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Archive for March, 2009

Who are the most prone to suicide among doctors?

According to CN-, it’s the psychiatrists and the anaesthetists.

I wonder why.

We’re both so screwed 😉

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Rantings…

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.

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Two weeks ago, my pastor mentioned this joke during his sermon. I had planned to look it up earlier but got carried away with work. Anyway, here it is…

In the beginning, God created the Heavens and the Earth and populated the Earth with broccoli, cauliflower and spinach, green and yellow and red vegetables of all kinds, so Man and Woman would live long and healthy lives.

Then using God’s great gifts, Satan created Ben and Jerry’s Ice Cream and Krispy Creme Donuts. And Satan said, “You want chocolate with that?” And Man said, “Yes!” and Woman said, “and as long as you’re at it, add some sprinkles.” And they gained 10 pounds. And Satan smiled.

And God created the healthful yogurt that Woman might keep the figure that Man found so fair. And Satan brought forth white flour from the wheat, and sugar from the cane and combined them. And Woman went from size 6 to size 14.

So God said, “Try my fresh green salad.” And Satan presented Ranch Dressing, buttery croutons and garlic toast on the side. And Man and Woman unfastened their belts following the repast.

God then said, “I have sent you heart healthy vegetables and olive oil in which to cook them.” And Satan brought forth deep fried fish and chicken-fried steak so big it needed its own platter. And Man gained more weight and his cholesterol went through the roof.

God then created a light, fluffy white cake, named it “Angel Food Cake,” and said, “It is good.” Satan then created chocolate cake and named it “Devil’s Food.”

God then brought forth running shoes so that His children might lose those extra pounds. And Satan gave cable TV with a remote control so Man would not have to toil changing the channels. And Man and Woman laughed and cried before the flickering blue light and gained pounds.

Then God brought forth the potato, naturally low in fat and brimming with nutrition. And Satan peeled off the healthful skin and sliced the starchy center into chips and deep-fried them. And Man gained pounds.

God then gave lean beef so that Man might consume fewer calories and still satisfy his appetite. And Satan created McDonald’s and its 99-cent double cheeseburger. Then said, “You want fries with that?” And Man replied, “Yes! And super size them!”And Satan said, “It is good.” And Man went into cardiac arrest.

God sighed and created quadruple bypass surgery.

Then Satan created HMOs.

~ Author Unkown

Just to let you know, HMO is not our HO-MO or Junior MO. Found this on wikipedia…

A health maintenance organization (HMO) is a type of managed care organization (MCO) that provides a form of health care coverage in the United States that is fulfilled through hospitals, doctors, and other providers with which the HMO has a contract.

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Itchy, itchy.

Today, I had an old patient with multiple medical problems who was planned for a hernioplasty. I gave him spinal anaesthesia (half body anaesthesia) and then sat around waiting for the operation to be over, and of course keeping an eye on his vital signs. Half way through, the old uncle kept mumbling something. I couldn’t quite decipher what he was saying, so I kept asking him to tell me what was his problem.

Finally, turned out he was mumbling “hidung gatal” (my nose is itchy). I then took his hand and guided him to scratch his nose. I reassured him that he is only paralysed from waist downwards and he is free to use his hands to scratch his nose.

A few minutes later, he was still mumbling the same thing. “Hidung gatal. hidung gatal.” This time my GA assistant attended to him and used a cloth to wipe his nose for him. Thank goodness the surgery was over by then, so we could remove the facemask and let him scratch his nose to his heart’s content.

Another funny case was when this young gal was planned for insertion of a metal thingy into her thigh to fix her fractured bone. I gave her spinal anaesthesia too as the operation was only involving her leg. But unlike the uncle above, her hands and body had to be strapped together to prevent her from falling because they had to hang her leg off the edge of the operating table so that they could have access to her leg.

Half way through the operation, she called for me. I asked her what the matter was, and she said that her head was itchy. Damn, I couldn’t get her to scratch her own head, so I had to sit there and scratch her scalp for her, praying hard that she had no lice or “kutu”. Throughout the entired operation, she had 3 episodes of itchy scalp. It didn’t help that she later told me that it was probably because she hadn’t washed her hair in ages, since admission to the ward. Ugh…

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