The tumour that gave me peace

I purposely volunteered to assist in an anterior resection in OT today, eventhough I knew it would take HOURS (actually it took about 7 hours) just to escape the ward for a while after quite a horrific call. I was so sleepy and tired retracting the obese abdomen of a 70+ lady with a low rectal tumour (see picture above). Just wanted to be rid of the ward for a couple of hours. I only had about 2 hours of interrupted sleep last night. On my feet from 7am to 8pm, then had a quick shower and dinner then it was non-stop again. Upper gastrointestinal hemorrhage, followed by a 81yo man with a painful and throbbing abdominal artery aneurysm, followed by a cerebral concussion at 1am, followed by an obstructed hernia at 3am, then just when I thought I could rest finally at 4am, another referral from Casualty for a man who fell from height of 10 feet with cerebral concussion at 5am. The man said he fell because he saw a "benda halus". Ghost la. So what? Still have to watch your steps. By the time I was done, it was the next working day, and I had to start my morning rounds at 7am. So can you blame me for trying to escape the ward? It's quite nice the little peace and quiet.

Ranting

My enthusiasm just died off this morning when I had admission after admission non-stop. On top of a stupid ward round. Felt like a houseman again. Doing brainless work. Hardly any quality control. The worse bit is that I worry that I might miss some things that can be catastrophic. And I can feel my temper getting, literally, shorter and shorter. I was disturbed that my specialist asked me to get an 'urgent' CT brain today for a patient who's been the ward for 4 months just because he wanted to make further plans for him tomorrow. It's not urgent at all. That patient had been DNRed in the past before, and is the chief of the 'vegetable patch' in the ward. How inconsiderate for me actually, all alone during a public holiday call with all these extra seriously non-urgent things. And it would put me on the radiologist black list. needless to say I didn't manage to get around it because after that I had admissions after admissions. Ran around like a headless chicken. And have to still keep my cool with patients' family members who would come and ask me the same questions batch after batch just because they couldn't coordinate and select one spokesperson to get the latest development. They couldn't be bothered, it's easier to bug the poor doctor because she's NOT busy.

Ouch

Ouch, but sorry I don't feel sorry for this guy at all. Driver of a vehicle in an accident that killed one and injured several others. His left leg was amputated the following morning. Sorry but I don't feel sorry for him. He can still drive with his right foot. Damn.

My breast cancer talk went ok today. Glad it's over. Now I can go back to routine. I'm oncall tomorrow which happens to be Deepavali, a public holiday here in Sabah. Strangely feeling happy.

Continuation of the story about the policeman with pancreatitis (pls refer last entry)

I'm back. I had to drop everything yesterday because I forgot I had a facial appointment until my handphone alarm rang 15mins before the time. Phew I reached there on time. Because I have an OCD with punctuality. Next time I'll put the alarm 1 hour earlier. The 15mins was the default setting of the phone.

Anyways, so I told the patient and his wife that I would speak to the boss regarding their transfer request and explored why they couldn't wait for a few more days. The patient himself said that he wanted to be with his family. The wife said that she wanted her husband to be under "specialist" care.

OMG. How ignorant. My boss is the most super senior consultant in Sabah, who scanned the SOB patient. How insulting. I imagine if he's in the hospital in KK, he would probably not get as better care there compared to Sandakan. He would have had a hard time getting an ICU bed, let alone 4days observation in the ICU! And I doubt the consultant there would have scanned him personally.

But of course I didn't say all that. I graciously explained to them that they are receiving the best care for his condition under two, not one specialist, and assure them that if they were in KK, it would have been the same.

Shit I'm the mediator now. I have to accomodate the patient and his wife's request for transfer that morning (it was already 9.30am, and I have to go to OT) and I was battling with myself whether to tell my boss what the patient's wife told me.

So I stupidly just told my boss that patient insisted on transfering that morning itself and would leave irregardless whether we let them or not (without telling him what the wife has told me) and that he was still running a high temperature. He said unfortunately we were understaffed that week and couldn't spare the escorting doctor and nurse for a transfer that morning itself, so if they insisted, then they have to be discharged at their own risk (AOR).

When I got back to the patient, he was flanked by his wife and relatives, and 3 uniform with lots of bling on their shoulders. Wow. Not. They were ready to leave. So I communicated what my boss had said and patient was AOR discharged.

THE PROBLEM IS NOW... 2 weeks later, they made a complain against us. And though I was not named in the complain, I have to make the most explaining because I AOR discharged him. And my boss was unhappy because he said my documentation of the whole incident was inadequate.

I agree.

How would I know that the patient would lodge a complain? I really can't spare the time documentating EVERY single conversation. So now it's their words against ours.

And now my other colleagues who took care of him in the ICU are telling me that he actually requested to be transfered many days earlier, even while he was in the ICU, which was not made known to me by my colleagues, nor the patient. So now I feel that I'm getting all the blame just because he was transfered out to my ward that morning. Sucky.

Anyways. the matter is not resolved yet.

"People".

Real life

I am so tired this week. The preparation for my breast cancer awareness public forum tomorrow has been quite stressful. I resented it even up to this morning when I had to wake up early and drive over to the hospital for a rehearsal with my boss. For me, the public forum would be just a simple educational thing, something fun and something out of my very mundane and routine life in Sandakan. I was hoping that I would feel the rush of standing in front of a crowd but talking about something that I see everyday in my work, which would not be a very big deal. But for my boss, who's a dinosaur super consultant, I have a very important work, I'm the ambassador for the hospital, I'm the learned one, the one with the most influential role, which are all true. The week-long process was eye-opening. I'm glad however I finally see the wisdom of the whole process even before the actual event. But I can't give credit all to myself for the perspicacious moment of realization. It's hugely because of the constant reassurance and sharing of opinion by my 2 colleagues, C and J, that helped me through this week.

Another dose of reality this week. 2 weeks ago, there was a police officer who was admitted to my ward for acute severe pancreatitis, but on the same day of admission he was transfered to the ICU, where he was observed for 4 days. Once he was transfered out to the general ward (my ward), the problem began. He was still having a temperature and on IV antibiotic, but physically he was getting better. The morning he was transfered out, he requested to be transfered to KK Hospital (which required flying with doctor's escort) the next day so that he could be with his family. Because of the resources involved, the non-urgent nature of his condition and for the reason that he was improving, we couldn't accomodate him, and convinced him that if he waited it out for a few more days, he could be discharged well and travel back to KK on his own. The patient agreed. But later that day, when I was busy in the morning general clinic which stretched to afternoon FNAC clinic, I was called several times in the clinic, which interrupted my work, from the ward sister that patient requested to be transfered anyways, after all the explaining on my part. So I asked the sister to inform the patient that I'll see what I can do the following morning. I couldn't just drop everything in the clinic and run back to the ward to settle this "non-urgent" thing. There were so many patients waiting. *sigh* The following morning, I spoke to the patient again. This time his wife was with him. He was still running a temperature. This time, patient was silent and his domineering wife took over the "negotiation". She insisted her husband to be transfered that morning. They were leaving irregardless we let them or not.

To be continued...

Not fair

OMG. Just came out of OT. Assisted in a laparatomy and splenectomy. A stupid guy got into a high-velocity car vs. car head on collision this evening, resulting in polytrauma. He was driver of the vehicle. Maybe drinking. Spleen laceration, maxillary fracture, left hip dislocation, left tibia open fracture with near amputation of the left foot and a right closed femur fracture. And survived to drive recklessly again for another day. Life is NOt fair.

"People"

What happened today didn’t help with my natural “resentment” for people. I know, I know. How can I be a doctor and not like people? The fact is, I can. I have the ability to separate my sentiments from my professionalism in my job. I am sure many in my field are the same too.
My old pair of shoes were stolen from the so-called “secure” changing room of the operation theatre in the hospital. The changing room had a security code locking system only accessible to the doctors and medical staff. I have no doubt that it was stolen by a hospital staff.
I just feel very frustrated because after working so hard for “people” to the point of self-neglect, this is what I get. I know it’s a little silly to generalize the whole incident, but I’m only human, and I have every right to be prejudice.
I called the OT sister and even the hospital director just to let them know that their staff were thieves. I was not surprised to be informed that I was not the 1st victim. They promised an investigation, but seriously, I’m not hopeful.
The fuss I’m making is not about that old pair of shoes obviously, but really about “people”.

That wonderful few seconds of anoxia

That’s why I love an evening swim. I slept so well last night after a brief swim immediately after work around 7pm. Dreamless, no dry airconditioner on, in my birthday suit … and I woke up feeling perky and motivated to make ammends for my lascklustre day yesterday. The other thing is that my muscles feel more relaxed and supple, and there’s a calmness in my general demeanor and mannerism. Another swim this evening, here I come.

Cutting Department

My progress is rather slow in the surgical department. I’m into my 4th month and I’ve not done a single appendectomy. I’ve assisted in a few but just have not done any yet. I’m getting this feeling that I’m not learning the proper techniques from my colleagues who have their own individual “styles” that didn’t seem so fluid or clean to me. Haha. So I’m not feeling confident just yet. But I vow that by the end of this year, I would have perform my first full unassisted appendectomy. Tomorrow is elective surgery day, and there’s a man scheduled for excision of lipomatosis. So I’ve sort of “booked” him. Hopefully I’ll be able to finish my ward work in time for the case.
I’m supposed to give a public talk on breast cancer awareness this coming weekend. I was initially quite excited and pumped for the event until today when I showed my slides to my boss. I realized just how not nurturing he was. And he subconsciously enjoys being antagonistic and illogically critical towards everything. I’ve noticed this trait of his for quite a while in his interaction with my colleagues, but today I get to experience it myself. Oh well, wet blanket, whatever. Now I have a chore this weekend. Just want to get it over with. Remind me in the future not to agree for any more public health talks. It’s too stressful to prepare and just not worth the anguish, because it’s never ever going to be good enough for my boss. I just hope the public would learn a little something though.

I spent my postcall Saturday morning writing this email to the Pos Malaysia Customer Service Centre to complain about my most frustrating experience with Pos Laju (SANDAKAN BRANCH), in diarrhea mode:

To the Management,

I am infuriated with Pos Laju (Sandakan Branch) who have systematically mishandled my mail and insulted me:

1. My mail (EN 140461768 MY) was sent from Kuching on 14 OCTOBER 2008, and apparently arrived in Sandakan Pos Laju Branch the following day, 15 OCTOBER 2008. But for some reason, my mail was marked "Tidak dikenali 15/10" and chucked in the office until today, 18 OCTOBER 2008 when I personally had to go to the branch to trace my mail. No attempts on the Sandakan Branch to contact me or the sender despite our active mobile numbers PRINTED clearly on the envelope.


2. Out of desperation not knowing the fate of my mail, I located the Sandakan Pos Office number on the Pos Malaysia website (089-201501) and called to get help around 10.45AM on Saturday 18 OCTOBER 2008. From there, I was directed to 3 different numbers in succession. When I could not get the help I needed (I could hear the staff's voice who was suppose to be handling my pos laju mail asking her colleague to direct me to her line but she did not pick up the phone when I called), I called 089-201501 again only to be cut short and dismissed rudely. Subsequent attempts were futile because no one was picking up the phone. (Later when I was at the Branch, the staff were having a hari raya "makan-makan" in the office)


3. So I resorted to calling the Customer Service Centre, who promptly located and confirmed that my mail was already in Sandakan Branch since 15 OCTOBER 2008.


4. With that information, I made my way to the office, only again to be "entertained" by another imbecile:

• When I said I was there to trace my mail he asked very rudely, "Kamu dapat call kah?", and when I said "No", he was so quick to answer back "Jadi?", giving me the impression that he was irritated that I was there to trace my mail when they have not called.


• "Besarkah parcel kamu?" "Bila hantar?" "Kamu beri address betulkah?" Asking me all these stupid questions before cross checking my mail referrence no.He did not bother to write down my mail reference no. when I gave it to him, asking me to repeat it again when he apparently forgot.


• He dismised my IC when I attempted to pass it to him for positive identification. But he asked me to repeat my address multiple times (apparently for positive identification when he found my mail), which I found very insulting. Anyone can recite an address, but he dismissed my IC. STUPID.


• Fortunately he realized the mistake on the branch side when I showed him a Pos Ekspres envelope with the exact address use for my mentioned pos laju mail. But unfortunately for him and his stupidity, he did not acknowledge the mistake and apologize to me. Instead, he started questioning the staff around him and trying to figure out the name of the postman on duty on the day of delivery. Like I care. Because of his unprofesionalism, hence this very lengthy complaint.

My issues:

1. Mishandling of my mail
2. Unprofessional and below average intelligent staff handling my mail and my enquiry to tracing my mail

I demand a letter of apology from Pos Laju Sandakan Branch in a week's time, as promised by the Customer Service Centre, or else I will pursue my complaint and take necessary litigation measures. I am very frustrated because we pay for your lousy service. Be assured that after this is settled, if ever, I will never personally use your service again and I will advise family and friends the same. That I can personally assure will materialize.

NO THANK YOU FOR YOUR LOUSY SERVICE.

Sharon Chin

18 OCTOBER 2008.

Emotional Infidelity

How can I not feel like he is my soulmate? My kindred spirit? For more than a year I went on with life cold turkey without him. Out of sight, and out of touch. Torture. The worst kind. But I was so strong and so successful. But fate diabolically brought us together again and my sanity is tested and battered over and over again. The closeness that I feel with him, and the vulnerability that I want to plunge into whenever I’m with him. How he talks about his life, his family, his wife… how he shares his feelings with me. It just makes me melt inside and want to open up and share my feelings too and hug him. It makes me happy and euphoric. But I can’t, and I won’t because he is married. But everytime I’m alone at home thinking about him at his home with his wife and family, I feel guilty and sinful because of our emotional connection. It is emotional infidelity?

A time of change

That starts with a bang. Literally. Hehe. I got myself a fringe, to battle the balding spot at my parting.

Then I've made a another big decision. I've decided to stay put in the surgical department. Why? Many reasons, but suffice to say that it's better for my learning experience, as a doctor in general, and as a transition before I decide what I really want to pursue. I really feel bad for the staff in the casualty who had prematurely extended their welcome to me the last couple of weeks. Haha.

Then my housemate and I have started the ball rolling on our backpacking trip to Europe next year! Well, actually just Benelux-France for our first. She's also planning a Hong Kong-Macau trip but that's KIV for me because of my work situation. It's a little difficult to apply for leave for me. So I am now 5K poorer because of the flight tickets which we purchased online this morning. But both of us are so excited!

And I'm planning a trip home to Kuching for Christmas! Excited to see my "new" house after the little renovation my parents did the past couple of weeks.

So whenever I'm feeling blue or down or when my left toe hurts, I just shift my thoughts and focus on my plans and all that I have to thank God for. Abundant.