and the tone has been set

Two thousand and twelve.

You've only been here for 23 minutes and you already suck!!
Am stuck in Canberra. Was hoping to catch the Sydney fireworks on TV. Please enlighten me... which of the local channels actually showed live coverage of new years' fireworks, let alone the Sydney ones? All I could find were reruns of some Barbra Streisand movie, an episode of That 70s Show, some sci-fi thing called Paranormal talking about alternate universes and gravitons (interesting stuff tho!), some Star Trek episode where some Trekkie looking like Data was making out with some Elvira-like female and Van Helsing, amongst the numerous SBS channels that included Bollywood movies. I had to search through Youtube to watch the fireworks that I could've seen from our apartment, had I been in Sydney. So, I watched the fireworks belatedly on my laptop, alone. Without the hubby. WHEN I COULD HAVE SEEN IT LIVE, even if it was via TV. Pathetically sad, even for my standards.

Spent the rest of it since I started this post talking to my parents. Lovely as they are, I had wanted to call up my grandma's place to catch up with all my aunts and uncles and cousins. I thought they'd all be there, but nobody tells me anything as usual. Turns out, everyone had left for their respective homes in different countries around the world by today. Ended up yakking to my parents for nearly an hour instead. Was kinda nice to be able to tell them I had thoughts of leaving medicine completely. Again, I blame two thousand and eleven for that change of heart.

Two thousand and twelve. You better shape up and get your act together. Don't you dare emulate two thousand and eleven or I'll kick your butt so far, you'll end up in some parallel universe. *roar*

hurry up and leave, 2011

The year's coming to a close and I'm glum. Not because it means I'm one year closer to death. Am momentarily stuck in a moment of feeling helpless. Driving for four hours straight, at times in rain so heavy I couldn't see more than 5 feet in front of me.. driving back to a rented apartment alone gives one a few moments to reflect.

It's not very gratifying to feel that I haven't made any difference to people. Do you realize how frustrating it is to come across patients regularly who travel several hours to wait another few more at a crowded clinic, to be seen by a registrar (they're lucky if they get one of the good ones..) for less than 10 minutes and then be either be told that they're not healing well, or they are but to come back in another couple of weeks once their broken bone has healed? Some of these people struggle to find the means to come, either because of lack of transport or lack of funds. Couple that with a painful injury, sometimes in a cast that doesn't allow them to bend at the knees to sit comfortably in the car... And yet, there are ads on TV telling people that help is never too far away (via helicopter), showing signs in the middle of nowhere with things like "pediatrician --> 500km" or "heart specialist <--- 630km" on them.

It's not near. It's bloody far away for these people. It's frustrating to be part of this system, where we're at the bottom of the food chain. People "up there" sit there making rules that affect the lives of many hundreds out there without full understanding of the implications for those affected.

Do you know how much of a lightbulb moment it was for me to admit to myself that I've enjoyed my short weeks of ICU more than I've enjoyed ortho all year (except for my secondment hospital posting)? Yes, the huge blocks of days off help a lot. Maybe it's that. Or maybe I feel like I'm doing something useful - like preventing home teams from inadvertently killing their patients from sheer neglect when I go on MET calls. Coming from someone who has been gunning to get into ortho since internship, this is huge.

I thought 2010 was a crap year. The workplace woes resulting in a non-negotiable boss-initiated week off, no questions asked. The stress associated with planning the wedding (would have been worse without the support of the Tubby-Hubby) - so much so that I forgot to actually enjoy the moment of getting married because it passed in such a huge blur. Sad, eh? The disappointment of not scoring an ortho interview (for that was the goal) and scrambling around to rack up the points. The bulk of it was mostly the mental torture stemming from work, and a particular colleague at the time.

This year was worse. It's like the universe is out to prove that it can outdo itself. The few moments we could steal of married life were good but we were mostly apart this year due to work. I'm renting an apartment nearly 300km away for goodness sakes. And then, I lost my rings. On the one-year anniversary of his proposal. Both rings. And then the bitching at work! This year took my workplace woes to a new level of hell. Then my car died on me. A minor crack in the radiator was undetected and ended up blowing the gasket. The engine needed to be replaced and the car was at the mechanic's for more than a month. I got stuck in floods, the worst in the region for decades. The regional hospital was basically in shutdown mode for the week until waters receded. And then my grandpa. The parents thought it would be a nice thing to tell me that my grandpa isn't likely to make it.. one month into his ICU admission overseas. You have no idea how much I seethed at being told so late. He died soon after. I found out on the train, via a text message. Gee, thanks for the kind gesture. The Tubby-Hubby was next to me on our way to pick up our wedding album. We were to bring it back home to show my grandparents the wedding they missed. It was the main reason we got the album made. He never got to see it. It kills me every time I think about it still. We flew back for the funeral. We flew back again less than a month later for the vacation we planned half a year ago, wedding album in tow. The poor Tubby-Hubby has occasionally had to suffer the under-the-surface bubblings of angst and frustration I can't contain but otherwise, I've been trying to lie low ever since..

So yeah, given all that, I'm glad this year's coming to a close. I'm glad I'm getting a new shot at things. I'm scared of not living up to expectations, but am glad nevertheless to start fresh. I'm glad that I get to go home every night to home, not some derelict run-down apartment where I look over my shoulder all the time to ensure my own safety. Two thousand and eleven, I'm glad you're going to be history soon.

C is for Cookie

Sometimes, I wonder

Why suffer so?

Why jump through the hoops

When there's other places to go!

The operating room,

It has its thrills

Those bloody messes

And the drilling of drills!

But then I think,

Is this worth the time?

To while away the years

As I while away my prime.

I'd rather be happy

Than trudge through the day

To come back home exhausted

It's not worth the pay..

So once again

Here, I stand

At crossroads familiar

A decision in demand

But let me be,

And let me stay

In my dreamland

For another day!

So for all you friends

and family too

A happy Cookie Day

to all of you!

medical marvels

Once again, I'm warning all of you. Do not land yourself in the hospital if you can prevent it. You will be surrounded by incompetent nincompoops, especially on weekends. Just take a peek at these pieces about UK hospitals. It's old news, really.

I'm most likely offering a skewed view so indulge me and share your thoughts with me after you hear out my tales. All names are fictional in this context.

***

Teddy, the ICU registrar receives a call on the Outreach phone, a dedicated line meant for consults by the rest of the hospital. His side of the conversation goes something like this:
"Yes, I remember Mr Connors. Uh huh. ..you're concerned about his heart rate?"
*long pause accompanied by a myriad of facial expressions ranging from bewilderment to utterly lost*
"So you're the team registrar?"
*another long pause with the facial accompaniments*
"So you're the intern?"
*a slightly shorter pause*
"So you're the nurse? Um.. why don't you call the resident looking after your floor to review the patient first, and if they have issues, they can call the medical registrar to review. If the med reg thinks the patient needs ICU to get involve, they can call us then."

For those of you who don't work in a hospital, the ridiculousness of this might be lost on you. I don't mean to sound elitist, but am just stating how the chain of command works. Ward nurses aren't supposed to MAKE referrals to any team - it's not the job they were trained to do, it's not their call to make. If they were concerned, they should refer to the doctor responsible for the patient they're worried about. If they're still concerned for the patient's safety, there's a MET call/Code Blue system in place to get senior help FAST. There was absolutely no role for them to call up the ICU registrar to request a review, yet this particular one was quite indignant that ICU hadn't reviewed this WARD patient (who was NOT in ICU) in two days and why not?!


****

The Outreach phone rings again.
Jack starts to talk to his counterpart, another registar, on the other end of the line.
The full story emerges after Jack hangs up the phone with a very bemused on his face.
"There's this paranoid schizophrenic patient down at the psychiatric unit who's refused to eat for the past two days now. They want us to bring him up here to ICU, sedate him and give him IV fluids"

... where do you even START?!

First of all, the patient is mentally ill and is a scheduled patient, basically classifying them as an involuntary in-patient. Therefore, as a doctor (they obviously forgot what that entailed), the psych team is legally allowed to implement any and all treatment/evaluation deemed appropriate to the benefit of the patient. That translates to "go and restrain him so you can put in an IV cannula to start the fluids through, you nincompoops"

So the ICU Outreach team troops down to the mental health unit to review this patient, made sure he was all ok and document that the medical ward is perfectly capable of having patients with cannulae in situ, and if they required any help to insert lines, to call the anesthetic team. The medical team hadn't even reviewed the patient yet, as Jack had advised over the phone.

As the ICU team troop back to the unit, Jack gets a call from some manager up in hospital administration, saying that it was unsafe to have the patient up in the ward. Honestly, medical admin, you're making that clinical call?! If you were so concerned about the patient, why don't you come and review the patient yourself to reach a decision, usurping both the medical registrar, the psychiatry registrar and the ICU registrar of their jobs?

Oh, the saga continues. After Jack finishes entering the review into the ICU database, the MET call/Code Blue pager goes off. Guess where at? No prizes for guessing.. the psychiatric unit. The reason? "The patient dropped his GCS a little." By the time the ICU team arrived again, the patient had his eyes closed. They flipped open immediately and the mouth uttered a very comprehensible "Yah, what mate?" as soon as the ICU registrar approached and tapped him on the shoulder. Decreased GCS - what utter crap!!


***

And then there were the phone calls - 3 so far in my two days at work this block of shifts. All kept asking about a certain patient in one of the ICU single rooms, inquiring about his health. Um, how do I put it without being blunt... "He died last week." It's like he hasn't let go.. his xrays are still around, random teams that have been involved with his care have been calling at random times (what consultant calls up on a weekend afternoon anyway!?), and even family have called. Awkward.

***

What about our Dancing Queen.. the one that's been in ICU for over 150 days and counting. The one that has stiffened up from being bedbound, intubated and ventilated for most of this time and has grown all sorts of bugs that can only be managed with nephrotoxic antibiotics that are reserved as a last resort? Now, do you think the family is being considerate, or being just plain cruel, to plaster the only wall she can see from her bed with enlarged pictures of the patient when she was well.. when she was leaning over balconies enjoying sunsets, or when she was playing with her grandkids. I call it cruel, especially if I was the patient sitting there with multiple holes in my abdomen from so many surgeries that I'm leaking everywhere. I wouldn't want to be reminded of what could have been, what was, what I could have done.. Yet, the family refuse to let her fade away in a comfortable, painfree manner but insist on us shoving tubes down the patient's throat and other awful maneuvers that wouldn't improve the patient's eventual quality of life.. if she made it out of ICU, let alone the hospital at all.

***

Oh, I could go on but my head hurts. So many other similar events happen on a daily basis. Add that to the incompetence of certain staff members on any given shift (or those with personality problems, or those that like the thrill of power struggles). Then add truly sick patients in ICU requiring medical attention. Then add the occasional procedure required like central or arterial lines. Factor in patients arriving and leaving the unit at any given time, plus the paperwork involved. All in a day's work. My head hurts =(

ungrateful wench

The ICU. At night. Be scared. Be very scared... of Angry Amy. She reared her face and made a guest appearance last night when we had this lady yell the house down. Post-craniotomy for removal of a brain mets, she was brought into HDU and wouldn't shut her shrill little mouth all night. She obviously subscribed to the "The louder I yell, the more attention they'll pay me" school of thought. To make matters worse, she was Cantonese-speaking and her poor daughter had to interpret for her. The lady obviously could understand and speak some English, for by the end of the night, she was forming simple, blunt sentences such as "You no care" and "I want to leave." The daughter had enough before we hit this stage and left for home at around 4am in the morning.

Now, I don't have a lot of patience but I make up for it with tolerance. This lady had used up any and all -ence I had about two hours into the shift. She claimed she was in pain but refused analgesia. Ok.. that's not so uncommon amongst the patient population. Matyrs. Or plain stubborn idiots. That was just the tip of the iceberg. She then loudly claimed that ICU wasn't providing her adequate care along the lines of "24-hour care my foot. Someone comes to check on me every hour and looks at the computer. Otherwise, they only come when I yell out." So I spend the next 40 minutes going through explaining that ICU has gone electronic and all notes are in the computer now, to pointing out that she has a dedicated nurse looking after her and all sorts of things. She managed to say in English "I don't accept that" to all my explanations like a freeeeeeaking petulant child. She tried the "I want to speak to the boss of ICU" angle, at 3am in the morning. Uh, no. She finally agreed to have some fentanyl after demanding that she'll be fine with paracetamol. Uh lady, it's not your call. She still wasn't happy and resorted to "Oh, it's all my fault then, I'm wrong and you're right." and kept repeating that for the rest of the hour. *gnash teeth silently* Every. single. button. pushed. She kicked up such a fuss, claiming we didn't care for her, let her die, blahblahblah, that she set off the confused hypoxic guy opposite her and caused her neighbor to develop stridor.

So I cracked the shits. Apologized to her daughter and asked if she could please translate what I was about to say. And let the feral woman have it. I was this close to rhetorically asking her if she was the doctor here, and would like to dictate her own management after having her skull just cut open. Never have I said that to the patient, and seldom does the thought cross my mind. Seems really arrogant and I wouldn't have been able to get the words out completely before sheepishly apologizing halfway through.. but tonight. MAN. that close to saying it to her. crazy woman. Thanks a lot for reinforcing the maybe wayward views I have about Chinese culture and habits.. where the more you fuss, the more it means you care.. or how nothing else but an injection (for whatever ailment befalls you that day, even a sniffly nose) is the only way to "cure" you. Olanzapine gun, you were my best friend tonight =)

Halloween 2011

So All Hallows' Eve 

Is here once more

But this year is different

From the ones before

Yes, there are things

That never seem to change

Like the Christmas decorations

In the supermarket range

Or the lack of pumpkins

That were suitable to carve

There were a few, a few weeks back

But the night itself was pumpkin-starved

But that's ok, 

Because I made do

Like every year, 

It's nothing new

The only change is

I'm now wed

'Twas a year ago today

I became a missus instead

So screw the candy

and the lack of tricks

Forget the kiddies

And the decorations for kicks

For Halloween is still not quite,

It's not quite right here, but that's alright

A feast we'll have, and a feast to enjoy

A feast for two without the fright!

morons

I really really need to get this off my chest, especially before my night shift starts.
Am already cranky for not being able to sleep through this afternoon in preparation for the next few nights, and for having an awful dream where I met someone in-dream I really didn't want to see and then I wake up to find idiots in my inbox.

The medical admin where I currently work really need to get their act together. I've never come across a more incompetent team (despite having only worked long-term with three previous teams - one during university, the others up in Sydney).

I have been working at this hospital since mid-January this year. We're now nearing the end of October and I get an email saying "I have been advised that you have not been to see the staff at the Occupational Medicine Unit at The Canberra Hospital on Level 10 for your immunisation/vaccination screening." You're joking right? It took you until now? I went away for 8 weeks early on during the year and got my little vaccination card after getting verification of my immunization status. But, no, that doesn't count because we're in a frickin' different state that really doesn't have much going on  for it except that someone decided a while back to cordon off an area of New South Wales and declare it the capital territory. To be honest, I completely forgot about immunization. I vaguely remember attempting to do the right thing and seek them out, until I shortly gave up trying. Seriously, they open for two hours a day - from 1.30 - 3.30pm and then you need to go to another clinic for them to be happy you don't have TB. That clinic's not much better, opening between 12 and 3pm. What planet did these people come from!? Do they honestly believe that doctors who are hauling ass around the hospital trying to work have time to go up during their measly opening hours so they can shuffle some paper around? Especially surgeons?

And then there's that mandatory training of a new x-ray machine that the operating theaters are getting. You gotta know, this mass email telling us we all had to attend included everyone from registars to bosses from both orthopedics and plastics. The first email came out early August, telling us training sessions would be either Sept 8th or Sept 22 during bloody working hours: 2 - 4pm! Again, what planet did these people come from?! So a boss emailed, saying they'd rather come back Saturday and get the thing over and done with in one shot without having to worry that we were losing precious allocated theater time. After 2 more emails hounding for us to reply and sign up because training couldn't proceed unless there are 10 or more people (or what? you lose money? why does it matter if this is all mandatory for us anyway?), we get an email four days before the rescheduled session to say it's been cancelled. We have since had three more reschedulings and several emails in between to nag us of the new training dates. Why? Because they couldn't get their act together. The first two times, rescheduling happened because the bloody x-ray machine hadn't physically arrived. The last, was because they couldn't get it "commissioned" in time, whatever that means. Seriously?! Eleven emails since August and they still couldn't get it together.

And don't get me started on the horrible rostering, or their lack of responsibility.. or the fact that they somehow "forgot" to give the IT department a list of all new incoming doctors at the beginning of the year and therefore, none of us had passwords issued for immediate use on our first day of work. They're here to support us - bullshit! They told one consultant colleague of mine they would pay for his relocation costs, seeing that he was shifting all his stuff from overseas to here. He arrived, they stuck him in accommodation for only 6 weeks because his contract is for a year (and not 6 months, so apparently they're not obliged to provide him with accommodation) and then refused to pay for relocation costs because "it was never promised." Sorry, there's just so much wrong with this place.. I'm really really looking forward to leaving and have already started counting down the days. I don't know how anyone who has worked here before had anything good to say about it. Personally, all the consultants I've met have just smirked and skirted the issue about their previous stints here - and that's not even taking the awful medical admin into account.

And with that, off to night shift a little less angsty. =)

another round of gnnnnaarrrrrgh!

Can i hazard a guess that it's universally annoying to all to know that one is right, but can't do a thing about it? Patients are lovely like that. they revive random sentiments every so often, just to keep me on my toes. Just yesterday, I had to talk to a 40 year old housewife in Mandarin to explain why her distal radius fracture really needs surgery.

Despite explaining that:

• her bones would heal in about 6 weeks regardless of surgery
• she would continue to have improving levels of pain until her bones healed
• we would give her medications through the drip and tablets to control her pain
• her arm would be out of action for the next 6 weeks until her bones healed
• she would have poor function if her bones healed in a not-so-ideal position like they're in now
• she may not have pain now, but may experience pain in the future with unsatisfactory positioning of the pieces
• she will have no guarantee of finding an orthopod who will perform the required surgery up in sydney, let alone guarantee that the surgery will proceed at the latest, tomorrow
• she doesn't even know where to find an orthopod
• any number of friends she's got, unless they're in the medical system, will not even come close to getting her near an orthopod in Sydney (I was also thinking that it would prolly help if she had some English speaking friends in an English-based country but kept that thought to myself)
• she is already fasted for more than 6 hours and is technically ready to go to theaters
• she could be home in sydney by tomorrow afternoon if all goes well
• she is lucky there wasn't much trauma on in theaters and we could fit her in within the next few hours
• we don't advocate operations just because we like cutting people open and we have nothing better to do (shush, all you naysayers! *waits for the ortho-bashing*)

We traced lines and angles on her xrays to explain. We got her friend to explain (after we went through the above again in Mandarin because, much to my dismay, her friend couldn't speak English either. URGH!). We showed her what normal bone alignment was supposed to be like and what hers looked like. She obviously got it because there was a lot of tsk-tsking and shaking of her head along with her gasps.


And despite all that..



The lady refused surgery. 
And for what reason?


She was paiseh. Really, lady. You would rather live with a broken wrist that would very likely continue to collapse and shift in position (especially after you refuse a backslab because you were scared of pain) and cause you functional problems in the future, besides the possibility of pain and future corrective surgery or wrist fusion. You would rather live with that because you were too shy or polite or whatever you call it for not wanting to bother your friends by staying an extra night because you were only meant to stay one night. Really, lady? Really?


So, I got a bit shitty with her. I was right! She knew it just as well as I did. She knew I was being so persistent as her advocate, so she kept thanking me. That really made me more mad. I told her to stop thanking me because it wasn't going to help her wrist return to normal function. And then I launched into the consequences of declining surgery, making sure she understood them all. She said she did. Then she would start to thank me again. We went in circles and it drove me mad. My Aussie colleague could only roll her eyes as she figured out the gist of it without needing to understand a word of Chinese. Because nobody was happy, we got an ED intern that could speak Mandarin to reiterate everything again just to make sure the lady wasn't being daft because of my linguistic skills, or lack of.


By then, my colleague and I had had it. Why the hell were we wasting time with an obstinate idiot who obviously values "face" to avoid any "shame" (such as walking out with a backslab) more than her well-being, or that of her family's. So we left it at that and told her that ultimately, it was her body, her choice but she had to be put in a backslab as basic fracture management.


Imagine my surprise when I saw her name on the pre-op patient list this morning!!
She had some sense of self-preservation after all! Yay, there's hope.. but boo, she made me work for it dammit!

oh chute!

uncouth neighbors with no manners irk me to bits. just had to get that off my chest..
out of curiosity, what's the worst "payback" anyone's given to their unruly neighbors? sadly, or not.. mine haven't been too creative. they mostly involved poking a broom or bouncing a ball up at the ceiling to coincide and drown out stomping from upstairs.. or sarcastic passive-aggressive letters. the latest of which had photographic evidence of the oodles of garbage left in front of our garbage chute. seriously, who does that?! they bothered to take the trash all the way to the chute but couldn't be bothered opening the door to dump it in! they're either really stupid, or really lazy.. or both. some people, honestly! *huffs*