I came to work and my colleague told me that there was an Eye case that was not done from the previous day. Apparently this 70-year old lady had left globe rupture some eye injury and needed to have the eye looked at under anaesthesia. The reason her case was postponed was that apparently Orthopaedics the bone doctors were trying to stabilize her condition.

The patient was in the Red Zone (critical area of the Emergency Department) overnight, thus my specialist was suspicious as to why the patient is there as the Eye doctors only mentioned that her eye needs fixing. To cut a long story short, I went down to the Red Zone to have a look at her before calling her case to the Operation Theater (OT).

When I arrived there, I was horrified to find out she had so many other injuries the Eye people failed to mention when they told us about her case. In fact, she had injuries from head to toe. Anyway, seeing that she is obviously not stable and that the eye injury is the least of her problems, she was then sent up to the surgical ward for observation.

Later in the evening, I decided to visit the patient again, as I had to speak to her relatives and explain the high risk of anaesthesia when she goes for surgery due to her multiple injuries. In the ward, her daugther was there, all distraught from the feeble explanations given by the surgical doctors who kept implying that they are only in charge of her stomach region etc.

So when I got my turn to speak, I pulled her aside, explain the graveness of her mother’s situation and all the injuries from head to toe, thus making her condition fragile and high risk during anaesthesia due to obvious reasons. The daughter however, was not the least bit interested in my explanation about the anaesthesia but as usual kept interrupting me and asking me about the eye about the bones about this and that, and I had to gently explain that they are being taken care of my different teams and that they are doing what they can.

The last straw was when she asked me “are you a real doctor?”. I gave her a quizzing look and said, of course I’m a real doctor. She said “are you a training doctor or real doctor?”. That was it, I was slowly losing it. I told her, I am a real doctor, I’m in anaesthesia and I have been working for a couple of years already. However, I am not a specialist. She then asked me if I had qualifications, and I just simply stared at her, lost for words. She said it’s because I look so young. I said I may look young, but I’m not that young. Finally, she said, then looks like I have to trust you. WTH?????

Anyway, finally she signed the consent for anaesthesia, and back I went to the OT, straight to the pantry to get myself a big glass of water and chill as I was already fuming and on the verge of exploding. After all my careful explanation, she thinks I’m a fake?

Here’s some pictures to illustrate the madness of my job…

Snippet 1

One day during one of my ICU calls, I went to the Redzone (Accident & Emergency Department) to see a head injury patient which was referred to me. It was written that he also had a clavicle fracture. When I checked out his Chest X-ray, I saw the darnest thing…

Obviously the fella couldn’t have swallowed the laryngoscope. Just wondering whether it was left above or below the patient when the X-ray was taken and how did the radiographer miss it when setting the cassette to shoot the film??

Snippet 2

This sort of things only happens when I am on call. Those in blue are the elective cases, and those in red are the emergencies. Just looking at the board is enough to make me feel tired…

Snippet 3

During on calls, whenever there’s a short break, i.e. the few minutes in between cases while waiting for the patient to arrive, one would usually grab the opportunity to lie down on the on-call room bed to catch a quick nap if possible. However, to my horror, this is what I saw stuck to the bed frame…

So I had to contend with resting on the chair…Sigh!

This is a sequel to Cyanide’s post entitled Because Work is Too Much

What happens when work is too much?

1. You do not want to go to sleep at night even though you are super tired, because going to sleep, means the end of the day and fast forwarding to tomorrow.

2. Your 3 alarm clocks ring, and you’ve snoozed them 15 times and yet you can’t seem to get your ass off the bed to get ready for work.

3. And when you’ve finally gotten yourself upright in bed, you think to yourself, is there any reason to not go to work today.

4. You finally drag your feet to work, and put on a super fake smile when you meet people you know. Somedays, you can’t even fake a smile.

5. Everything irritates you.

6. You spend the day wondering why the hell did you take up this profession.

7. You count the hours, then the minutes to clocking out.

8. You finally come back from work just to go into denial about going to sleep again because tomorrow is another day – the same shit, different day.

I’ve had three ICU calls in a row, and it has been bad. I was practically busy the entire time, the phone wouldn’t stop ringing until I now carry a phone charger in my on-call bag. I even had to change my ringtone, because I cound no longer stand hearing the intro to Linkin Park’s New Divide.

Yesterday was totally horrific. I was literally running to and fro from ICU to the Redzone, which is 5 floors apart til my legs were gonna break. On top of that, I had so many other referrals from the wards in the 7th and 8th floor. If anyone wants to lose weight, why not try doing an ICU call in my hospital. Of course, you’ve also gotta be the “jonah” type and not the type who gets to sleep all night til you have a bedsore.

I transfered out and brought in so many new patients into ICU last night that my friend congratulated me on changing the population of ICU. Wow, what an achievement that I don’t need at the moment. Why, oh why can’t I have a peaceful call?

So exhausted by everything and worse still, I’m on call again tomorrow! Yippee! Ugh!

Guess I better sleep more and conserve more energy.

ZZZZZzzzzzzzzzzzzzzzzzzzzzzzzz……..

I’ve taken a break from light reading as recently I’ve been so fed up with work until my brain has given out on me and refuses to even tolerate light reading. So I’m back to a less intelectual past time – watching tv series. However, I seem to be hopping from one series to another, so basically I’m halfway through everything. Bones-Gossip Girl-Burning Flame III-Grey’s Anatomy-House and more. How brilliantly confusing for the already tired mind and body.

Recently, I’ve also been feeling extremely tired of the political nature of my working environment. Being a totally apolitical person, I just hate working politics. Why can’t everyone just focus on getting the job done, and on putting the patient’s interest first. Instead, they seem to have so much time and energy to stab each other in the back, make extra work, bitch about one another and simply cause disharmony and unhappiness all around. Both inter and intra-departmentally. What a total waste of energy. What happened to “first, do no harm”?

Annoyed.

Disappointed.

Fed up.

Sigh.

So frustrated. Reason? A series of collected grievances by the same person. Being at the wrong place, at the wrong time.

Just feel like strangling someone or something. Sometimes, everything just feels so unfair. But what’s new about that? Shit happens, all the time.

Guess I better head off to sleep. Will need all the rest I can get and hopefully tomorrow will be a better day.

C’est la vie.

This afternoon, I saw a very annoying scene. I was busy running around seeing pre-op patients and having tons of work to do, when I saw four, yes FOUR housemen at the nursing station totally idle. They were simply jobless, with nothing to do. And to make matters worse, that was what they were chit-chatting about; having nothing to do.

The irony is there will be plenty of such scenes to come in the near future as there continue to be too many housemen and shortage of medical officers. I heard that there will be yet another bunch of new housemen coming in end of this month, so I guess there will be even more idle days for them…

What happens when people are continually leaving and no one new is coming? Yes, you said it. A negative balance and a reducing workforce. Since the workload is somewhat the same, if not more at some days, we are left with having to work a lot harder than previously, and thus leading being burnt out and perpetual exhaustion. In fact, I’m beginning to think that we’re working harder than the housemen (HOs), coz they are having more and more people and no one is leaving.

Maybe I should simplify the confusing paragraph above to enlighten those who are not in the medical field currenlty. Since housemanship has been extended to a 2 year long program since Jan 2008 onwards, from now until Jan 2010, there will be no HOs graduating to MOs. What this means is, the number of HOs will continue to increase, as there will always be new ones joining, while the rest can’t leave and be MOs until after they’ve complete their 2 years. On our side, MOs are leaving to the districts, to join the Master’s program, to become specialists, while no new MOs are being produced til Jan 2010. So it’s only obvious that there will be and currently is an acute shortage of MOs nationwide.

I think in Cindy’s department there is only 2 MOs running on EoD calls. As for my department, we no longer have our afternoon shift work and on-call relief system, which is fine for small and non-busy hospitals, but definitely torture for busy places like our shitholes. It has come to the stage that she takes more than a day to reply my SMS, and when she apologizes for the late reply, I realised that I did not even realise that she did not reply. Yes, we are that tired and exhausted.

Anyway, I don’t see a solution to this problem in the near future, at least not until Jan 2010, but I really don’t think I can last very long working like this.

I just got an interesting sms from a friend…

“So actually what do you do post call? One whole day!”

Well, it all depends. If I’ve had a bad call i.e. cases running the whole night up til 7 am in the morning, then the only thing I do when I get back is SLEEP. I will enjoy sleeping almost the whole day, and only awaken to eat one or two meals for the day. Blame it on the anaesthetic gases, or blame it on age catching up, I can no longer stay “hyper” after not sleeping the entire night. Sometimes I wonder how I did it as a houseman; not sleeping the entire night and working til 7pm the next day – the 36-hour stretches.

But on the occasion of a polka-dot moon (Cindy’s beloved terminology), if I’ve had a good call with a couple of hours of sleep during the night, my post-call activities are slightly more colourful. I would usually start the post-call day searching for food to satisfy the growling stomach. Since it’s 15 degrees cold in the OT, after a whole night of freezing, regardless being awake or asleep, I’m usually starved by morning.

Today I bought 2 packets of nasi lemak due to sheer gluttony, but after devouring 1 and a half packets, I was seriously full up to the upper esophagus. Maybe someone should sell 1.5 packets of nasi lemak for occasions like this. Meanwhile, I would browse through the limited channels of national TV and watch random nonsense. After the satisfying meal, I would then proceed to log on to the internet to surf/facebook/chat.

When the sleepiness finally kicks in about 1-2 hours later, I would then proceed to sleep til about midafternoon. Depending on mood and fancy, I may go shopping or pay a visit to my beloved little sister who’s always trying to get a free meal out of me. After more lazing around and being a total sloth, I may make a feeble attempt to do some studying or light reading. When that fails, I’d then proceed to catch up on my backlogged sitcoms and tv series.

All in all, I love the post-call day off. Haha…

Recently, I’ve been needing a lot of patience to carry on my daily work. Main source of irritation = housemen/house officers (HO). Thankfully in my department, we do not have housemen, so I have slightly less contact with them. I know I used to be a houseman not too long ago, but I notice the recent trend that some of them are simply annoying, rude and unteachable.

I didn’t know very much when I started out as a HO, but at least I had the heart to learn and was respectful of my seniors. Nowadays, while they know nearly zilch, yet somehow they think that they are geniuses. They speak to you as if they know better, they write rubbish in the patient notes, getting their superiors in trouble and are not the least bit remorseful when they screw up.

Example 1

A HO called me up one day to post a case. She said that the patient had necrotizing fasciitis and needed wound debridement. I asked her, which part of the body had necrotizing fasciitis, and she paused a moment, and said in a rude tone, “of the groin, lah!”, implying that I was an idiot for not knowing.

My darling HO, necrotizing fasciitis is when you have bacteria “eating your flesh” which affects the layers of the skin above the fascia and thereby destroying it. This destroyed skin therefore needs to be removed together with the bacteria to stop the spread. So since we have skin almost everywhere on our body, necrotizing fasciitis can happen anywhere on the body, and not just at the groin, which is why I am asking you where it is.

I then proceded to ask her a little more about the patient, whether the patient was well or sickly and if there were other things I should know regarding this patient. She said the patient was fine. Just a young guy, with newly diagnosed diabetes. Deciding not to trust her, I made a trip to the ward to see the patient. When I arrived, the patient had already “collapsed/coded” and was being  resuscitated. He was later sent to ICU for more than a week. He also had previously underwent multiple surgeries for this infection in the past 2 weeks, which the HO failed to mention to me.

I saw the HO in the ward, and asked her, “What happened to the patient? I thought you told me he was fine?” She said, “Oh, they were changing his bedsheet and he suddenly couldn’t breathe.” Interesting. Obviously he was already in sepsis and was rather ill from the infection which caused him to collapse and not because of the change of bedsheet.

Example 2

An orthopaedic HO wanted to post a case of infected farm injury of the hand for wound debridement. When I answered the phone, the first thing he said was “Who are you?”. Hello?? YOU are the one calling me, shouldn’t YOU introduce yourself first. I calmly answered back, “Who are YOU?”. After that unappetizing start to the conversation, he proceeded to ramble another bunch of rubbish which I had to filter out to get the gist of the story.

Anyway, I finally decided that the patient’s renal profile was not acceptable for a young fit guy with no previous medical illness. Thinking that perhaps the patient was dehydrated from pre-op fasting etc, I told him to give some IV fluids to the guy and repeat the renal profile. He did all that and called my colleague during the evening to inform the new results which were thankfully better, and confirmed my suspicion that the patient was dehydated.

I called for the case to be done that night, and when the patient arrived, I was shocked. Firstly, the patient was 120kg and I specifically asked the HO what was the patient’s weight. He told me he was average. About 70kg. Why was the weight important? Well, when we give gas to knock patients out for surgery, if they are big-sized, it may be harder to get the “breathing tube” in their “breathing chute” which can be dangerous to the patient life. Therefore there are many things to be considered to prevent complications.

Next, I flipped through the folder and saw the most horrendous thing of all. The HO’s last entry in the medical notes which were:

S/T (spoke to) Dr XX (Anaest MO).

Informed renal profile and patient’s current condition.

Plan: to leave it as it is.

Signed and stamped.

OMG. What in the world is that?? How can someone who’ve worked for more than 6 months still not know the importance of documentation and write such a “plan”?

I rest my case.