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