KIV Home soon
The hospital is a dirty place.
Not that it is physically dirty with rubbish and litter, although sometimes the MO room is just that; but that it is full of germs (bacteria, viruses and fungi).
And these are not your typical common flora, these are 'commando-trained' bugs that will make you very very ill.
MRSA
VRE
VISA (not your American Express)
There are so resistant that a new term was coined for them - "Nosocomial".
And when your doctor says you can go home, please go home. Because the last thing we want to do is to treat a nosocomial infection.
And trust us, sometimes treatment CAN continue at home.
A non-medical entry...finally
4 months have passed since HOship started. Looking back, it seemed like time flashed by. But I can still remember how excruciatingly slow time passed by when the day was bad.
Almost all my time during these 4 months was occupied by work, sleep and food. I work almost everyday including weekends, except for my measly 1 week leave which I spent time doing my presentations anyway. I sleep post-work hours, trying to catch up on lost sleep. And I eat to stay alive and continue working.
All work and no play makes Wei Qiang a dull person. There's really nothing else to talk about, except how difficult that plug was or how the patient kept complaining cannot pass urine even when he's on a catheter.
I can so count the number of minutes I spent doing anything else other than work, sleep or eat.
Thursdays soccer with the guys at SGH.
Weekly jogs in preparation of the Standard Chartered run this December.
And the occasion climb, during my leave, where I destress and get pumped.
Maybe there is life outside of medicine, but it sure is limited.
Involved
The more involved I am in my patient's condition, the more I worry when I go off work.
Even at home, I think about how they are doing, especially the acutely ill ones.
Sometimes I wonder whether I will see them tomorrow morning.
So when I walk into the ward, I glance at the beds to see if my patients are still there.
And when my area of coverage has more ill patients than I can manage (which happens to be any number more than zero), I find myself feeling very vunerable.
I worry that any tardiness or wrong move on my part could potentially mean life or death for the patient.
That is mentally stressful.
Karma
It's been a long time since I've talked about any serious issues.
During this month at my current ward posting, I've been allowed to almost fully manage the patient with minimal supervision.
Not that I'm so good that the consultant lets me loose, but more of a lack of manpower, resulting in 'less supervision'.
As I've mentioned in other entries, this places a tremendous amount of mental stress on me as I have to consider all aspects of the patient (history, physicals, investigations, social and nursing care issues) and have a plan ready to present to my consultant.
It is unlike other departments whereby our senior's make much of the decisions and we just carry out the changes.
As doctors, we treat and help patients. A consultant once said, "1/3 of patients will live no matter what you do, 1/3 will die no matter what is done and the last 1/3 will survive based on the treatment we give."
Some patients will deteriorate, and I always ask myself if I could have done more for this patient.
What if the patient belonged to the group whereby my treatment matters and I did not manage her adequately?
Is that harm to patient? How do I know the patient doesn't belong to the group that will deteriorate despite treatment?
If I did not do my best? Wouldn't that be harming the patient?
So instead of saving lives, I'm doing the opposite.
I dread to think so. I really hope I'm not. And so I always ask my seniors when in doubt.
Sometimes it amazes me how they can eyeball a patient and immediately tell if the patient is going to make it.
Clinical acumen? I wish I had it, because it's really useful.
Want
There's a shoe that I want to get.
Problem is I can't find it in Singapore!
Muesli Man
Doing a nightcall is tough, and therefore there must be adequate equipment to ensure you survive the night with minimal fuss and maximum sleep.
The essentials of a night call include:
Your name tag and stamp. You will really want to be identifiable as the on-call and not some doctor who has decided to stay back late. You will also be asked to make several entries during the night on how patient refused blood taking or medicines.
Your handphone will not stop ringing, so make sure you have a full charge before you start. Have a piece of paper to write all the cases and passives now. Prepare two pieces if you are feeling unlucky. Have at least 2 pens because looking for a pen in the middle of the night is really frustrating.
You will need your stethoscope, no doubt. A watch is useful. And I always carry my little life-saving pouch.
It's life-saving because it contains coins which I will need to buy drinks from the vending machine at 2am to quench my parched lips. It has money for me to grab my dinner. It also has the important 'gerald tan' drug lists. A torch should be carried around because looking for one wastes precious sleep time. And I always carry butterfly needles bacause it can mean half hour of venepuncture on a patient or 3 minutes, thus ensuring you get 27 minutes of sleep.
And most importantly, you need food.
I always carry muesli bars around, you don't see it here because I've finished them. A happy doctor is a well fed one.
Breaking Bad News
When someone comes in for something as innocuous as low back pain and eventually gets diagnosed as metastatic cancer, you will suddenly feel that life has grabbed you by the neck and flung you down mercilessly into a bottomless pit.
It was so unexpected, so unpredictable, so sudden.
And how do you break such news to the patient, when all this time, he/she thinks it was just low back pain.
How can we deal with the torrent of emotions that will pour forth after breaking the news, or even the lack of emotions.
Denial, Anger, Bargaining, Depression, Acceptance
How do we deal with each stage?
Favours
In my time at SGH medicine, I have received help from many friends / colleagues and likewise have tried to return such favours or rendered help when needed.
It is indeed fortunate to be able to help than be helped.
But when you receive help, be grateful and remember to return the favour.
So in view of creating a cohesive work environment, please 'pay it forward' the next time you have the chance to help someone.
Who knows? You may receive some help too.
* Thanks Oriana. I owe you a big one. *
