springwind's Xanga

Saturday, October 06, 2007

Sat, 06 Oct 2007 11:11:09 GMT

One week of rotation in QEH Pediatrics and I already missed QEH MED so much. Shouldn't be saying this but I don't think I'm going to like Pedi. On the first briefing session, the supervisor already labelled us (me and another HO from QEH MED) as "reckless" because of where we came from. Sure we had seen a lot of emergencies and are confident in handling a lot of things by ourselves, but we do know our limits. It is not necessary to warn us to restrain ourselves, as if we're some untamed animals. Even it may have been a joke, but what does that suppose to mean?

Anyway, apart from this, there's litter satisfaction in daily work in Pedi. First, the nurses are always rushing you to do things, even there's only one thing lying on the houseman workstation - while you're trying to attend ward rounds. In addition, they are unhelpful and rude so I'm starting to solve problems by myself.

Apart from poor working environment, we are not involved most of the patient care, except taking blood. Every night, if you're calling infant wards, you'll have to take blood from the start of your duty until the next day. Sometiimes during the night it is not uncommon to have thoughts of child abuse. Blood taking is all a Pedi houseman is required from. Even if you admitted patients and wrote down some simple management, it is often disregarded and the nurse will wait until the MO has given the order. For me it is hard to imagine how one can learn about Pedi if he wants to work there in the future when all you can do is spooning blood from a neonate's bleeding heel.

Still 11 more weeks to go.

Sunday, September 16, 2007

Sun, 16 Sep 2007 09:52:28 GMT

First rotation is coming to an end. So far I've done multiple bone marrows, some lumbar punctures and abdominal taps, a few pleural tap, 1 central line insertion and 1 chest drain. (and countless CPR and many tedious blood cultures WITH ASEPTIC TECHNIQUE, which have to be done 3 times if the patient has a Hickman line...).

No matter how expirenced I am in doing procedures (in fact I'm not the expert), I don't think the seniors will take this into consideration when they are hiring people. But my tutors were either not senior enough or too cool to approach...how can I get a reference letter from them??

Trying to write a CV...so far it's still blank...what am I supposed to put in??

Saturday, August 25, 2007

Sat, 25 Aug 2007 13:36:17 GMT

A 70-something lady with hepatocellular carcinoma, not for resuscitation. She has a son who is a medical officer. Her condition had become critical, with low hemoglobin requiring blood transfusion and fluid and ionotropic support to maintain her blood pressure. Then, more than 500ml of coffee-ground aspirate came out from the Ryle's tube, she must had had more bleeding. More blood-taking would only show further drop in hemoglobin, which was already very hard to do since the patient's blood pressure was dropping, and with the poor clotthing profile, femoral blood taking was not allowed. Is there a need for more transfusion? The medical officer is standing right by her side, knowing all about this. What was going on in his mind? He had had this experience every day in his career. He knew about doing more is just causing more suffering to his mother. If this were his patient he would not hesitate in making a decision, but this was his mother...

"Do not resuscitate" - this is a decision all medical officers have to make when they think that a patient's prognosis is dismal and aggressive resuscitation will only cause more trauma to the patient's body. But can they make and accept this decision if it was for their love ones?

At the end, the medical officer agreed not to take more blood samples. He just stood by his mother's side, watching her last gasps for air, until there was no more effort of breathing...

He must have had considered this situation some time ago since he entered medical school. He understands that medicine has its limits. But can he still be rational when it happens to his close ones? Isn't it ironic that he, being a doctor himself, was not able to treat his mother, and watched her died in front of his eyes?

What will I do when this happens to me?

Sunday, August 05, 2007

Sun, 05 Aug 2007 04:34:20 GMT

Something learned from recent days - when you've completed most of the work during on-call nights, be sure to get some rest instead of feeling like being helpful. Or else this is what you might get: needle stick injury, cardiac arrest requiring CPR, skipping important image or lab result findings which you thought was unimportant in the first place, then later being scolded by the medical officer the next day. Some I've experienced and some I've heard of. This may sound irresponsible, but sometimes it will be much safer for oneself and the patients if we only mind our own business.

Recently there is much pressure in daily ward duties, mainly due to the widely reported medical incidents. "Urgent" cases need to be attended quickly, especially when the patient is accompanied by concerned relatives. K+ need to be corrected carefully and on each lab result form the value, electrolyte, name of the patient have to be underlined, and sodium level have to be written down before correcting K+. Each blood taking is takes longer than before for the fear of taking blood from the wrong patient or printing out wrong labels.

One of the most satisfying things is that the management you have ordered for a new patient had not been changed after assessment by the medical officer who comes in later. Although that was only a minor case of fever, at least now I know how to admit a case of fever in the future.

QEH is undoubtedly a place that can really drain all the juice out of you, but the team spirit in the medical department really impresses me, and within us interns this is developing too. Thanks for those who have helped out during the times of collapse. Can't believe a month have passed already. Really wish to come back and work here a year later.

Life as a houseman in QEH

Sat, 21 Jul 2007 04:17:15 GMT

Have always known that QEH would be hell, but the first day was really overwhelming. On the first day, with nothing in my head, already had to manage a lot of problems: drop in blood pressure, desaturation, raised Troponin I with chest pain, fast atrail fibrillation...it was too much and too sudden for someone like me, for I used to take on problems slowly... But in the hospital patients like to have problems together, and they like to do it at night when you have that least support from seniors and other staff.

The first night oncall was a long night. Complaints and ugly-looking lab results kept pouring in from 10+ wards from night until dawn. There was no time for a drink, not to mention to sleep or even a short nap. Feeling of loneliness and helplessness flushed in as I saw the sunrise during that night. Luckily I could still hold on.

Procedures I've done so far: >10 bone marrow aspirations, 2 lumbar punctures, 2 abdominal tapping, 1 venesection . Sounds like I've done a lot, but the price of doing a pricedure is a mountain (or several mountains) of work piled up in other wards.

So far, I haven't the chance to sleep during my oncall nights like the others did. I guess I really have to work on my effiency. But have to admit I'm quite happy working here, even I worked my ass off. I have very nice and supportive colleagues and I can feel a team spirit is emerging within us.

Tuesday, June 19, 2007

Tue, 19 Jun 2007 11:29:39 GMT

Currently listening to Bon Jovi's latest album - Lost Highway

Very different from previous albums. This one's much more intimate and "homey". It kind of marked a new stage of the band. From previously the great vigor and the desire to take control of oneself's life expressed in "It's my life", "Everyday", "Bounce", to the present more mature, more subtle feelings as in "(You Want To) Make a Memory".

Never thought Bon Jovi would take on a duet. "Till We Ain't Strangers Anymore" with Leann Rimes was surprisingly beautiful. A very simple song but moves the listener with an effect that is undescribable.

The album ends well with the last track "I Love This Town". With its kind of old-fashioned style and sound effects, it really paints a picture of your favorite place, a place where you really call home. As a personal opinion, I think this song can be much appreciated when the listener listen to it on a bus, preferably a tour bus which travels in the busiest and most lively part of the city.

As a conclusion, this is a great album. It is more quiet than the previous ones, but the band's style still remains. Though the band has been there for ?20 years (probably more), it continues to give a lot of surprises to its listeners.

Wednesday, June 13, 2007

Wed, 13 Jun 2007 11:39:56 GMT

Swapping of intern position is finally drawing to an end. Postings remained unchanged (QEH MED/PED; PWH ORT; QEH SUR). Wanted to get another medical rotation, but pediatric will do fine...still have some interest in pedi. Will have to decide between medical or pedi (or even A&E or ORT) later on.

Even starting from now felt as if life is fixed.

Don't be narrow-minded, there will be a lot of options available out there.

Time for some soul-searching and goals-setting.

Friday, June 08, 2007

Fri, 08 Jun 2007 11:36:36 GMT

One of the most important thing to do during this "holiday" is to meet up with old friends and catch up on how they're doing.

Many of them have changed. They are no longer the carefree youngsters they used to be. They now have lots to worry about: job, money, relationship...

We no long stay out and hang around late in the streets. We're getting old and lack the physical strength the stay up all night and play, and we're playing less basketball. We can't just go on a trip spontaneously because we have to fit each other's work schedule...How I missed those days...

But I'm grateful being able to see all of you guys still. That's what friendship's all about.

Friday, May 18, 2007

Fri, 18 May 2007 13:15:24 GMT

No more exams in my life...for the time being...

Sitting in front of my computer...seem to have all the time in the world...

There are so much that I want to write down...but I was never a good writer, can't put my thoughts into words...

I should write down something...anything...before I forget...

2 years have gone by since the last entry. I'm now a doctor, which I have been keep telling myself since the results were released. I've dreamed of this day for a long time. I kept rehearsing in my mind what I would (should) do and feel like after I've got my results. I thought I would cheer or shed a few tears of joy. It should be one of the most joyful day in my life and I should be going out and celebrating and getting wild. But instead, I'm sitting at my desk typing this long-lost entry. There's a lot going on in my mind, and Iguess this is happening to many of the other doctors-to-be. Carefree days as a student have gone, there are now lots of things ahead of us: work, responsibilities, making a living...

As I stepped out of the hostel and took off from PWH, I felt something like an angina in my chest: I missed the place already. I know I may come back to work or something, but that'll be different. This place has been my "home" for the past 3 years of my life.

5 years was a long time, but now that it's over, it didn't feel that long. It was like yesterday when I took the interview 5 years ago, it was in PEC too, the same place I found out I'd be a real doctor.

I'm glad I have taken some pictures every year. I realised that I've changed a lot, especially my clothes and hair (haha...). My classmates have changed a lot too. I wonder what we'll all be like 5 years later?

To be honest, I'm not quite ready. I'm not ready to wake up early for work every day, not to mention about working overnight on-call. I'm not ready to stop reading books and put my knowledge into practice. I'm not ready to stop going to video game centres during working hours with my roommate (how I'll miss those days!). ...I'm not even sure I'm ready to take on so much responsibilies that await me...I'd better collect myself during this month...I'll be a grown-up soon, I should treasure the remaining of my student life, reflect on my past, and look forward to the new chapter in my life.

Monday, August 08, 2005

Mon, 08 Aug 2005 13:29:43 GMT

Seems far-reach