Thursday, December 25, 2008

Sick MO on call rambling....

My body is burning up. My nose is blocked on alternate nostril and my chest feels like it's about to burst. When I cough, I feel like my head is going to explode.

and I have done something bad at the beginning of my oncall this morning, something which previously I have only said to myself but today came out verbally; I blame it on my URTI. Die la die la die la.....

Ah well, only 10 hours to go till the end of oncall. and hubby has gone 'berlarok' to N9 and I'm left alone with three cats with similar blocked nose and sneezing fits. As fat as he has become, I hope Fizzy can still fit through the opening in the window, or else have more sense to do his business in the toilet rather on my bed because I have left him locked inside the house and his eternal arch enemy, Meme has also run off somewhere and I just can't be bothered to go round 'Tsk Tsk Tsk'ing in order to find her. At the moment, they can fight to death, for all I care.

I've left enough food so I hope my kids have more sense than to tip the food container over and leave the kibbles to the ants and chickens.

I wish I haven't said that thing I said this morning...I wish I wish I wish......argh, 10 hours to go.......

Friday, December 19, 2008

My giddy 2 cents

Well well well - housemen all over the nation must be jumping for joy at this piece of news - Day off after 24 hour duty - and I am just waiting for the barrage of doctor bloggers who will definitely be airing their opinions on this. No need betting on what the housemen would say, lah, I think!

I do, however agree with Dr eAy-Lalle that hopefully this isn't just one of the so many knee-jerk responses that our politicians just love to give. Child dies after being hit by lorry on busy highway - build a pedestrian bridge! I remember one knee-jerk response a few years ago about lorries not allowed to be on the road during peak periods - whatever happened to that? Standard of english dropping - let's teach Science and Maths in English! What about more good quality english programmes on TV or lowering the price of english books?

In the hospital where I did my housemanship, there was one time when there were only 5 housemen in the department due to the poor coordination of posting rotation. Suppose there were 3 or maybe 4 wards, not including the peripheral patients in ICU or the first and second class wards - and at each time, 2 housemen would be oncall. If they were to get the day off, imagine the chaos this would cause.

I'm all for human rights and what nots - and I have had my share of nightmare oncalls and postings - but a drastic change like this isn't the answer.

Far from putting myself on a pedestal and awarding myself Houseman of the Year, I do find that some future doctors and current housemen lacking work ethics, integrity and inner strength. Perhaps they were pressured into doing Medicine by parents or simply because they were straight A students - I seriously think we Malaysians still have a conventional way of thinking when it comes to our children's future - but most of them ended up having the shock of their lives when faced with the work load. Perhaps made worst after comparing themselves with friends who end up with regular 9-5 jobs with a RM2500 starting salary and 4-month bonuses.

This is how I look at it. Ever seen those Karate Kid movies or those cantonese Kungfu movies like the Drunken Master starring Jacky Chan? Karate Kid had to wash cars and paint fences before he could learn to execute his one legged kick, right?

Yes, I suffered during my housemanship period and yes it was horrible and yes I have fallen asleep on the nurses' counter as I was clerking cases but no I never wanted to quit and yes I think it made me a better MO. and I think a lot of MOs look back to their housemanship and think, "Man, that was mad but I enjoyed it!"

and Yes, I thoroughly agree that the system needs a make over - AS A WHOLE - should we try the shift system as some hospitals overseas are doing? Maybe we should think about training phlebotomists to take over the tedious blood-taking work? (Sheesh, QID and sometimes 5 sessions perday of taking blood!?) Faster and paperless ways discharging patients? (Discharge summary, discharge notes, MC, medication slips and 'surat pengesahan menemani pesakit' and updating patient's TCA books and after ALL that, summaries for feedbacks to referring centres! I went through a pen a week!)

Times have changed - we don't need more speeches of "Oh, when I was houseman back in the 1940s I had to do EVERYTHING" translating as "Oh, I went through hell and so should you all - mwahahaha!".

Friday, December 12, 2008

Sense and nonsense on an oncall

Isn't it strange that I'm always in a writing mood when oncall? Perhaps it is the serenity of being by myself in the oncall room that is just so inspiring.

On some days, it really is calming to walk along the hospital's covered way, observing how relatives are glued to the windows talking in hushed voices as it is now way past visiting hours. When the beeps of the monitoring devices in the casualty and wards gets too overwhelming, a breather outside always helps.

But anyway, it is coming to the end of the year, and in February we will be celebrating our 5th anniversary. Has it been 5 years already? Sometimes 5 feels like merely a moment and at times, an eternity.

It is hard writing without going into specifics; there is a thin line between contemplating and gossiping/talking bad, when it comes to people close to you. There have been many times when I have started an entry, ready to launch into a full page rant about how badly I felt people were treating me or how people just won't understand me when I would stop halfway and save it, but never to be published. I guess an unpublished blog post can be therapeutical too.

I wonder what my long suffering husband is thinking as we approach this significant milestone. Is he happy I wonder, being married to an on/off harpy like me? Has he ever regretted taking the kadhi's hand and reciting the marriage vows to me five years ago? If he does, even for a fleeting second, I hope I have given him some happiness because I know he has given me loads. My Abg is the Yin to my Yang, the soothing effect on my temper, the calming balm to my razor sharp tongue.

Marriage is, to me, an acceptance. One must full heartedly accept the other's shortcomings before one can be truly happy. If there are so many things that you wish your partner to be, perhaps your partner is not the person that you should be with. But then, is there a difference between ACCEPTING and SETTLING? Ahh, what is life without the proverbial thin lines!

and of shortcomings, I know I have many. Sometimes, I hate me, if that makes any sense, but I know I haven't stopped trying. I think it is when people stop trying that problems occur. When people give up and don't think anything is worth fighting for, then you know that you are in trouble.

It is late, and I sense that I am no longer making sense so perhaps it is sensible to end this here for the moment...till the next on call, perhaps.

Tuesday, December 09, 2008

A decision made

Just a few days short of December, I received news that the transfer to HRPZII, which application I had handed in about a year and a half ago, has been granted. First it was just fleeting news via the grapevine and it became real when my senior MO informed me that the letter has arrived at the office.

I spent many nights thinking about it. If it was a year ago I would be jumping right now but things have changed from the time I was suffering in the OPD tolerating spoilt bohsias who would kick my door when I wouldn't sign the MC.

My mum would kill me if she read this, but I don't think I was ever the ambitious type. Many times I would wonder how on earth did I manage to pass medical school. I have asked myself repeatedly and even blogged about it; Have I become too content for my own good? - am I taking the cowardly way out? Am I choosing to remain here because I am quietly resisting change? As we all know, change is when something you don't want to happen, has happened (Haha, I just had a re-viewing of You've Got Mail - only the best internet romance movie ever made!).

What do I want for my future? I look at my specialists, and yes, they do get more pay but I don't see them happier than when they were MOs. Regardless of what or when or who, there will always be someone bigger than you giving you a hard time.

The report duty letter still sits in the glove compartment of my car. In fact, two weeks ago I was minutes away from stepping into the Pengarah's office when I chickened out. But the short break with Mum has helped me decide. Being in the district hospital will give me more flexibility in taking breaks and a better one-to-one teaching should I decide that I may want to pursue it academically afterall.

One can never say that he/she has made the right decision at the time they made it but one can always hope for the best.

Thursday, December 04, 2008

Postcall ramblings

It is half six in the morning, I am in front of the PC, sipping chilled coffee from last night and contemplating my call.

It was one of those heavy, almost bizarre ones.

The A&E was pretty quiet. I received two referrals from a local clinic, only to discharge both. One of them ended up being referred again later that night after he developed cramps after a bout of loose stools.

About half 8 a case was brought in, initially unconscious then she became disorientated. She was bleeding from the right nostril and later from both. According to the daughter, she fainted and then started to talk rubbish before vomiting blood. Her case was one of those when you know you can't keep her here but you don't really know where to refer her to. I hate cases like those. Fortunately, a mate was oncall on the medical team that night and accepted the case without actually listening to the full story. I hope she did not end up regretting that.

and just when I thought I could get some shut eye at about 1, a case of BID (brought in dead) arrived. Apparently pakcik became restless after taking his meds and did not survive the journey here. Luckily, because it is a BID case, I didn't have to do much.

The labour room was highly 'jonah' that night. It started with case of term pregnancy who was just discharged from the ward the day before. My staff nurses was setting up the CTG (a method of fetal monitoring) when they couldn't find the heart beat. A quick ultrasound revealed no heart activity. The baby was perfect, normal and of good weight. I would have been crushed.

Then the cases just could not stop coming. For once, ALL the labour room rooms were occupied. I only managed to snatch 15 minute naps here and there between checking babies, clerking new cases and waiting for the 24 weeker to expire.

I think one of the hardest things about my job is the so called 'conservative managements'. It wasn't so bad when I was the houseman; decisions like that were made by MOs or the specialists. Maybe I felt I wasn't involved; I was just following instructions but as I progress in my career, I am now making the decisions.

A few weeks ago I wrote about an infant with severe congenital malformations, the worst being cordis ectopia (heart in an abnormal position) - in this case my baby had his heart beating outside his chest wall. Apart from that he also had other malformations.

I knew what had to be done but it doesn't make it any easier. How do you tell parents that you, the doctor, is just going to let the baby die? We can scoot around and use ambiguous words but the reality is just that.

I had to do the same thing to the 24 weeker that was delivered at 0240 this morning. Seeing people die doesn't make it any easier, I can tell you that.

So, as much as I like my job, sometimes I can hate it too.