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

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!

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..

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 =)

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!

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.

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

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.

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!