Conversing with Life

Changeover

Just when I thought I was getting used to it, change happens.

Change is difficult.

But difficulty builds character.

Wei Qiang converses @ 21:05 0 buzzes

Never closes

SGH is the only hospital in Singapore that never shuts its doors even when all the beds are filled up.

That means there'll always be new cases to clerk, always.

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I remember my previous MO said there used to be a commadarie in the past.

Whereby the HOs on call would try to help each other, especially when their call is lighter.

I think that's very nice, and a practice we should try to keep up.

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Being on call is like a lucky draw.

You start off the call in anticipation of a trying call, especially when you are either HO 1, 2, 4.

Sometimes, you get really unlucky and the load knocks you off your feet.

Sometimes you get lucky and manage to rest your butt on the red armchair in your call room.

So, do you feel lucky today?

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Being on call is like going to war.

Every call is like a battle, you go in without knowing if you'll survive or not.

But when you see the morning sun, you know you will make it.

Wei Qiang converses @ 20:49 2 buzzes

Healers

What does a doctor do?

"To cure sometimes, to relieve often, and to comfort always."

Every patient needs some Tender Loving Care.

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From Liping's blog:

"... the ward/ the cubicle is the 2nd home."

That's why we are called house officers. And our job to to make our patients feel at home, where they receive concern and warmth.

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Wei Qiang converses @ 23:23 0 buzzes

Marathon Nightcall

In a sense, a nightcall is like a marathon.

Especially when the cases don't seem to stop coming in.

Because it's tough. Because the night seems so long and that you always wish dawn would break earlier.

Because with every call that tells you there's a new case, you realise you will never get started on the passive changes.

And when the clock is reaching 5am, you realise the last few hours are the toughest.

But after every night-mare-call, you realise that you've made it, even though barely alive.

And you know that you have extended your pain threshold to another level.

If you are sado-masochistic enough, you will want to do it again, in even better style.

Personal best: 24 and counting.

Wei Qiang converses @ 21:00 0 buzzes

I love my nurses

You know you have great nurses when they offer to do the changes for you when they realise you are post-call.

You know your nurses care about you when they try to help you finish your changes by asking the MOs to help.

You know that the nurses are your friends when they are concerned whether you are going to collapse from sheer exhaustion.

Wei Qiang converses @ 15:10 0 buzzes

Angry, Anxious, Altercation

We meet all kinds of patients.

And we dread the angry ones. Especially if the relatives are angry too.

Ever been surrounded by 10 relatives and one upset patient? It's not pleasant.

But stay calm. In the face of such anger and anxiety.

Afterall, we were taught how to handle angry relatives in our clinical OSCEs.

Sure, there'll be scoldings, hurtful words. Humiliation may be felt.

But ultimately, the first thing is for everyone to stay calm. And the first thing to do is to be calm yourself.

Just remember that the anger, anxiety comes from concern.

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Nobody likes to be poked with a needle. Much less so, if the orders are for daily FBC.

Sometimes doubt may surface when patients are angry at you for venepuncturing them daily. And it's even more acutely felt when they express doubt in your skill as a doctor.

It's easy to feel: "If I didn't have to, I wouldn't want to spend time venepuncturing you also."

Nobody likes to be poked with a needle. I don't like to be poking you everyday too.

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It's a thankless job.

Wei Qiang converses @ 21:05 0 buzzes

Appreciation, Assurance, Affirmation

Some patients are real gems.

Not that they have exotic diseases and signs, but that they are appreciative of the work we do.

They express understanding for the effort we put in to improve their health, and show appreciation and respect for us.

This indurectly assures us that we are in the right job and affirms our dedication.

It's patients like these who make our working hours more bearable.

It's patients like these who make us feel bad (out of guilt) for missing their veins repeatedly, and making me more determined to be better at venepuncture.

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Walking into the ward and having the patients recognise you and greeting you is a wonderful feeling.

Having them thank you even though all you did was ask them how was their sleep last night is a nice feeling.

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It's a job full of thanks.

Wei Qiang converses @ 20:34 0 buzzes

Acumen

Practising medicine can be so much fun sometimes.

Especially when one is not made to feel like a glorified clerk.

The joy of using my clinical skills to pick up signs from patients and being able to correlate them to the disease is indescribable.

It really justifies the 5 long years we have spent in clinical years.

Wei Qiang converses @ 22:32 0 buzzes

Hello Dr...

Night calls.

It is of the common opinion that night calls are tough and just plain tiring.

Hearing your phone ring non-stop gets on the nerves especially when you are overworked, under-appreciated, helpless, hungry and frustrated.

How many people have thought about like smashing their phones or just switching it off, which of course we never do.

Busy, definitely.

But last night I've learnt that nightcalls can be really useful.

The best way to learn is through experience, and memorable experiences are those which I have gone through crap, hardship and mistakes.

Nightcalls can be exciting. When faced with a patient who is dyspneic and suddenly realising that you are staring at Kussmaul's breathing is the best clinical example of bedside learning.

Acidosis of pH 6.800 is incompatible with life. Somehow the patient survives the night, only because it was picked up and treated.


Sometimes assuring relatives that it is time to let go can be emotionally daunting, but we have to believe that death does happen eventually.

So even in the midst of it all, we are growing.

Just remember: a fall in the pit, a gain in wit.

Wei Qiang converses @ 17:02 1 buzzes

Code Blue

Have you ever killed somebody?

The first time is always tough. Once you get the hang of things, the rest becomes easier.

Everyday, every nightcall; I'm just waiting for the first casualty of the night.

Inevitably, someone will be DIL. Someone will be for max ward management. Someone will collapse.

I'm just waiting.

Sure, I'm worried the first few night calls. I keep rehearsing the ACLS guidelines in my head, but when it happens, paralysis happens.

Or at least for the first time.

The first time is always tough. Once you get the hang of things, the rest becomes easier.

Wei Qiang converses @ 16:34 0 buzzes

I miss having a life

Wei Qiang converses @ 18:37 0 buzzes

An eternal minute

Whenever I'm called on to attend to a patient whose condition have taken a turn for the worse; for example:

1) patient is hypotensive
2) patient is drowsy
3) patient is breathless
4) patient is confused
5) patient got abdominal pain

certain changes can be done in a few minutes.


Run in fluids, give oxygen, nebulise the patient, give paracetamol...

But if we take the time to think about it. In that few minutes, the patient's life is in our hands.

One wrong judgement, one wrong decision; could potentially be fatal.

So whenever I see a patient, 1 min seems so long.

Wei Qiang converses @ 21:07 0 buzzes

The process

It's hard to be nice when you are flustered and overwhelmed.

Tempers flare when you are hungry and tired.

Disillusion sets in when patients complain even if you are trying your best.

Fear strikes when you are tasked to do new things which you are not confident.

But just remember, if today is so bad, tomorrow can only be better.

Wei Qiang converses @ 16:33 0 buzzes

Survival instinct

I think all of us know how to be doctors. Even though we feel insecure even after 5 years of medical school, I believe we can handle this HO year.

It's like an inherent characteristic. One will only discover his own ability when tested.

And there is no better way to test it than to jump straight into the deep end.

SGH Medicine posting.

It doesn't get any deeper than that.

How to give painkillers?
What to do when hypocount is high?
Hyperkalemic?!

We will learn, and we will learn fast.

For nothing makes you learn faster and better than stress and pressure.

But for all things unsure, please consult the MO!

Remember, we are only HOs.

Wei Qiang converses @ 22:06 0 buzzes

A helping hand at night

When you are drowning in the ocean of busy-ness,

There is no greater thing than a helping hand.

Thank you Dr Min Min for being such a great MO4. I have learnt so much in that one night.

Thank you Dr Ezolene for buying me dinner before you went off. It tasted really good even at 11.30pm.

Thank you Dr Lynette for clerking the patient even before admission. It was wonderful to open up the clerking sheet to find that it has been done.

Thank you to all the nurses who helped me, without which I would have been lost.

Wei Qiang converses @ 23:12 0 buzzes

Work Inspiration

Wei Qiang converses @ 07:11 0 buzzes

Change

"The only thing that is constant is change." - Anon -

I am facing an immense change in my life.
Stepping out into the working world.
Being responsible for patients' lives.
Working to earn a keep.
And working to gain experience.
Ultimately to be a better doctor and person.

I started this blog to chronicle the experiences of a final year medical student. And many many memorable feelings and thoughts have happened during the past year.

And I have also realised that this house officership year is an extension of our final medical year, except for the increased responsibility and also the more practical usage of medical knowledge.

Therefore I'll be blogging still on this blog with regards to my experiences as a HO.

This year being touted as one of the toughest year that any doctor will have to go through promises to be memorable (or traumatic).

"Doctors don't make mistakes, because when we do, people die." ~House.MD~

However I'm setting up a separate blog for my non-medical experiences and basically life outside of work.

I sure hope I write more in the other blog than this one.

Visit "Wheeze Quarterly"! It's still under construction, but I hope to have a different style from this blog.

"Everything changes except exceptions." - Anon -

Wei Qiang converses @ 13:25 0 buzzes