12.18.2009

happy holidays!

what a week it's been since returning to australian soil! managed to come back in one piece. for those of you curious about the airbus 380... let them iron out the kinks first before you let yourself be game enough to try new technology. our flight was delayed two and half hours from sydney to singapore. we started to accelerate at the top of the runway before decelerating not 2 seconds afterwards. looked out the window onto the wing to see lovely streams of smoke trailing behind. the captain put me out of my misery with his announcement a few minutes later by saying we had to return to the terminal to change the plane's tires.. and that there was a minor techinical fault with one of the engines. i turned back to the window to spy four fire engines trailing our plane back to the terminal. when the plane finally took off, everyone clapped and cheered.. it's been a while since i've been in a cabin full of cheering strangers. our luck couldn't have been any better. our flight was delayed again on the return trip, what were the odds! this time, the tire pressure light apparently sounded prior to take-off and the pilot wasn't sure if the light was faulty or if the tire pressures were truly low. back to the terminal before we finally lift off.

in the spirit of the holiday season.. c'mon everyone, feel free to sing along with me now.


on the twelfth day of r'turning
my karma gave to me
twelve crazy patients
eleven more as nutty
ten bagels weekly
nine dental fillings
eight missing cards
seven hours of working
six new hairbands
five working days!
four plants dying
three dental bills
two wonky handphones
and a dead car battery!

happy holidays from the newest fluff, bah'wahn and the rest of the fluffmily!

11.24.2009

who DOES this?

seriously, who does this? it baffles me to no end to stumble upon such unique specimens of the human race every so often...

what kind of person comes up to the main desk area of a hospital ward to borrow a pen to scribble down a phone number and never returns with an uncapped pen? worse still, the person didn't even have a relative on the ward! now, all i have left of my purdy pen is its cap you see above. hmph. seriously, what're they gonna do with a half used un-capped pen. i spent the rest of the day providing great entertainment to the nurses everytime i decided to whine out a "gimme back my pehhhhhn" when i saw my pen cap hanging forlornly from my ID tag lanyard.

what kind of person goes to the laundry room in the dorms to take all your wet clothes out from the washer and plonk them on the dirty bench so they can use your machine? worse still, what kind of person opens the dryer door for whatever reason while your clothes are in there tumbling towards dryness and then leaves the door open so the timer runs out and your clothes are still wet an hour afterwards when you go down to collect them? (yes A, like i told you, i don't think i'll ever get over that one)

what kind of person blocks up a whole lane of cars in a one-lane street for the next few minutes waiting for a good time to make an u-turn? drive around the block dammit! selfish prat!

what kind of person catches your eye from the back of the car in front of you and then proceeds to pick his nose AND eat his booger.. all the while watching you?!

any more you'd like to add? the more the merrier!
here's to the start of a wonderful holiday season..
may we all survive it.

11.08.2009

Say what?! Keep wishing, it's not quite Christmas yet

OHHhhh hohoho. Christmas didn't come early, nope. Though I might be in the southern hemisphere where things are supposedly the opposite of normal and where the toilet flushes counterclockwise, it doesn't mean that Christmas gets to come early for chiropractors. It's weird enough to spend Christmas at the beach with the sun searing nice burns into your skin.

Sydney Morning Herald's "Emergency Department Turf War" was an eye-opener. I've depended on a chiropractor for a couple of years in the past, even following her to her new practice but stopped when I realized that I could crack my own back to achieve the same results with less frightening and sudden twists of my spine and neck. Suddenly, the $60 a pop (and that was a discount for being a long-time customer with weekly appointments that later degenerated to monthly appointments) seemed a tad too much and I stopped going.

"If chiropractic was [an] emergency treatment option, we could avoid thousands of patients being admitted" the chief of the NSW arm of the Chiropractors' Association of Australia was quoted as saying by the SMH. Goodness, where do I start?! I know the media is infamous for taking things out of context so I'm taking everything with large helpings of salt, but geez they did a good job this time around. Chiropractic practices has no place in the emergency department - I completely agree with several of the doctors quoted later on in the article.

First of all, how the hell is back pain amenable to chiropractic therapy life-threatening? Isn't that the whole point of the emergency department? For people with life-threatening conditions, ie an ee-mer-jen-see? Don't get me started. I'm the one that's always going on about implementing a public education campaign to educate people as to what an emergency is. That guy that collapsed on the street is an emergency. So's that woman with a river of blood pouring out from her netherbits. The graze you got while snorkling yesterday that's still painful is not an emergency. You broke skin. IT WILL HURT. Insomnia is not an emergency. It's an unfortunate inconvinience that you can see your GP about. The ED is not a 24h pharmacy, and the will not dispense drugs as you demand. Your cucumber up your ass is just plain hilarious and if you're able to walk in, it's not an emergency but we'll help you get it out eventually.

Also, tell me - if chiropractors were so beneficial, shouldn't all those people whom they're targeting at the ED... shouldn't they all have been seen in the community by a chiropractor as more of a preventative measure in nipping the pain before it got too debilitating? That being said, I would really like someone to explain to me how back pain warrants a trip to the ED when it's been grumbling along. Sure, when one's immobilized by the pain and requires analgesia only obtainable in a hospital setting.. sure, come on through. For the rest of you who refuse to take your pain medications and show up to ED a week later with back pain so bad you can't get out of bed.. TAKE YOUR FREAKING PAINKILLERS and then we'll talk.

Forget the oodles of studies disproving the efficacy of chiropractic therapy. Forget the fact that chiropractors as poo-pooed by the medical community as a whole. Really, forget all of that. Just concentrate on what they're currently proposing. Imagine your local emergency department.. yes, the one that looks (and sometimes smells like) an asian wet local market at times with the hours of waiting you need to do just to get seen by a nurse, let alone a doctor. Now imagine a section of that ED cordoned off with curtains drawn and massage oil in place next to the Aquim gel with patients being wheeled in, bed by bed, for their chiropractic treatment and seeing them walk out one by one. Seriously, if you were the patient in the next bed who had come in for acute abdominal pain because of gallstones, would you want your nurse pre-occupied with wheeling the next patients in and out of the chiropractic booth while you writhe in pain because she was too busy to give you that morphine the doctor charted up 3 hours ago? And also, why would the chiropractors need to take up already precious and scarce resources from the ED budget when they could very well run their own "emergency department" for people with back pain on a walk-in basis. Really. Christmas isn't coming early for you this year, go try to mooch off another system. hmph.

11.04.2009

happy belated halloween!

seems like i'm half a step behind since starting psychiatry. it must have been messing with my mind...

anyway, the newest fluff (now, in aquatic!) wishes you a happy halloween 2009 - hope everyone had oodles of fun regardless of whether you chose to trick or treat!


10.23.2009

what would you do for a klondike bar?

i'd do a lot, especially given the fact that they don't even have klondike bars in this country (not even at usafoods.com) but repeating this is not on the list..

the cast is as follows

  • me as myself

  • P for patient

  • B for blockhead aka patient's daughter

  • and away we go..

    [hospital corridor]
    nurse: B would like to talk to a doctor about her mother

    me: sure
    *turns to B*
    how can i help you? (again, does it not remind you of the retail industry?)

    B
    : I would like to now how my mother is going

    me: she's doing great. they let her weight bear as tolerated on her broken ankle that we've fixed. the operation went well, we had to put in some metal plates and the xrays afterwards show that everything is in the right place. She's been seen by the physiotherapists and if safe, will be going home. If not, she will be going to rehab for more physio. She's doing quite well and we think she might be stable and independent enough by monday with her walking to go back home!

    B
    : She can't go home. I was assured that she was going to rehab. Right from the start. P can't go home.

    me
    : why not? a rehab spot may take weeks to become available. if it takes two weeks to get P to rehab and she is back to her baseline level of function before then, she will be fine at home

    B
    : she can't go home, she needs rehab. she can't manage at home, i won't be there to take care of her all the time and she will be alone at times during the day. who's going to look after her when i'm not around? how will she walk to the toilet? she'll fall down again, she can't go home.

    me
    : i understand that you're worried about how P will function when she goes home but she is being seen by the physiotherapists every day and she will only go home once she is able to walk safely and independently, by herself! if she can't make the cut and needs more help, she's not going home and will go to rehab. she will only go home if she is back to her baseline level of walking and function.

    B
    : Ok. So how long will it take for her to get a rehab bed?

    me
    : ...
    *tries hard not to roll eyes or groan*
    it's hard to say. P is on their waiting list. it could take weeks. she may not need rehab by that time because she is walking too well to need rehab. in that case, she would go home instead.

    B
    : no, but she's not going home.

    me
    : why not?

    B
    : because she can't go home! she's got dementia and psych issues you know

    me
    : ok, how was she like before the fall and fracture? was she at home by herself at times? you weren't there all the time, right?

    B
    : yes, i had to go to work and i do odd shifts

    me
    : well, was P able to manage by herself during that time?

    B
    : yes

    me
    : was she able to go to the toilet by herself when you weren't around before her fall?

    B
    : yes

    me
    : *thinking i've got this in the bag now* so you're telling me she was able to manage and do things by herself before her fall, even when you weren't around right. we aim to get her to the same level as she was before her fall and fracture. when she goes home, she will be able to safely and independently get to the bathroom and do everything else she did before the fall.

    B
    : but she can't go home, she's got the fracture! she can't walk properly and even with the frame.. what if she falls again? no, she can't go home

    me
    : *gnashing teeth by now* that's what i'm trying to tell you!! she WILL be able to walk properly because our physiotherapists would have made sure of that! we will ONLY send P home if she is able to walk the way she did before her fall. the fracture has been fixed now. that's why she. had. the. op.per.ray.shun. we put METAL in there to fix her bones. that's why she is allowed to walk.on.it... because her bones are now strong enough with the metal in place to support.her.full.weight. she will fall when she falls. it is not going to make a difference whether she goes to rehab first before going home, or if she went home straight from the hospital whether she will fall down again in the future.

    B
    : but she's got the fracture and it's not healed properly! she can't walk on it! she can't go home!

    me
    : yes, the bones will take about 6 weeks to heal but the metal plates we put are keeping the pieces in place so they can heal in the right positions. if it wasn't strong enough, the consultant wouldn't have let P put her FULL weight through it. she.can.walk.fine.

    B
    : no, but i was assured right from the start that she would be going to rehab. she can't go home, sheblahblahblahblahblah

    (you get the point. the conversation, if you could call it that, would go on for another 10 minutes in a moebius loop)

    today was the second of such conversations i've had with her.
    the social worker, the occupational therapist and both physiotherapists have had similar conversations with her throughout this week.

    the blockhead made me miss the chance to pick up my mail from the post office. i got there as the roller door scooted its last few inches towards a resounding thud on the ground as the post office closed for the day.

    saying i was irked would be the major understatement of the year.
    wwwwwhhhhhhhhyyy... oh why did evolution miss these fine specimens of the human race?
    gnnargh.

    sorry, just had to get that out of my system. thanks for tuning in. until next time...!

    10.02.2009

    The Perfect Patient

    The Perfect Patient (as would only exist in the land of Mary Poppins)

    [Spoken]
    Wanted: a patient for one adorable doctor

    [Sung]
    If you want to be my patient
    Have a cheery disposition
    No nonsense, amaze!
    Complies, all days.

    You must be good, you must be with it
    Proactive and smile a wee bit
    Have some common sense, time will tell
    Listen, don't yell

    Never be coy or linger
    Never you point or wag your finger
    Respect me as your treating doctor
    And never show me all that's under

    If you won't scold and dominate me
    I will never give you cause to hate me
    I won't add more movicol
    So you will poot
    Put blood in your bed
    Or needles in your boot
    Hurry, Patient!

    Many thanks
    Sincerely,

    Ay El Double Ee.

    9.14.2009

    i understand but i don't believe

    it's job hunting time. i never realized how stressful it would be. i never realized how calm i would be either, staring the very real possibility of having to leave the country in the face should i be unemployed next year.

    everyone tells me to stop worrying, that there are plenty of jobs around, that nobody is jobless. everyone tells me i'll be fine, that someone will snap me up.

    i spent the past week being very grouchy nevertheless.

    what i can't reason out in my own mind is why they can get away with what i call discrimination. yes, i can play the devil's advocate and see things from their own perspective. it doesn't mean i agree though.

    the policy states that visa holders can only be offered a job if all other applicants of the same job who are citizens or permanent residents have rejected their job offers - in other words, visa holders get treated almost as second-class, getting offered jobs that none of their own want. the scraps i tell you. the leftovers.

    from their point of view, it would be less hassle to employ non-visa holders - less paperwork, protecting their own, ensuring a better guarantee that the person they choose wouldn't need to be suddenly deported or leave the country mid-contract and creating a position that needed to be filled. i get it. i just don't agree with it.

    how is it fair that we go through the same education and training as the others, only to have a computer program shift us to the bottom of the list of applicants on the basis of our visa status and nothing else. it doesn't matter if we may be the best person for the job, that we might have more experience or qualifications. one of their own will get the offer first. all we can do is sit here twiddling our thumbs hoping one of them rejects their offer so we can move up a spot or two on the list and claim the position as our own. should we not be so lucky, we sit there twiddling our thumbs at a faster rate with the increasing frustration and angst building up at all this inaction.

    to make matters worse, you hear stories dribbling in about others in the same situation. visa-holders. they were luckier. they were offered jobs. now, i don't hold anything against them - congrats to them for being able to find jobs with such harsh odds. my question would be to the employers of these aforementioned visa holders. how in the world did you manage to offer them jobs so early in the recruitment period? we're talking about the first week or so of interviews when some others haven't even gotten to that recruitment stage yet. do you mean to tell me that out of all the applicants you've interviewed that applied for that position (up to 75 in some cases) after culling some on the basis of their qualifications, visa status or both, that every single one of them rejected their initial early job offers knowing full well that might've been their one and only at the time? really now. how else would you explain offering the position to a visa holder so early on?

    i knew the system wasn't perfect, i thought i had become cynical with low expectations but this..
    tell me, have i been naive enough to be viewing the world through rose-colored glasses still? i thought i ditched those sometime through med school.

    8.19.2009

    a farewell letter

    dear moron patient,

    do you too have fluff between your ears like the puppets of Avenue Q? you leave me with no choice but to assume so.

    goodness, where should i start? shall we go into detail about that time you came with a week's history of lower back pain that was getting so bad you couldn't get out of bed? you know, it might have helped if you had taken some sort of pain relief at some point during the week. the walking thing might have been less painful. it would've also saved you about three hundred bucks to call the ambulance to bring you in.. well, the taxpayers i guess. and it also would've saved you a two hour wait to be given some paracetamol and ibuprofen before getting sent home.

    what about the time you giggled your way into the department with your boy in tow to tell us that your netherbits were accidentally chomped on and you're now left with one nub less?

    or that other time where you've had a few weeks worth of anal pain. shush, don't tell me, i don't want to know. that's what your gp is for. to treat your damn hemarrhoids. or wikipedia. good on you for braving the crowded waiting room for the past five hours. there was a reason why you were triaged as a category 4.

    i guess this next one wasn't really your fault. you just picked a crappy gp to trust. why else would your gp send you to the emergency department at a bit past eight on a sunday night so you could get an xray of a wooden splinter in your finger just to see how deep it is. that being said, why did you listen to him instead of pulling the splinter out with tweezers like we eventually did, 4 hours later?

    you should be ashamed of yourself - what kind of parent notices that the backing of the earring on your two year old daughter is starting to disappear but waits three more weeks until it completely disappears before thinking it might be time to remove that offending earring? your daughter is now going to be literally scarred for life. look at those dressings on her ear covering where we had to gouge out that earring backing!

    and please, try to hang onto those memories tighter. the next time another doctor asks you if you've seen anyone for your cough of two weeks, do not look blankly at her and say no when you have just been to the same emergency department less than 24 hours ago for the exact same complaint. bloody liar. and when accosted with this information, please have the decency to admit that you're just an idiot forgetful instead of insisting that no doctor saw you that first time. and when further reminded that you were indeed seen and discharged by a doctor, learn when it's time to give up instead of complaining that you weren't sure who saw you but whoever it was only spoke to you from the end of the bed. you. bloody. fool. i'm sorry you had to find out that you were deaf this way. after all, i greeted you the same way i greeted all other patients. "hi my name is amy. i'm one of the doctors and i will be looking after you today." everytime i say it, i feel like a masseuse or an airline hostess but i put up with it for your sake. so don't you dare tell me you don't know who the hell saw you. i had to fumble through the folds of fat to reach your tummy and i had to listen hard to hear your distant heart sounds. i sat next to you to take your history and found you the cordless phone so you could call your husband to pick you up. don't you dare tell me that whoever it was that saw you spoke to you from the end of the bed.

    ohhh, it's only been a short six or seven weeks since i've been here this year but oh, you have opened my eyes so. i didn't think they could've gotten any bigger but you proved me wrong.

    if i had things my way (and i assure you that many of my colleagues would agree, for this was one of their wishes i've usurped), there would be a sign that covered all those huge shiny ones with the big red cross on it pointing you towards the emergency department. this new sign would boldly command you to keep on driving past, do not stop, do not pass go unless you fulfilled these next criteria - that you must have a saturation of 60% or less on room air, acopic at your nursing home, have an ejection fraction of 5% or less and still continue to smoke, unable to walk into ED, be an octogenarian or older and/or be bipap dependent. only then, are you allowed to step foot into the emergency department, let alone the rest of the hospital.

    luckily for you, i have yet to receive news of any job promotion granting me such power to change presentation criteria. in the meantime, i wish you all the best in your endeavors and try not to win any darwin awards.

    sincerely,
    your caring doctor

    6.30.2009

    eedee


    ortho's come and ortho's gone
    and it's been weeks since i've moved on

    they chucked me back to ol' eee-dee
    oh how it's disagreed with me!

    i hate the fact that it never ends
    that stream of patients makes no amends

    headaches, toothaches and bleeding noses
    life sure ain't a bed of roses

    chest pain, sprains and broken bones
    stuff that i greet with big fat groans

    it's never enough that you do your job
    patient expect more, or they will dob

    and then you have 'em chinese-speakers
    they latch on 'til i turn a streaker!

    as if they deserve some special care
    don't you assume, oh don't you dare!

    my hat off to those who like the term
    the thought of ed just makes me squirm

    the only thing that gets me through
    is the fact i love my ed crew =)

    so on i stay for a month or so more
    and then i'll be rid of this terrible chore!

    but in the meantime, please bear with me
    i'll be cranky and whiny and be hardly free!

    5.17.2009

    let nature do its thing

    Is it too cruel to sometimes wonder why we have hospitals at all, or why there's such a large R&D industry flourishing at the moment in various races against time to come up with the latest medical breakthroughs and drugs? Would it be better to let nature take its course and let the weakened and sick go on their own time, rather than prolong their misery both physically and mentally? Sure, we could come up with measures to make the process more comfortable.

    In such a world, palliative care would be the end all and be all of medicine as we know it. ICUs wouldn't be filled with a geriatric population averaging 80 years old. Drunks who get into punch-ups and break their wrists wouldn't be allowed into the hospital. They would be able to smoke and drink as they like, with lots of painkillers prescribed until their fracture healed. They would be given advice on how to take care of their injury but their lives are their own to ruin if they refuse compliance. None of this would be the fault of their doctor and better yet, none of this would be known to their doctor if they were never allowed onto a hospital bed in the first place.

    Blood banks would be non-existent because there wouldn't be a need to transfuse people. If they're anemic from disease, we would let the disease take its course. If they're anemic from huge blood loss from trauma, well then we let the survival of the fittest.. or luckiest continue. There would be no subspecialties. No cardiologists to put in pacemakers, no respiratory physicians to manage those who chose to smokebliterate their lungs, no gastroenterologists to worry over those whose first instinct is to reach for the booze nor surgeons to cut out tumors, let alone perform tummy tucks and facelifts. Wait, I take that back. I guess there should be cosmetic surgeons around. Those who choose to take that risk and encounter complications would just fall into the survival of the fittest category, seeing that there would be no resuscitative measures available in their world to save them from their own folly.

    Is such a world really too cruel, or would it take us back to a simpler, less complicated world. Why is there such a drive in the first place to prolong our lives, to survive.. for what? The world as we know it has limited resources that can't keep up with the careless reckless nature of our existence, yet we strive to stay here for as long as we can with any means possible so we can continue with blatant disregard and misguided good-will to unbalance the cycle of life. Why do we bother, why does medicine even exist? Surely, we would all be better off letting nature take its course for no path would likely be worse than the one we've paved for ourselves already, no? Sometimes, I wonder..

    4.03.2009

    typicalities

    So.. my ortho term started.

    My first week started in chaos and ended in chaos, w00t! go me.

    Monday found me showing up half an hour late because Medical Admin sent me the wrong info pack and therefore, I got the handover last Friday from the wrong team. To think I was so happy to hear that all the discharge summaries have been done for all the inpatients... I showed up Monday to find that NONE of my patients had bloods ordered over the past weekend. Some hadn't had a blood result since the middle of the previous week. So wasn't impressed. Then there were the pre-admission clinics to attend, without a stethescope of course so I could assess my patients pre-operatively quite well thank you.

    Tuesday found me telling an old demented chap from a nursing home that I had to put in a catheter. I was less than an arm's length away from his face - I thought he was deaf and drowsy. I was so wrong.. next thing I knew, he had taken a swipe at me and punched my right eye. By the time I got the catheter inserted, with the help of a male nurse.. both the nurse and I walked away with our battle wounds. The guy had dug his nails into us and clawed us relentlessly.

    Wednesday found me in the operating theaters - short notice and short of staff due to sickies. Went in for the wrong operation so I ended up assisting in two rather than 1 surgery...

    Thursday found me a sugar daddy. Well, he was a rich elderly stuck up and eccentric guy who said he had no daughters, how he wished I was his daughter and would I like to have lunch or dinner with him and his wife during the weekend, and how nice it would be if my parents were here so we could all have a group meal and chat. ....ahhuh.

    Friday found me introducing myself to my boss twice, once in the morning and once just before he left. I had forgotten that I'd met him before you see....

    I can only hope that the rest of the term gets better =)

    3.25.2009

    season two

    it's nearing the end of term.. one down, four more to go before i mark the end of my resident year. if you were counting my life in terms of scrubs episodes, we would be around episode 6ish of season two. season two! goodness, time's flown.


    so here's an itty bitty li'l ditty
    one of those random bursts
    the term's nearly done, what a pity
    for i went through a lot of firsts

    i learnt a lot and felt more comfy
    relating to matters of the heart
    those ecgs still don't fill me with glee
    but i'm a wee bit closer to perfecting the art.

    this term has been full of laughs and tears,
    snorts, giggles, grins and shrieks,
    frustration and angst with cavaliers
    or when an ignorant patient speaks.

    i've dealt with death and liars,
    gentlemen, absconders, fools and saints
    we've had drunks and high fliers
    a colorful picture, my workplace paints!

    the variety that's normal, or "nfc"
    along with the staff, will be something i'll miss
    for i'll be dealing with bones, wherever they'll be
    the rest of the body will no longer exist

    hopefully though, i won't become one of those
    those surgeons that don't know medicine
    and can't recognize a nose..

    i'm starting to ramble and run out of rhymes
    i think i should end this before i commit any crimes!

    ...

    but before i go, a wee bit of goss
    here's my thank you for my mentor and boss!



    2.27.2009

    mind your manners

    HOW FUCKING DARE YOU TELL ME HOW TO BE POLITE.

    i came home today, pushed the button in the parking lot to get up to my apartment.
    the doors opened to reveal three men and a full shopping cart of flattened cardboard.
    i wasn't paying attention to where the elevator had come from.. downstairs in B2 or from the ground floor upstairs.
    so the doors opened.
    none of the three men moved.
    they stood as one would stand in a bar, crowded over a skinny tall table with a bowl of peanuts atop.
    so i asked "going up?"
    no reply.
    i proceeded to walk in.

    "letting us out would be the polite thing to do" one of the men in a striped apron said.

    "WELL NONE OF YOU WERE MOVING SO I ASSUMED YOU WERE GOING UP LIKE I ASKED" i replied, albeit in a normal tone of voice. the voice in my head on the other hand.. it was exacerbating a pre-existing headache that had refused to leave me alone all week.

    frickin hell.

    telling me about manners.
    why don't you try some introspection and reply to a question like any other normal courteous person would.

    *storms off*

    so not the week to test my temper i tell you. so not.

    2.24.2009

    what the fuck is wrong with everyone today

    do you ever get the urge to shout from the rooftops at the top of your voice, preferably with a megaphone "what the fuck is wrong with everyone today?" i know that every so often, i do when i come across a shitty day. today was one of them.

    being tired, cranky and starving with a hypoglycemia-induced headache is a great baseline state to start with i suppose. sorry for the lack of compassion. i find it hard to muster any for this one patient of ours whom created unnecessary stress by demanding to be discharged here and now this afternoon. this little idiot was a 19 year old diabetic who keeps coming back to hospital with diabetic ketoacidosis. this was her 6th admission since the start of 2009. it didn't help that we've linked her up with all the services she needed. it didn't help that we told her over and over and over and over and over again how serious it was, that one of these days.. she would end up dead with her poor compliance with her insulin regime. we told her it would be sad to see her in the obituaries for something so easily treatable if she would just bother to take care of herself. of course, i doubt that any of that has sunken in. the little shit lied that she had a follow-up appointment with the diabetic clinic last time she was in. we called up to confirm and they had no records of her. she lied again today, saying her boyfriend had arranged for her to meet her diabetic educator today after leaving hospital. lucky for all of us i was cynical. i called up her diabetic educator, explained the situation with the idiot teen in front of me and found out that no such arrangement had been made. surprise surprise! the little shit is standing in front of me, gesturing wildly and mouthing that her boyfriend lied to her (now why the hell would he lie about making a medical appointment for her?) and all the while, her face turned red as a beet. of course, i told the diabetic educator that the patient was standing in front of me, would she like to speak to her.

    other minor incidents happened at work, all of which were nuisances. one of them involved a boss. the endocrinologist called up to consult with 3 of our patients slickly turfed them all off to either local doctors or pre-existing ones looking after them outside of hospital. that left me tracking them down through various hospital switchboards and the white pages all afternoon to come up with a fricking management plan for these people.

    then there were the surgeons who decided that this dude needed to be transferred to another hospital without having the courtesy to tell our ICU team what the plans were, let alone figure the logistics of how we'd actually get the patient across at nearly 5pm when everyone's gone home, who the patient would be admitted under, and most importantly, if the other hospital had an empty bed for the guy once he arrived. on top of that, the procedure wasn't even booked and the ultrasound results weren't even available to confirm the diagnosis that would be treated by the proposed procedure. what a farce.

    and then i come home and was accosted with idiots on the road left right and center. those that drove slower than a snail, and those that drove too fast for their own good in good going traffic. came back and opened my email to find more idiocracy. "Please be advised I have spoken to Automatic Fire and they have been in 98% of the apartments so they advised they do not need access in your apartment."

    How the hell does one conduct a fire and safety inspection on a building and say "oh it's ok, we've inspected 98% of the building, therefore it must be 100% safe" Explain that one to me.

    time for food, i'm out of brain juice.

    on a final note, the only good news today was that my mom underwent her hysterectomy and all's well. they found osme sort of fibroid, i'm guessing from my dad's description, and a cyst that have been sent off for histopath but seems benign.

    ok, food time. hungry amy = bitchy, cranky amy

    2.20.2009

    i knew it was too good to be true

    what an end to what started out as a bloody wonderful week. by the time i left work on tuesday, we had 5 patients in icu. one hadn't even arrived yet. it was about the same on wednesday when we effectively had 3 patients all day. one had gone off for investigations, another was post-op and didn't arrive til afterhours.

    with days like that, anything more would be relatively shitty. by thurs afternoon though, it was starting to get a bit ridiculous. we started with a code blue/met call - the guy died after failing to respond to 10min of cpr. what a way to start. the day ended with 2 more codes, each within 5 minutes of each other. both ended up in icu, ready to greet me when i got to work this morning.

    that wasn't all that greeted me. we had another code blue within 5 minutes of walking in - the guy's heart decided to go wonky and danced at bullet speed. in the meantime, all the respective teams had come and gone and before i knew it, i had to discharge half the ward today before even getting the chance to start our own icu rounds! of course, things must always go wrong on days when you least want them to... pharmacy couldn't find discharge medication scripts and we ended up writing outside prescriptions for everyone going home. ct scans were done with no results available. patients were getting antsy waiting (for goodness sakes, it was still before noon) and being bloody nuisances. this one guy kept talking over me, pointing at his room door and wanted me to ask the doctor when he could go home. after trying to ignore it a few times, all the while explaining he could go home in another hour or two, i gave up, looked him squarely in the eye and said quite flatly "i AM the doctor." (now will you shut up and listen) would be what was left unsaid. bloody people never listen. i always introduce myself with "hi i'm amy. i'm one of the doctors working in this unit" and most people respond with a hi to acknowledge they were listening. anyway...

    the day's come and going.. sucks that i have no break to look forward to - i'll be at work =(
    before i go, one last gripe to let loose. i'm pre-empting that i'll offend a few people but frankly.. it's just an opinion. take it or leave it, i say.

    and the gripe starts like this...

    i check my email to find a link to rsvp to a 130th birthday celebration of rgs, the secondary school i went to when i moved to singapore. i had lots of fond memories of my time there.. mostly of choir pracs and shows. in comparison to my time in junior college over there, i would've much preferred my time in secondary school. that being said, i was quite appalled.. with mild amusement at the program they had proposed. a birthday celebrating 130 years, and they get the current principle to say something, sing the school song, listen to a concert (which will likely be the usual gamut of song and dance with proportionate ethnic representation) and then bellow out some school cheers (what exactly would they be cheering for when most of the cheers are shouted in baritone voices at sporting events?). it all sounded very artificial and concocted. corniness aside, the clincher in my books would be the allocated 1.5 hours after all of that for "conversations and reminiscences" .. which mind you, is completely optional (so why allocate it in the first place when there was nothing else after this optional segment anyway?) did they not think, that with all the independence they've instilled in us through their innovative teaching, that we would have the brains to organize our own time to catch up with whoever we wanted to? seriously, if they had wanted to set aside time for catchups, they could've at least marketed it as the after-party rather than part of the proposed program for the night. and speaking of the program... it's a milestone and yes, they've invited old teachers and principals to attend the function but wouldn't it be a lot better to get them as guest speakers to share their thoughts on how far along the school has come and all that kind of catch-up, rather than fill up the bulk of the night with a concert of random acts?

    *sigh* all i could think of when i was reading the program was .."how typically singaporean, to be so regimented that even free time and will needed to be allocated and spoonfed to a population of sheep." i mean no disrespect, but from random conversations here and there with singaporean friends, those with independent thought and free will have gotten the hell outta there as soon as they could, leaving the sheep behind to be sheparded by a group of communists at heart who mask their true motives behind slick propaganda and glib half-truths.

    i'd much rather you let me vent and rant and get rid of all the steam that's built up over the past couple of days but if you must, go ahead... may the blasting begin.

    2.14.2009

    the annual gripe

    maybe for the first time since i've started this yearly tradition (which in a way is kind of hypocritical i suppose, seeing that the point is to be anti-valentines and i dedicate a post annually to it... but anyway, that's besides the point)...

    so as i was rambling..

    maybe for the first time, this won't be a gripe per se, but more of a sense of relief.
    yes, there are the smattering of stories and pictures of valentines, but for once.. it crept up on me. the stores seemed to have skipped right over it and plonked lots of chocolate eggs and fuzzy bunnies on their shelves next to the little pile of red. for once, it seems that priorities have been straightened out and people were more concerned about the raging bushfires down in victoria, or the floods up in queensland on this valentines' day. w00t to the sensible! i've maintained again and again that seriously, holidays are only nice if you get the day off. you could hold a party every single day of the year if you truly wanted and come up with something to celebrate.. my many many unbirthdays (to you? to me!), anniversaries, other people's birthdays, the day this blog started, the day i first started biting my nails, the day i met you, the day i stopped biting my nails, blahblahblah.

    so yeah, this year's gripe is much more muted and more of a sigh of relief that there's enough hope left to steer us away from eventual idiocracy. the origin of the fires on the other hand...

    anyway, as usual.. today's like any other day on any other year. i skipped my surgical tutorials even though i had psyched myself up for them just last night. for 7.30am, it was such a calm, quiet morning with the faint twittering of birds to be heard outside. i had planned to stop by a nearby cafe and saunter to my tutorials with a coffee in hand and was drooling about breakfast, mentally going down the street to pick a cafe. i was about to walk out the door when i took one last peek outside, stopped in my tracks and said to myself, this is crazy! you've woken up at the crack of dawn on the one weekend where you didn't need to work after working overtime last weekend and this past thursday... to attend these tutorials that you haven't rsvped to, at a place you'll need to take 20 minutes to walk to and another 20 minutes to find, to sit for several hours in a room full of registrars you barely know who are sitting their exams this year, to listen to topics you haven't prepared for, in a class where you don't know the structure of, with two pieces of scratch paper to take down notes with... on a grey drizzly cold morning.. for what? out of interest.

    the last bit did me in.

    for those of you that do celebrate vday, hope you have a sweet one =)
    meanwhile, it's back to my warm comfy bed for me!

    1.16.2009



    this is it!
    such an anticlimax..
    no epiphanies, no lightbulb moments...
    and surprisingly very little contact with poo despite it being a colorectal term.

    guess that if there wasn't the SISTER2sister bootcamp coming up in less than 48 hours with two consecutive days of unsuccessful attempts at contacting my new little sister, i'd be in a better frame of mind to mull over what the past year as an intern has been or not been for me.

    ah well..

    a la typical taurian slow but steady style, maybe i'll grok in another day.. or twenty.

    1.14.2009

    borrowing santa's sleigh

    if i could be santa
    for just a single day
    any day of the year will do,
    how 'bout the fourth of may?
    i'd traipse around the world
    in my special santa sleigh
    i think i'd ditch the reindeer though
    you'd think they'd rather play.

    there are so many friends,
    and all of them dear
    i have grand plans to catch up with all
    but time always falls short, i fear

    i'd travel in my santa sleigh
    i'd visit friends far and near
    but 'twas too late to catch up with one
    now i've one less friend who's here

    i had barely started this ditty
    and then the bad news broke
    it came in the form of an sms
    i had hoped it was one twisted joke.

    at first, it was just disbelief
    and then the news sunk in
    why in the world would he take his life?
    when it was just about to begin...

    i don't think that anyone's quite sure
    the whys and hows will keep us a'guessing
    i just hope that he has escaped his pain
    having the chance to know him 'twas indeed a blessing.

    tonight, i've returned from an end-of-term meal
    and such an awful feeling 'twas to know
    that i couldn't catch up with all who came
    some didn't even hear my hello =(

    as much as i know that life goes on
    though i've bawled my eyes out just yesternoon
    it still feels just a tad naughty
    to be enjoying life, or whistling a tune

    but time, as usual, will always pass
    so i guess it's just as well
    that there's work to do and camps to attend
    no time for unhappy thoughts upon to dwell

    speaking of friends in this ditty to nowhere,
    my borrowed sleigh still firmly parked
    i've been catching up with an old classmate of mine
    and finally... well something sparked ;)

    now two more days are all i have
    until the resident year begins
    whatever the new year decides to bring
    guess it's good enough to start with some grins