The doggie magic

I'm keeping track of patients' urine output twice a day and making sure that that they are not too concentrated, and I've been having concentrated urine for almost a week.

I'm trying to drink more every day but every time I have the time to take a big gulp, it's like like 5-6 hours lapsed my last drink.

Yesterday was post-call. But I managed an amazing 3 hours of undisturbed sleep during my call! All the oncall admissions came at reasonably decent times, and none were critically ill. And I had my fav MO oncall with me. Fav because he's the most reliable, and he would give clear and detailed instructions, no ambiguity and room for guessing games, and he would come to see the patient very quickly if I raise the red flag. And he covered me several times when there were some ambiguity on my part.

And secondly, he let me play with his doggies! :) Yes, yesterday, post-call, I had my buddy Wendy chaffeur me around KK looking for a pet shop to get some rawhid for the doggies. He has one adult rotweiller, three 7-month-old roitwellers (which were the same size as the adult one) and 1 dalmatian! They were so cute! But they were terribly rough and after only 20mins of palying with them, I was dead tired, and I was drenched with doggie saliva, paw prints on my clothings, scratches everywhere, and a very heavy heart.

I miss my deary Pheobe at home!

To remedy that, I officiated the swimming pool at my apartment complex with a midnight swim last night! :) I had Wendy sitting poolside watching my stuff, and keeping eye on peverts. Nolah. :) It was dark, no lights, so I don't think anyone saw.

Even if anyone did, nothing la also. Initially I was told that it would be quite "strange" to swim in the apartment complex pool because half the population there are hospital staff; specialists, MOs and other interns.

But I figured that if I was sniffing glue or having public sex, then I should worry. Swimming shouldn't be problem. I know it's Malaysia, but swimming is not immoral

"There goes that immoral intern again. How could she swim in the pool?!"

I imagine them lamenting.

Besides, I can't drive 12km everyday to Likas Sports Centre, where there's a gorgeous, gorgeous pool, but a yucky yucky toilet, and showers with no place to hang anything.

I'm thinking of playing with my MO's dogs again, today, but I don't want him to find me irritating. Let me work up the courage later to ask whether I could go to his place and play with his dogs again. He doesn't need to be at home mah. His maid knows me and can let me just play with the dogs at the backyard.

I hung out with Wendy yesterday and I felt very happy, despite she being a little down these couple of weeks. There's something just genuinely nice and sincere about her. She'll tell me anything, answer any of my stupid questions.

I was asking her whether she thought I was weird, because some of my colleagues in my ward commented that I was weird. She said no lar. Maybe a little wacky at times. I just like to think that I'm a little expressive. But I behave appropriately with time and situation.

And I notice sometimes people laugh with the things I say eventhough I did not mean for the things to be funny.

Funny.

On a happier note, Dr. V came to the ward the other day for rounds with the consultant. I caught him looking at me. I was hidden behind the nurses' counter, writing a referral letter. Then later half-way though the rounds, he came to the counter and stood behind me. He was flipping through the stuff around me, looking for paper.

"Hi Sharon. How are doing?"

"I'm fine Dr. V, thank you. How are you?" I couldn't help beaming I think.

"I'm good, I'm good."

My other colleagues looked suspiciously at my red face. Shit. Cover up, cover up. Continue writing referral letter.

One of my colleagues later said, "Why look for paper all the way here? Get la the nurses to get him some..."

I didn't care. The stupid paper just made my day. :)

I'm craving for Indian food now la. And I want a large glass of Mango lassi. Yummy!

I need to enjoy my Sunday before tomorrow. Hope you guys enjoy yours too! Cheers!

Pictures from home!

Decided to use my internet time to send a long email to my parents. They sent me these 2 pictures. :) The cat is a stray they stumbled upon at a traffic light. My dad picked him up and now he's adopted by my aunt, and now he's called Bruce. What an ugly little thing, but I love his sattelite dish ears!! Cute!!



























That's my new car in Kuching! I'm now driving my parents' old Wira in KK. But it's cool because I'm just so used to that old thing. But I'm turning into a KK driver! Aiks.

I just came from the Likas Sports centre after a miserable 15 laps swim. I was cramping quite badly so I decided to go slow. But it did lift some of that heaviness that I've been carrying around for the last couple of days. I wish that the sports centre wasn't so far away. I can't wait for the pool in my condo to get serviced soon. It's been out of comission for the last 2 weeks.

The 12-year-old girl is doing well. The lady with haematuria is still bleeding, but markedly less. I just sent a lady with TB lymphadenopathy home this morning, with still an ascitic abdomen. I just sutured her peritoneal tap site and sent her home to Pitas, some 3-4 hours from KK, and hoped that she would continue her anti-TB treatment in her district hospital and not default her appointment with us in 2 months time.

And it's about time I leant to scrub tomorrow. After 5 weeks as an intern in surgery, I've not been inside the OT yet! It's just crazy in the wards and the clinics, but I think it's about time I start with OT.

My next call in Friday, with the infamous Chainsaw surgeon, which is worth not even a paragraph of my blog, except that her existence in my lifetime is God's trial for me.

Ok, keying off. Want to look for some more food. Which reminds me. In another post I want to talk about my housemate, the girl who does not have a stomach.

Cheers!

Insignificant middle man

I had a bad call yesterday. Didn't get even a minute of sleep. And I had only 3 critical patients.

One was a 12-year-old girl with a thrombus (blood clot) in her left leg, and she was in agonizing pain the whole day yesterday. The first surgical team that saw her planned that she was to be heparinized (blood-thinning therapy to dissolve the clot) for a day and if that didn't work, they were to proceed with surgery.

So I was the intern to monitor her heparin infusion, and take her blood every 2 hours to check for clotting time. And the poor girl was very uncooperative because she's been poked too, too many times. A skinny, scrawny girl with a failing heart on top of her blood clot in her left leg.

That was fine because she became my main focus the whole day.

The second surgical team came in at 10pm at night and was very unhappy with the plan of management.

"What the hell are you guys doing with this patient?" He yelled at me.

I was a little taken aback, because as far as I know, I'm just following the surgeon's plan. So I explained what the other surgeon ordered.

"I'm not angry with you Sharon, but seriously, what are you guys doing with this girl?"

So his team changed the management and went agressive with heparinization. So I had to switch mode and set a new target for the patient.

But guess what? the following morning (this morning), the first team that saw her took a look at the plan drawn out by the team from last night, and thought that it was not good enough, and changed it again. Fuck. I seriously don't care what they think is best, or which school of thoughts they follow. Just do right by the patient. Fucking assholes la.

But for now that's not my problem. I've handed it over to the intern oncall today. Poor girl. I just will follow up on her tomorrow morning.

Then when all the other interns who were not on call left for the day, the Urology (study of the urinary system) team handed over a lady with blood in her urine. She was not bleeding as heavily when they were around... but when they left, she started to bleed very heavily, the bottle that was collecting her flushed bladder was turbid with blood. And the staff nurse alerted me that the patient complained of diziness. So I assessed her, and she was tachycardic, and very pale.

Shit. I quickly went through her notes and noted that she was already tranfused 5 pines of packed cells in a district hospital before she was transfered to Queen Elizabeth.

I quickly took her blood for Hb level and to cross match some blood because I knew she had to be transfused. The irrigation that she was on was not stopping her bleeding, somewhere in her urinary tract, the Urology team still hadn't got a clue what her problem was.

I called to inform my MO, and he sort of dismissed me as a little over-reacting, even laughing a little when I toild him that I cross-matched 5 pines of packed cells. (Her Hb level in the District Hospital dropped to 4.0! So I don't think I was being over-reacting) He came only like 5 hours later. And when he finally saw the patient, he was upset with me. He said,

"Sharon, the patient's not doing well. She's tachycardic. Transfuse her tonight. You should have done something for her earlier" (It was already 3am when he came). I guess he was also a little panicky because he had to answer to the Urologist come morning if anything had happened to the patient.

Like fucking what?! I can't just transfuse her without the green light from my MO, especially when she's already been transfused so much for the last 3 days. My MO could have come earlier when I called him to assess the patient, so something could have been done earlier.

But anyways, I suspect if I had transfused her without the ok from my MO, I wouldn't have been praised either.

But it's all for the patient, I keep reminding myself. Do right by the patient. I feel better already just thinking about that.

The other consolation. My MO was a hot one. :) So when he was lecturing me, I just concentrated on his facial features. Yummy. Muahahahah!

The 3rd patient was a case of interstinal obstruction. I have managed a few since I started working, so I was not so worried about her. But it was the timing I guess. Came in around 3.30am. Had to run around getting her worked up to rpepare her for emergency surgery.

It's tough because I needed to make sure that the heparin infusion for the 12-year-old was given acurately and on time because we were puzzled as to why she remained unanti-coagulated fro 12 hours despite continuous infusion and a few boluses. The nursing staff are nice, but they don't have the concept of how certain things are urgent and some of critical. To them, extra work means extra work.

My surgeon would be calling me several times through the night to ask me trace her results and asking me to make adjustments to her heparin doses. and Then finish each call by saying, "Sharon, go get some rest."

??? How ? It's the thought that counts.

---

So post-call luckily today is public holiday so I had the afternoon off after morning work is done. Got home, slept couple of hours, and then wanted to swim. The condo pool was being serviced, so can't swim there. Drove 12km to Likas Sports Centre to swim, it's closed. I forgot, it's Monday. Shit. Close tomorrow also. Wednesday then la.

And I'm oncall coming Friday. Luckily. I can't face another oncall if it had been sooner. Last week was oncall every other day. So fortunately this week only 2 days.

So since I can't destress with swimming, I drove to this internet cafe just to destress. :) And it's working, thank God.

Now hungry. Want to eat Japanese, Italian and McD. How? And I want to pee but I wearing my swim suit under, a bit hard to pee.

Other than work, I'm perfectly fine. My left toe reminds me constantly that I need to slow down. And I want to learn to be more relaxed. I don't actually feel panicky, but I get people telling me to relax, to chill. Is it my face ang\d my actions, or is it just how panicky feels like?

Other better key off now. It starts getting dark around 6.30 freaking pm here in KK. I need to find food.

Week 4

I just couldn't wait to leave the ward this morning. I had so many things planned out for today, but all went down the drain. I wanted to get my Streamyx thingy done in my apartment, and I promised a friend to chauffer her around to get her car purchase done, and I was supposed to go for a pinic with my colleagues in the afternoon. Nada. Everything had to be canceled because as a doctor, my life is second to my work.

I may sound whiny and all but there's a tinge of pride with that. Who in their freaking sane minds would be so dumb to study so many years and then spend the prime time of their lives working their butts off like there's nothing else in the world to do?

I attended my first department meeting yesterday afternoon. No, no... it's not all formality and blood donation drives or suturing workshop (because surgery mah)... instead, it's interns revert back into medical students time.

I'm in the "department of fines", I quote my head of department. Write trade name of drugs, fine RM1. Don't write duration of drug, fine RM1. Don't check resuscitation trolley, fine RM5. Take extra blood and store in the refrigerator, fine RM10 each bottle, but if nobody owns up, each intern gets fine RM1. And I think there are about 30 of us.

We are so busy running around getting ward work done (blood taking, getting appointments for some imaging studies, tracing investigation results, etc.). But on Fridays we have to attend CME in the morning, intern lecture at 10am, then grand rounds at 11am, then in the afternoon at 2pm, some histopathology conference or every once a month, department meeting.

How to get work in the wards done when we have to run around attending this and that? And later when it's time for ward rounds with the specialists, there's just something that's just left out or undone. And we get the whacking.

Not that I'm complaining. I just figure that common sense tells us that interns are humans? Not robots?

Middle of this week I had the most denerving experience. A 45-year-old breast cancer survivor arrived from Labuan with jaundice and in respiratory distress. Her abdomen was grossly distended because of ascites. I volunteered to clerk (meaning to take history and work her up) because I thought it would more comfortable for her that I examine her since I'm the only female intern of the 3 interns in my unit.

That was the take off point of a series of unfortunate events for me.

First, she was the first seriously ill patient I've ever processed in the ward. I was trying to get the nurses to help get her oxygen in place, set IV access and propped up, but apparently no one noticed that she was very ill, and took their time to make her comfortable. I was very upset because I was thinking that they were being very neglectful, and that they were not taking my orders seriously.

Then my most senior specialist came an hour later, took a look at her and immediately concluded that she had recurrent breast cancer with metastasis. She was unhappy with me that the patient was not on oxygen up and there was still no IV access. I was so tempted to rat on the nurses, but I figured that they would see that I'm covering for them and that they owe me one.

I seriously need to earn my respect quick. I can't function properly without the nursing staff behind me.

And she immediately explained the prognosis to the relatives of the patient. They looked very upset, and were starting to make arrangements to bring her home for palliative management.

Then later in the afternoon, my MO came and did a bedside ultrasound for her and said that her jaundice was caused by stone in her biliary tree, and that there's treatment for that.

The relatives were confused. But I guess their spirits picked up regardless.

Then my specialist came again late evening and told them to discuss among themselves to bring her sister back to Labuan.

They were even more confused at this juncture.

You see they (specialists and MOs) are not always in the wards. Only the interns, so the relatives would asking me lots and lots of questions. It came to a point that the patient's 3 really big and really hooligan-looking brothers were confronting me, making demands for explanation of their sister's actual condition and whether the hospital could provide oxygen for her journey back to Labuan.

I had to do my best to explain that the patient had double pathology. She had advance cancer, complicated with obstructive jaundice secondary to biliary stone. And because of that, there's no point of putting her through the treatment for the stone. And that when they signed the AOR letter (At Own Risk) letter, the hospital is free from anything that might happen to the patient on the journey back.

One of the brothers actually demanded that I write a letter to say that the patient does not require oxygen for the journey.

"Saya tidak mahu berdosa bila saya buka oxygen dia".

He said something like that.

I calmly (not very calm also la) told him that we don't have to go to that extend. His sister's condition was grave and terminal. The oxygen doesn't keep her going. It's just to make her more comfortable.

Ok, I guess the relatives were not the most difficult bit. My specialist and MO would create all the mess, but I have to do all the cleaning up.

They would disappear and ask me to "talk" to the relatives through the phone. I was even asked to literally see to that they leave the hospital immediately after they sign the AOR letter, which I didn't. They patient was a huge lady, way over 100kg, so it's really difficult to transport her, so the relatives appealed to ME to let them stay until they could arrange a way to transport her.

I didn't have any authority to let them stay but I said ok anyways, so the following day I got a scolding from my MO (whom by the way didn't even say anything to the relatives when he did his rounds in the morning)... I was wasting government money. I shouldn't have allowed them to stay because they signed the AOR letter. Bla. Bla. Bla.

Then I did the weirdest thing. All his scolding just became very airy and diluted when they reached my ears. I suddenly exclaimed, "Dr. W, do you have dogs?"

Dr. W stopped in his tracks, his eyes wide open, and replied, "Yes, I do. " and continued scolding me.

But I was happy.

Later that evening after everything, he promised to let me play with his dogs soon. :)

The patient expired 8.40pm last night, her 3rd day in the ward. May she rest in peace.

But that same night I was oncall, and I was called my the nurse at the Burns Unit. A Filipino lady came in with 90% 3rd degree burns, and DIL (Death in Line) and DNR (Do not resuscitate) were issued the day before because of her grave condition. Her relatives just arrived from KL were making a fuss in the ward, nad the nurses felt physically threatened.

Shit. I'm strong and all, but a group of angry relatives?

I had to run up, as the unfortunate oncall intern. I sat the most dominant sister down and asked her why she was so upset. She claimed that her sister were not getting "medicines" and they was some prejudice going on, since they were Filipinos.

I was shocked. But I proceeded to explain the management of burns and what DIL and DNR were. She understood. About the racial discrimination, I won't lie to her, it's everywhere. But I assured her that her sister was getting the appropriate treatment, all according to protocol. That much I can assure her. There were no "medicines" to treat her sister's burns.

I guess she was a little surprise with my frankness. But they were calm the whole evening until the patient expired later in the night. She was the first death I pronouced in my career.

Sure I was nervous. What if she didn't really die? But no spontaneous breathing, pupils fixed and dilated, cardiac monitor showed asystole. She's dead. And the nurse nudged me to say a few words to the grieving relatives.

"It's confirmed doctor? She's really gone?"

"Yes, I'm sorry." That's all I can say.

---

On lighter note, I'm learning to get over my little crush for Dr. V. But I'm always still so elated to see him whenever he comes around to the ward.

A friend spotted him having dinner with his wife, and I questioned her 101. Were they sitting side-by-side? Were talking and laughing a lot? How did his wife look like? Was she pretty? Did he touch her a lot? Were they in love?

My friends thought I was crazy. But I just had to know.

---

Ok, better key off here. Need some retail therapy. I'm oncall tomorrow. Yes, Sunday.

Cheers!

It's tough, but I'm happy.

I'm alive and well here in KK.

Hey, I really, really miss you guys!

I don't have my internet connection yet in my apartment, so now I'm in an internet cafe in Centre Point, one the more happening malls in KK.

So many things happened in my 3 weeks here, but I guess what I care to share are those things that affected me the most.

I want to believe that I'm changed, and humbled by my very traumatic first 3 weeks as a medical intern.

Had my very first call (on-call means working 8am through the night until the next day 5pm) early this last week and my 2nd last Friday. Scary because I'm all alone manning the male surgical ward of about 40 patients, and currently I'm famous for being the "hottest" intern so far. 6 admissions on my call and 4 of them ended up on the operation table the same night. Didn't sit down the whole night, and needless to say, I didn't even sleep for a minute.

One came in with an apparent infected drain site from a previous laparatomy, so I was asked by my MO (Medical Officer) to just off the suture... and guess what, some 40ml of faecal material burst out and I had to quickly collect it in a sterile bottle as proof, just in case my MO thought I was cracking under pressure. Faecal peritonitis is really, really bad news.

One 21-year-old got admitted around 3am for acute abdomen. But on further examination, we suspected him to have infective endocarditis, and was in heart failure. So I was asked to take blood for culture 3 times, half an hour apart, from 3 different sites, 4am, 4.30am and then 5am. But after the first blood-taking, my patient disappeared into the hollow corridors of Queen Elizabeth Hospital. I was so afraid that he might just collapse somewhere in the very desserted hospital compound so I went looking for him. Nada.

Around 9am after my morning rounds I called the ward and found out that the patient made his way, on foot, back home, and refused to go for any treatment. Aiks. Is it because I gave him the green needle? It's faster mah. If I give him the blue needle, even though smaller, and apparently less painful, I have to poke him longer mah.

When I started, I had 2 weeks of tagging, which was a really tough period for me. 6.30am to 10pm, 7 days a week. Tagging means that I tag onto a more senior intern and follow him/her around and observe the trade. So I was very lucky to get a really, really nice tagee... a great teacher too. Let me do all the procedures, and he had this really great calmness in his voice and his actions... so I never felt nervous manouvering a chest tube and inserting a CVP line.

But now I'm in a new ward, no more tagee, and no more tagging, meaning real responsibilities. Whatever I write in the patients' files and whatever I write in the drug chart, they matter. So it's all very denerving at times.

My other friends who came with me to KK was constantly sharing their burdens with me, so I guess that helps because I don't feel so alone. And true to my true self, I managed to find myself a crush in my 2 weeks of tagging, a young surgeon, who became the main reason how I could drag my body out of bed every morning to make in to the wards before 6.30am every morning.

But later, after my tagging I found out from an unreliable sorce, that he might already be married. So I decided that I couldn't live with uncertainties, and I couldn't ask him directly whether he was married or not, so now I'm slowly weaning off him, so now I'm in another ward, and I don't get to see him that often anymore. It's really hard.

My friends were asking me to scout among my fellow interns... but I can't la. I like older men, period. Hehe. And I want to find a guy with doggies, so I can play with them. :)

And the ther day, this really mean MO from Medical Department made me cry. Sounds silly but he was merciless. It was my first time referring a case, and it was another senior HO who asked me to refer his case. So the MO grilled me on the case and later wrote nasty thing about me about being rude for not reviewing the case before refering it to him and wrote my name in bold and caps in the patient's file. He even misquoted me, but in the end my tagee said to just suck it in, and move on. Many more shitty times to come.

I get. So I move on.

Another thing I still struggling to get usedto is being called Dr. Sharon.

I'm staying at this really nice apartment complex with 2 other friends, fully furnished, with a washing machine, thank God. So now I'm quite happy and all eventhough I feel I don't have much life other than my life as an intern.

I have just, yes, after 3 weeks, made my way, alone, and quite courageously too, to the Likas Sports Complex to check out the indoor swimming pool. It's gorgeous. Will be going there this evening! Yipee! I'm sure I'll be feeling more confident too now in my suit now that I've shed off a couple of kilos since I started working. :)

Courageous I said because it's really confusing to drive here in KK, and now with all the construction going on with the new flyover. Oh ya, my parents sent over the old car to KK, and my new Myvi is in Kuching! :)The other day when we were moving to our new apartment, I got lost and ended driving over 50km around KK, only finally reaching our intended destination after we asked for direction in an abandoned road. Aiks. And by the way, KK drivers suck! Big time!

Excuse me for my lack of structure in this post. I need to key off for now. Have a buy a couple of things for the apartment. Will get internet access soon. Till then, take care people. I really miss you guys!