almost never are) and that I'd be able to get some sleep.

Pfft.

The reason why you are ON - CALL is so that people could call you up in the middle of the damn night to attend to - whatever. Wishing for a good night sleep is only WISHFUL THINKING.

Besides, the more you encounter during your oncalls, the more experience you get, the more procedures you are able to perform, subsequently building your personality to get over anything that work or life can throw at you. During my calls in O&G, I've had experienced red-alerts for post op intra-ab bleeding, bleeding miscarriages, high octane labour room calls, hordes of mothers coming into PAC to deliver, vacuum deliveries, ERPOC, caesarian section and for my most recent peds, I got to experience an intubation, exchange transfusion, and hordes of babies to poke and prick at 4 am in the morning. During these calls also I've picked up skills on management of certain common problems. I don't admit that I would know how to handle each of them again but the experience matters as it will most likely be stuck with you for the rest of your career.

Oncalls are then more valuable than the money earned, as in medicine, nothing is as important as the experience one gains during work. It's sort of unfortunate with the excess of housemen nowadays, calls are getting less. This may not be a good thing in the long run as we, young doctors won't be able to get the necessary experience needed. But I guess then one has to make the best of whatever they have and benefit from it.

People tend to get grumpy whenever they hava bad call. Me included. I can become a nit nastier than I usually am when faced with a bad call though I'm still generally nice :p But I'll try my best to be professional during my next call and do my best to go through them with a level head.


PROMO: If you need to switch calls, or need someone to take your calls do ask me. If I'm ok with it I don't mind the extra call. It'll only be beneficial for me.

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Mothers

I haven't worked in the hospital a very long time. But what I've seen amaze me time and time again. Working in O&G and pediatrics, I've seen durability or mothers, the immense sacrifice and time they take to nurse their kids. Heaven is at the footsteps of our mothers. Witnessing all this, it is justified to have mothers have at least a step in heaven.

I've seen mothers bearing child, while at risk themselves, harbouring life-threatening hypertensive disorders. These mom's are like Tamil Tigers suicide bombers carrying bombs. They can blow up at any moment. That's a metaphor. What I really mean is they can die just because they are carrying their precious child.

Labour comes. Along with the pain. Vaginal delivery, caesarian section. It doesn't matter which path both again carries risk of death. I've seen torrentous bleeding in both cases where the mothers life is just a few minutes away from death. The probability of mothers suffering post labour is like playing Russian roulette.

Then when the baby is out it's not all well yet. If she's the majority of the lucky mother, she'll have a normal baby that will grow to become you or me or better. But if fate has it that she is not, the baby ends up in the NICU for months, nursed til in good shape, if the baby's lucky. Ive seen twins nursed for 3 months for prematurity. And with patience, and support, mama and baby comes home well. And I've also seen baby with stormy post natal period ending up with a hypoxic brain. The baby is bound to grow with neurological defects, unable to live a normal life like you and me. Again the mother will suffer from the extra care the child will definitely require.

But she won't care. Because she's the child's mother. It's an inborn thing to care for her child. Whether her baby is diagnosed with Down syndrome, cerebral palsy, a restrictive lung disease with very poor prognosis and life span. She'll stay with the child until the end. Because that's what she does.

I've seen mothers spend almost half a year caring for her child with meningitis with hydrocephalus. She's in a hospital so far away from home with no nearby relatives. Her husband's earning is below average. Yet she stays. Coping with her whinny kid whom complains of everything. Her only company besides her kid is the nurses and the housemen. She'll be around for a long time. Along with other mothers with kids with tracheostomies, leukemia, and kids with malnutrition.

I've also seen mother's with kids whom are fat and thriving but still feel that they do not have enough. Kids whom whines for everything gets into trouble with everybody. Whom shouts back at their mothers when being told off about something. Despite all that, momma endures. For better or worst.

No I haven't seen everything. What I've seen are only fragments of what mothers are made of. Not every mothers are like this I concede, but most are. You don't a 'Mother's Day' to celebrate. That's because everyday is mothers day.

As long as she's around she'll care for you. Whatever you attempt to do to pay back for all that she's done will never ever be enough. But for her it will always be. Because you are your mother's sons and daughters.

The Hands That Heal... Is not mine

Doctor's hand has the ability to heal people.

Rubbish.

My hands and the patient's are just the same, except for our fingerprints (subhanallah, a miracle), and whatever anatomical differences.

It cannot heal. Only Allah may heal people. My hands can only be guided to do good. Or bad.

If we look back retrospectively, how much good have we done with the hands given to us? Being doctors, we have that responsibility to use our hands for good and never for harm unless the benefits outweighs the harm such as in surgery. Our hands have that scary potential of causing harm to our patient's whom trust us to touch them. Very few occupation allows us to touch another person when that other person is not Muhrim or related to us. So heavy a doctors responsibility with his or her hands.

Since I started working as a doctor, oh how many mistakes I have caused, and the repercussions only Allah knows. I pray that Allah guide my hands to do good and avoid harm to self and others.

Peripheral neuropathies and rheumatoid arthritis bites. I pray that our hand function well so that we can continue to do good with them Insyallah.

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