New Year Resolutions

my playground, originally uploaded by sharonhappymorgue.

Will probably be celebrating new year in the OT because I'm on 3rd call new year's eve. No problem with me because what's new year celebration without my family. The only unfortunate thing is that I'll be oncall with the 1 MO that currently everybody's (my team la) bitching about. Just hope that there'll be no emergency op tomorrow so I don't have to spend hours of uncomfortable silence with him while retracting some obese abdominal wall.

I've picked up from my slight stumble the other day before Christmas. In fact I'm deliriously happy at the moment. I'm in Mr. V's ward, and everyday is a great learning experience. I did my first excisional biopsy of an inguinal lymph node yesterday! So super cool, at the expence of 2 veins and 1 artery, and Mr. V's shirt. :) Mr. V patiently guided me through the supposedly 10-15mins procedure which I took some 1hr+! But he was so encouraging and nurturing. And I dropped 2 instruments. :)

He was like, "Very good. There goes another instrument..."

But my 2 envious colleagues observing me noted that I was calm and collected throughout my first "baby laparatomy". Hehe.

Because of the festivity at the moment, our ward is reduced to 3 patients! It's just sooooo amazing. It's difficult to accept looking into an empty ward. It's more familiar when it's ridden with some 30-40 patients.

But Mr. V won't let us take turns to come for morning rounds and insisted all 3 HOs to come eventhough there's only like 3 patients. So he would be discussing each case in detail with us and make us go back and read up on some topics for discussion the following day. And that's just really cool because I've learnt so much in these few days compared to my 3 months in the other wards.

So for tomorrow we'll be discussing on Starling's forces and oedema in a patient with Fournier's gangrene, SIRS, adrenal tuberculosis and urobilinogen and bile in the urine.

And Mr. V let us take turns to do peritoneal tapping on an uncle who has malignant ascites who's currently in the ward. It's no joke waiting almost 2 hours tapping 2L of blood-stained fluid. Mr. V insisted that we must be bedside throughout the tap until the end.

I'm learning to convert my infatuation for Mr. V into respect. I think the progress is excellent because there's nothing but respect I have for this fine man at the moment. He's such a great teacher, on top of a being a great doctor. Many patients I see everyday praise him for his compassion and personal touch. He would always grab a chair and sit next to the patient and ask how he was doing and always explained whatever management to the patient.

He's the only surgeon doing that.

I think my colleague W is suspecting some chemistry between Mr. V and I, but he can suspect all he wants. Mr. V would always have a special place in my heart, and I wish him all my very best. I know I'm going to miss him when I finish surgery in a couple of weeks time.

I was telling my friend this morning that what I'm feeling now is rather sad, but hopeful.

I feel the situation with Mr. V is like as if I've met my soulmate, but I can't be with him because someone else needs him more than me at the moment.

So my new year resolutions:

1) To be healthier physically
2) To be more inquisitive and eager to learn more of my field
3) To have more empathy
4) To appreciate what I have and not sulk over what I don't have

Happy 2007!

Christmas away from home

Let me sum up a very eventful week:

1. Subanxiety attack, went to psychistric clinic - told to have adjustment disorder, but should pass with some mentality change
2. Realization that I'm not over Mr. V - having fantasies of having an affair with him
3. Did a pretty damn good job with my HO presentation - the only thing that I can be proud of throughout my 3-month stint as a HO
4. My sis had a missed miscarriage - I don't know how to feel
5. Got an indecent proposal from an MO - the 1st time in my life I feel sexually threatened
6. Someone told me that I dress sloppy and old - very, VERY upset
7. I'm still binging Day 3 - Christmas resolution was to go on a diet starting Boxing Day
8. Realization that I have great friends - those here in my midst, and those faraway
9. First Christmas away from home - so touched by the choir of Sacred Heart Church this morning which sang like angels

Paul was asking why I never mention about my colleagues. It's hard to form any bond at all because of our weekly rotations, and sometimes solo HO rotations. Like in my case, I've been solo for the past 5 weeks; 2 weeks Neuro, 2 weeks Uro then 1 week surgical extension. It's lonely and frustrating because there's no one to share/bitch with. But tomorrow I'll be back in the acute ward with 2 other HOs. Happy.

But I admit I have found great friends, and binging buddies.

I'm counting down to going home on 4th January.

I'm feeling better, but am currently worried about my housemate, who's also a HO, who's very depressed recently and has been openly saying that she's having suicidal ideation. I need to figure out how to get her some help. At the rate she's binging, that criterium alone is enough to diagnose major depression.

Even I need some help

I'm not feeling too well these couple of days. I can't sleep well. I get palpitations at night and even some breathlessness thinking about going to work and all that I have to do for the day. And I'm just so tired all the time and I'm having some degree of anhedonia.

I had a bad, bad call last night. Nobody died, but I was on my toes from 6pm when my call started right up to 5.30am the following morning. Admissions after admissions. I think my MO thought I was a little bit too slow in my work, but being the perfectionist that I can be, I wanted details. Now compounded with the missing a fast AF incident, I'm to the point of obsessive.

The GA MO oncall was bitchy, and 1 patient's op was canceled because the patient drank prior to being wheeled into OT, and she claimed that I did not instruct her not to eat or drink. But later she admitted to my MO that she forgot that she wasn't supposed to eat or drink, but that was after everyone in the OT was bitching about me.

That's not the worse part. Mr. V was oncall, and I thought I sort of asked a very stupid question. I almost died.

I kept on reassuring myself by saying, "Ask, and be a fool for 5 minutes. Don't ask, be a fool forever".

Problem is, I'm feeling like a fool for about 14 hours now.

I was so tired this morning when I finally completed the clerking, blood-taking, filling all the investigation forms and drug chart for the 4.30am admission around 5.30am, I felt like crying.

I can't face my 20+ patients in the Surgical Extension Ward.

I called my supervisor and explained to her that I can't work today. She was asking a lot of questions... URTI? Pain? Fever? Must get MC from casulty, she doesn't give leave to situations like mine... etc.

I told her frankly I'm not running a temperature, no URTI, no pain, no physical illness. I just can't work today because I'm just so tired.

"Sharon, are you in depression?"

"No, I'm just tired."

Finally after a 15mins phone call, she finally gave me the EL (Emergency Leave).

I got home and collapsed onto my bed, but the palpitations started again, and I swear I was breathing quite fast. I can't rest.

I got up. Took my bath. Sat down. Waited to around 8am and I called the Hospital and asked to be connected to the Psychiatry Clinic. I wanted an appointment.

3.30pm.

I'm scared that I might just lose it. My sis did several years back, and it traumatised me quite a bit. I'm scared. I just need some reassurance that I'm ok. And that everyone else was going through the same thing. Some reassurance that I'll be able to get through all these.

I wish I was a bird flying in the KK skies.

Some updates

1. I'm now online. Got my broadband set up today. But I'm not feeling very motivated to write.
2. I'm still bummed about Uncle Patrick's passing.
3. I'm bummed that I missed a fast AF in a patient, which could have been fatal for the patient. And for that I got, needless to say, a big scolding from the cardiology MO. I wish he knew how sorry and incompetent I feel right now.
4. I'm so tired but I can't sleep well.
5. I have a presentation this Friday. 2 big topics.
6. I realized early this week that I'm not over Mr. V, and it's killing me.
7. I'll be taking care of 20+ patients all by myself starting tomorrow.
8. But I'm happy.

Patrick did not make it for Christmas

A dear patient of mine, Patrick, who was in the ward eversince I started working passed away unexpectedly during my call yesterday. And it's very hard to get over it.

The night before he passed we were chatting about life and his children and wife, and life for me in Sabah and English language standard in Sabah compared to Sarawak and how much he was hoping to go home for Christmas.

Then yesterday just after noon time, the nurses alerted me that he was having breathing troubles. I instructed him to be put on high-flow mask and I prepared to take his blood for ABG. But before I could poke him, his oxygen saturation dropped from 94% to 70% in just a flicker on the monitor. BP ridiculously low.

"Staff Nurse, tarik trolley, tarik screen."

I proceeded to call my MO.

"Dr. K. Patient desaturating. Come stat."

"Be there." Line dead.

Patrick went peacefully but the family's wish was for us to do everything possible to revive him. We resuscitated him for a record 2 hours and even ran a pint of blood.

But there was never any sign of life from Patrick's limp body in the 2 hours of resuscitation.

Earlier he went for a chest x-ray because the team that was seeing him was suspecting pneumonia. But it turned out he most probably has a pulmonary embolism, most probably due to a tumour embolus from his rectal ca. DVT was less likely because his coagulation profiles were prolonged.

I never felt so emotional and frustrated after an unsuccessful resuscitation before. I was forcing to keep my tears from flowing off the brim of my lower lids when the family came to thank me for trying so hard to resuscitate him.

That was so hard. So I went hiding in the HO room until after they brought his body home.

I will always remember brave and cheerful Uncle Patrick.

I'm sure Christmas is more beautiful in heaven.

No, no to guys who smoke and hate doggies

Time flies when you're having fun. But time flies even when I'm not. Good and bad la. Good because theoretically I'm supposedly be over the slavery of my job and the directionless life that I'm leading at the moment with each passing day and week and month. Bad because I'm getting old and still not a clear path ahead of me.

In some ways I envy my sis because she's forced to make a milestone, even though she's ill-prepared at the moment, but who is ever truly ready for marriage and kids?

I'll be very busy tomorrow onwards (yes tomorrow, Sunday) because some big-shot urologist consultant from KL is coming and we have to have a grand round with him tomorrow afternoon and it would be full swing operations from Monday to Wednesday. Seniors said be prepared to leave work 8-9pm everyday. Sigh.

Post-call today. Had a bad call last night because there was a 16-year-old girl with rectal cancer and brain mets in the ward who was in sepsis and having hallucinations last night. Throughout the night her BP was between 60/45 to 80/50 on noradrenaline and she was screaming and crying the whole night because she was seeing a ghost at the window. She even asked me to ask the ghost to leave, to which I obliged.

She even asked me half-way during one of her freaking-out episodes, in a very weird and calm voice, whether I was a Muslim. I just answered "no" and that I was a Christian, and she started screaming and kept pointing frantically at the glass window that showed a panoramic view of the brightly-lit street of Jalan Penanmpang. No ugly ghost.

The nurses were very annoyed with her, and I think they secretly gave her midazolam without letting the doctors knowing about it.

The surgeon on call came around 11pm last night to check on her, and discussed with the girl's sister about her poor prognosis and the final decision at the end of the discussion was not to resuscitate if she should collapse last night.

It should have been a relief for any HO on call, but seriously, how can I not feel for the 16-year-old girl. The world had given up on her.

So throughout the night I monitored her, and amazingly, her BP picked up around 3am this morning, and in fact she was quite well before I left the ward around 6am this morning to go to my regular ward to start my morning reviews.

She was throwing a tantrum because she wanted to drink Coke. She was actually not allowed orally, but I didn't see any reason why she was, so I allowed her sips of clear fluids because initially she was crying and begging for water because she felt thirsty.

She was still holding up when I enquired about her from my colleague around 1.30pm after I finished my work just now.

I would always remember little Masnini.

Another patient who kept me worrying the whole night was one lady, post-thyroidectomy with hypocalcaemia, who had all the classical symptoms and signs. Carpopedal spasm, perioral numbness, muscle twitching, etc. Luckily she slept through the night with her calcium correction infusion until I woke her up 5am this morning to take her blood for another serum calcium level.

I had a huge and hearty Indian lunch and just now an equally huge and hearty Japanese dinner. Spent more than RM50 for both meals. It's a personal tradition to treat myself after an exhausting call or a busy week. Or whenever I have the time. I actually slept the whole afternoon, and could have slept through the evening and probably until tomorrow morning, but I figured that I want to enjoy a little. That would pick my spirits up a little before tomorrow.

And I had Häagen-Dazs chocolate ice-cream. Heaven. :)

And the alone time was blissful too. It's only when I'm in this line of service that I truly appreciate my personal time more.

I just found out that government servants are not supposed to have body piercings or tattoos. Oops. It's in the agreemnet letter we signed before we accepted the post. Which I didn't actually got around reading. :) Oops.

It's hard to get over Mr. V. I still "catch" myself looking out for him in the ward. Hoping that he would notice me or make eye contact with me. I was telling a colleague who was trying to introduce me to his eligible friends that I was into Mr. V until I found out that he was married and expecting a baby.

"You backed out because he was married or because of the baby?"

Idiot!!!

I'm not such a bitch ok. :)

And he just said that I appeared in his life at the wrong time.

Yeah, that's true.

Anyways, I wasn't interested in any of his friends because they either smoke or don't like doggies, which are 2 basic things I look out for.

I think it's reasonable, kan? (In the Sabahan accent)

So I try to console myself by thinking that Mr. V probably hated doggies. I know he doesn't smoke.

Ok, it's 10. Need to drive back now. My broadband still not up yet. Telekom here in KK sucks la. 3 working days and my land line here still can't call out.

Good night!

a VERY long post

My week after returning from Kuching had been an eventful one.

I got back to work to find that I've been pulled out from Mr. V's ward back to the female ward. :( Bummer. Later I overheard that the consultant wanted to keep an eye on some new HOs coming into the department so that's why the reshuffling. I was moved to make room for the new HOs, so that's understandable but they cost me my Mr. V! :(

Then I saw the result list of the exam the other day! I was the only 1st poster to pass! Only 3 of us from about 13 HOs had clear passes! 3 had borderline passes, meaning that they had to go through a viva to pass the posting, and the rest have to resit another paper later this month.

I was delighted because I realized I made a few good decisions during my exam the other day. I couldn't manage most of the case scenarios in detail, but I gave the outline of the principle of management. I guess that's all they wanted. They didn't expect very much from us. It was even more surprising because I actually abandoned the exam 45mins earlier than my other colleagues because I just couldn't answer anything anymore. And for each question, I only wrote in 1 sheet of paper, where as my friends were scribbling in 3-4 sheets each question.

I guess they just wanted some common sense and practicability, not sheer brilliance.

But my elation was short-lived. In fact, it was the start of a series of unfortunate events for me.

That night on call started out a busy night. OT hadn't call, so I helped my colleague doing 1st Call to review the Urology patients in the male ward. The regular Urology HO just finished clerking a new admission and passed over the case to the HO oncall. He then saw me reviewing patients and asked me to help with blood-taking since the 1st Call HO was extremely busy that time. Of course I immediately agreed. I could understand very well how busy it can get in 1st Call.

30mins later, OT called. 4 pending cases. I told the 1st Call HO that I reveiwed all the Urology patients and took blood for the new admission and he was so grateful.

I was in the OT from 9pm until 1am. 1 simple acute appendicitis, 2 perforated ones, and one appendicular mass. Now I'm officially a competent retractor.

Just as I thought I could catch some sleep, the Neurosurgery MO called me to escort a patient with head injury for an urgent CT brain, because the Neuro HO oncall was busy in the ward. Of course I had to go la.

Got back to my HO room around 3.30am, and just as I was about to slip under the blanket, my phone rang again. OT stat. Ruptured ectopic pregnancy. Patient was in surgical ward because they initially thought she had ?pyelonephritis. And she's deteriorating.

That was one exciting case. As soon as they exposed her abdomen, clots of blood just popped out from her belly. I was excited but the MO doing the operation was very unsettled. But she got the bleeding controlled and her ruptured tube sutured back nicely. She survived the operation with blood and FFP transfusion.

I got back to my regular ward around 6am, only to have time for a quick shower and started reviwing my ward patients at 6.30am.

When my MO came for his rounds this morning, he asked me why I hadn't inform him of the new admission. Patient was in renal failure and I didn't inform anyone.

I was stunned. I didn't clerk any new admissions. I was in the OT the whole freaking night.

Then a few HOs from the male ward came up to the female ward just to ask how I was doing... had I heard about the mess?

What mess?

Apparently the Urology MO had blamed me for not informing anyone about the new admission. And he reported me to the Urology consultant, who went on to complaint about me to the Surgeon in charge of HOs and the Head of Department. And everyone knew about it except me.

I was shocked.

Why am I being blammed? Then I realized I took blood from that patient. I didn't even know what case he was. I just helped with blood-taking.

Then one senior HO pulled me aside and told me to watch out because the Urology MO was trying to cover his ass because he accepted the case to be admitted but he did not review the patient in the ward, so now he's trying to make me as a scapegoat by saying that I was so irresponsible to have taken the patient's blood without bothering tracing the results (even though I was in the OT the whole night) and because of that the patient in renal failure was left overnight in the ward without any specific management plan for his renal failure.

He has a reputation for that.

But why me? I had always been good to him. Everytime we were paired to be oncall, I always tried not to bother him too much with trivial things.

Damn. What injustice.

I was so upset. If I keep quiet, then it would mean that I was guilty and there's a risk of getting extended. So I decided to confront the stupid MO.

From the moment he started bombarding me through the phone, I learnt something new about him. He's just an egoistic and incompetent MO.

He just started saying that I was a lousy HO and that if I couldn't find time to trace the blood results I shouldn't have taken the blood in the first place and shit and stuff. And he even blamed the regular Urology HO for creating the mess for me. What a coward.

But I made one blunder... he was going on and on about how he was doing everything because he cared for the patients...

I remembered all the times when we were oncall he asked the patients to fuck off because they were complaining about stuff too much.

So my spinal cord reflex was to exclaim, "Come on, you don't give a damn about your patients!"

That was a mistake. He was stunned. Then he threatened me. If I was going to be like that, I had better watch out.

I was satisfied to have offended him, but when I imagine the possible consequences, I was really regretful. But the damage had been done.

So I decided in an instance to apologize and say that if it was going to make everyone happy, then I'll take the blame for whatever happens to the patient. I said sorry again and hung up.

There was no point arguing with a MO, because they are "boss" (my foot). I can't work with people I don't respect, but I have to do 2 weeks of Urology starting tomorrow. And I'm oncall with him coming Friday. Such bad luck.

In my heart I was plotting. I wasn't going to be a HO all my life. He better watch out for me. But I was very, very upset, and frustrated.

All I strive everyday when I drag my feet to the wards at 5.30am was to do everything right as much as possible, never losing focus and never slacking, and now this injustice.

I started walking to my head of department office to submit my claims form for my 2 months of oncalls, because it was the last day before the fiscal year was over for any claims to be made.

I greeted Mr. C and put my forms on the table. He said to leave it there. I looked at him, and I thought of dad. I needed to talk to dad. So I just braved myself and asked, "Mr. C, are you very busy now? Can I talk to you for a while?"

He looked up to make eye contact with me and I thought more of dad. And tears started trickling down my cheeks.

"Oh, sure. Take a sit." He was surprised to see my tears.

Then I started telling him about the whole incident, with the mess on my face because of my tears and runny nose.

He listened to me and after a minute or so after I finished with my account of the incident, he calmly outlined the situation to me, and explained what I should have done.

It's partly my fault because once we take a patient's blood, even though we might be just helping out a colleague, it comes with some degree of responsibility and obligation.

I understood.

Then he assured me that it was a small issue blown out of proportion. He said that I have to toughen up a bit. And that I would be blamed for more things in the future.

Not actually comforting words, but I guess listening to his fatherly voice and having him consoling me a little helped me a little. I asked to sit in his office for a while until I compose myself and excuse myself.

"Thank you Mr. C." Then I walked down the hall that was jam-packed with patients.

I don't know how, but I have become stronger. I'm sure I can face another insult like that.

But working has exposed me to so many kinds of people. Both good and bad. And know I know a little better.

When I'm down, I love to think of my family, especially my parents. It's just my greatest joy. Whcih brings me to my "big" news the other day when I was home but I just didn't know how to start telling.

My sis is 9 weeks pregnant.

She told me on my 2nd day home in Kuching. I was very happy for her, but I was very worried about how my parents would take the news. So for 2 days after that my sis and I were cracking our heads on how to tell my parents. The anguish of that 2 days were quite unbearable.

I felt like I was the one pregnant and had to tell my parents.

I was worried that my parents would be angry, and worse, terribly disappointed and heartbroken. This despite all those years of patience and understanding from them. Despite all that I still doubted them.

So that morning when finally my sis told my parents, I had never realized how silly I was for doubting them so much.

My parents were shocked, but they quickly accepted the situation and thought only the best for my sister.

My dad even said, "I'm going to be a very young grandpa!"

And my mum turned to Pheobe and said, "Pheobs, you're going to be an auntie soon!"

I was crying because I was so happy! And I felt silly for thinking my parents would disown my sister.

I'm so so proud of my parents.

So I truly recovered from my little incident in the ward very quickly because I kept thinking of my super family. And how much I love them all.

Even now that I'm all alone this weekend (friends off somewhere, no boyfriend, no doggies to play with, tired of shopping) I'm still so happy just thinking of my family.

And I'm very sure I can face my 2 weeks of Urology starting tomorrow with that monster of a MO without a hitch. I'll work so hard that he can't find any fault with me.

And I have to apply for leave again because my sis is getting married in January! :)