Saturday, July 23, 2011

What to do when....

..all you really want to say is "There is nothing we can do."

There is nothing we can do.

I am sure, in any doctor's life, there will be a few times when this is the one thing that you have to say, yet you know you can't.

For it means, there is no longer any hope, you have come to a dead end and there is nowhere else to go. There are no rays of light, no silver lining, no matter how hard you look.

There is nothing we can do for your mother.
There is nothing we can do for your father.

and the saddest of it all, There is nothing we can do for your child.

I seriously think, malignancies in children is the worst thing in the world. How does one cope with telling parents of a child, someone who's just only about to start his/her journey of life, that your kid may pass away before you do?

A few months ago, a 16 year-old girl came to the clinic with a swollen knee. Subsequently she was referred to another hospital for proper treatment for the cancer.

As doctors, we tend to 'suggest' certain treatment in a matter-of-fact of way and we don't stop to think what we are really telling our patient.

How does one tell a 16 year-old girl that she has to have her leg chopped off? I think about it and consider how I would feel if someone told me that I need to have my arm surgically removed. Devastation doesn't even cut it.

Of course then one may say, where are the parents and what are they doing?

I am not a parent myself so this is something I may never comprehend but apparently when one becomes a parent, all you want to do is to fulfill a child's needs and wants. How do you say to your daughter that her leg has to be removed?

How, indeed.

So of course this unfortunate family decided to seek alternatives.

A friend received her case a few days ago. Apparently the mass is now the size of a football, ulcerating and bleeding. She is pale as sheet and stopped breathing at the A&E but was revived with resuscitation.

No matter how they bandaged her knee, blood was dripping. Her condition had become so bad that her blood could not clot, it was like a leaky pipe. It took the highest concentration of medicine just to maintain the lowest of her blood pressure.

Of course, there is no way she is fit to go through an operation. Even if she is, there is no knowing the state and extension of the growth.

In short, there is nothing we can do for her except make her comfortable. The last I heard her heart stopped beating again in the ward and again she was resuscitated. It looks really bleak; even if she miraculously survives, her brain wouldn't have survived the periods when it was oxygen deprived.

My heart and prayers go to the family.

Wednesday, July 20, 2011

Winds of change

They say change is good.

The hospital will be implementing the shift system for the housemen soon. They started a trial run in one of the hospitals and since it has been getting such 'good' feedback, they are now starting it here.

I'm not too clear on how it is going to be, but apparently there will be three shifts with periods of overlap between the two for about two hours. The housemen at the other hospital allegedly loved this new system, because it meant abolishment of the oncall system and it is heard that the MOs, on the other hand aren't too happy as it meant that the housemen were handing over their work to the next shift and nothing ever gets done.

Things are bad as it is; I didn't have housemen till about a year and a half ago and even then we only had two or three at a time. Fortunately most of them have been really good and never brought us much problems so I was totally unprepared for the lousy quality of young doctors that I am seeing here.

I try to take a step back and wonder if I was ever this bad when I was a houseman and I think I was even worse so I try to cut them a little slack, but it irks me when their lack of responsibility for their patients and sense of pride in their work affects how the ward is run.

Note that I didn't say lack of knowledge - a boss I had once said it doesn't really matter if you don't have the knowledge, because you can always go back and read but if you have an attitude problem, well, good luck I guess.

I don't want to sound like an old fart and start reminiscing about the 'good old days' because I hated hearing it when I was being told off by my specialists - but I do honestly think the housemen nowadays have it easy. I have about 8-10 housemen in my ward which has about 45-50 patients. They distribute the patients according to cubicles and most of the times, 1 housemen will be in charge of only about 5-6 patients.

and they still muck things up; one told us confidently during morning rounds that the patient is still being kept fasting awaiting op whereas the said patient had already undergone his procedure the night before.

Eh, did you review the patient or just the case notes?

I try to be nice because I know it can be hard but seriously?

I remember coming to work at half six to bucketfuls of blood requests, going for rounds and then more blood taking - not to mention chasing after radiologists for appointments then accompanying patients for procedures and interspersed between all that, clerking anywhere between 4-8 cases per day.

Some housemen go through the day not clerking any cases at all.

Things are different nowadays indeed.

What will the shift system mean? No oncalls. That would be weird. Being oncall has been so synonymous with being a doctor, that I can't imagine not doing oncalls. I guess one can look at it and say, a well rested doctor is a safe doctor. But, an under exposed doctor can be a dangerous one too.

One doesn't learn during ward rounds; I learnt most of it while being oncall. Being oncall means you get to see the cases and come up with a preliminary plan before presenting it to your superior and see whether you have got it right. Being oncall also means that you get your MO to yourself so, depending on how approachable he/she is, you get to ask questions that you dare not ask during the rounds.

Some say the shift system is being introduced in response to the many parents who have complained about how tired their little princes and princesses after working for more than 36 hours. Some say, it it because too much money is being spent paying for oncall claims, now that there are so many of them but I think, the bottom line is whether it will be the best thing for the patients?

Furthermore, when the housemen have been trained in a shift system, how will they cope with the oncall system once they become MOs? Will that mean that subsequently the shift system will involve the MO as well?

I wait the future with bated breath.

Tuesday, July 05, 2011


After about 6-7 years being in a few district postings, I am finding myself slowly adapting to being in a tertiary centre.

As I said to a friend, I will be receiving cases of spinal shock and polytraumas rather than referring them. It will be quite a different kettle of fish.

On top of that, I found that I have forgotten the politics that are involved in a large department. You find that one says one thing yet means another. Being at the bottom of the rung, we found ourselves bearing the brunt of many dissatisfaction. Many times we were thrown the deep end of the pool with no one to tell us what to do. We found ourselves doing ward rounds and then rushing to the clinic and still get told off for being late yet the seniors get away with murder.

After many years of being the reliable one, the right hand woman - it takes a while to be the person everyone trusts the least simply because you are new.

I find solace in my fellow Masters Programme-mates; despite all this we can still find reason to laugh it off and make each other promise that we won't be 'that way' once we are at 'that stage'. Classes offer a short reprieve from the sometimes confusing rounds - yet I am sometimes reminded why I had deferred from applying in the past years.

Not having Abg around after work was a little weird as well. There were only a handful of times we were apart (exception of course when I am oncall because that counts as being at work) since we got married so it was weird being 'single' again.

It will take time but I am adapting.