Holiday

Christmas came and quickly passed. One week at home flew by, another week to indulge as much as I can. I feel rested and overly well-fed, and enjoying increasingly everyday the joys of sleeping in. My new year resolutions in a bit.

My other half

My heart is leaping with joy! 5 FREAKING more days to flying home! Miss dad and mum, Pheobe and home. So insanely happy that I'm like a machine, running crazily all over the place during my busy calls quite in a pleasant or rather emotionless demeanor. Not my sour-face, unfriendly front I usually put up during crazy busy calls to prevent people from interrupting me. I'll be having my last call on Thursday. Yipee. *squeak* ;P The only thing, yes, the only thing is, I feel intermittent waves of strong emotions everytime I think about Mr V. Yes, Mr V again. He is unknowingly making it very hard for me to forget him. Everytime I'm angry with him or upset with him about work, and he realizes it, he would 'make it up' by talking so nicely and tenderly to me, making sure he stands near me, touching me, encouraging me, calming my sometimes short-temper outbursts, being just the sane and level-headed half. But the fact is, he is NOT my half.

Weaning period

8 more days to go before I finish with Surgery and move on. I can't wait. I just went through a hell of a weekend with 3 consecutive bad EOD calls. And I'm EODing again this weekend starting tomorrow. But it's ok because it's going to be my last. Hopefully after this I'll appreciate my "free" time more. I used to complain like nobody's business when I was too free when I was in JPL. Ungrateful kan? :)

My weaning off process if successful so far. It's only difficult when he gives me a certain look, a look on a face that I can't hate, and I can't stay pissed at for long, even when I try very hard to.

The elusive milestone

I'm the most pathetic and silly girl alive. I just had to feel all depressed when Mr. V mentioned something about his daughter. I was commenting about a mother's account about how her 11-month-old son climbed up to a stove and caused a pot of boiling water to splash all over her back. How can a 11-month-old child who can barely walk managed to climb up a height to a stove? Using his upper body strength? A 11-month-old child? Maybe children nowadays skip several milestones at a time. Anyways Mr. V immediately responded by saying, "My daughter can do that too!". He said it with a twinkle in his eyes and with such pride. I think he interpreted my reaction as he was boasting and immediately said, "Actually more like reaching out and grabbing things". He thought I thought he was just being the kiasu father or something. What he didn't know that I was so sad and hurt to the core of my being that I'll never share that joy with him.

Tragedy

Truth be told is that I closed my blog because I was not discreet enough about Mr. V in the past. Me and my big mouth. That was back then some 2 years ago, but things like this follow one a lifetime. And now that I'm working with him, it would be highly inappropriate and may create a stir. So until I'm sure that I'm thousands of miles away from him, and no longer professionally affiliated with him, or when I'm ready to come out of my shell and profess my devotion to him when I'm old and grey, only then, and then only, I'll open this silly blog of mine for everyone to read. And maybe then only I'll read it or a random sympathizer who would enjoy a tragic love story. Yes, a tragedy.

Another lifetime

I'm ashamed to admit that I'm more tormented about "leaving" Mr. V when I leave the department before Christmas. Even more so than being tormented by the dragon boss, for which I can't wait to leave as soon as possible. Yes, my hatred for that sorry old man has escalated over the weeks. So I keep telling myself, "3 more weeks, 3 more weeks... just hang in there...".

But how about Mr. V?

This, however is interjected rudely by self-pity and a very severe heartache. Self-pity because I always have this feeling that I always love a man that I can never love, so to so that I'm having bad thoughts like hoping something disastrous would happen to Mr. V's marriage or his wife, giving me a chance to be with him, because I would be a more understanding partner, much more than her. Severe heartache because he's so good to me and I can't respond. He is always asking whether I'm ok with such concern, always making body contact with me during ward rounds, not in a sexual way, just with gentleness and fierce protectiveness.

I dread that I have to go through that most horrible "weaning off" phase for the second time. I remembered that not too long ago, about 2 years, I was in the same position, so so tormented, and so so vulnerable. But I managed to pull through, so I'm hoping that I would be successful second time around.

I wish we had met in another lifetime, so we could fall in love and be together.

I wish.

Emotion check

I've decided that from this moment onwards, my blog would be for my eyes only. I always thought that I was open enough to share my life with anyone at all who would read my blog, perfect strangers, and more daring, with people I know like my family and friends. But I'm ashamed sometimes to show my weaknesses and my struggles. I feel like a failure when I cannot control my emotion, when I feel so affected by something. I guess I know I am human to have all sorts of insecurities, it is just that I am not ready to share so much.

OMG tearjerker

@ Yahoo! Video

Breakaway

Spotted the proboscis monkeys during my trip to Sukau on Sunday. It was a beautiful and picturesque river. It was the perfect breeze, the perfect chilliness, the perfect pleasant and unpleasant passing odour. It was the perfect quietness and the indeed the perfect solitude despite sharing the boat with 5 others. Spotted also the long-tail macaques and pig-tail macaques.



The 2-hour lazy-paced boat ride made me think happy thoughts and relive my happy moments in life. It rejuvenated me and helped calm my tormented and unsettled soul. My spirit soared as a white-belly eagle flew above us.


After such an exhilarating experience, it was not unsurprising that I felt so lazy to wake up and drag my 2 feet to work this morning. Oh how I am dreading work nowadays.

Bad week

I had quite a horrific week at work. My boss was in his bad mood the whole week, jumping at all of us. And my calls were terrible. Stupid referrals and patients dying on me.

My big boss refused to believe me that a trauma patient had flail chest because he could not see the flail segment. That was because patient was on positive-pressure ventilation. And because the fractures were not clearly seen on the radiographs, he said the patient did not have flail chest and asked me to change my diagnosis. And he refused to see my video captured on my handphone just because he claimed that it was not taken from an angle showing both sides of the chest symmetrically. I was so hurt with the blatant mistrust. But I didn't change my diagnosis and continued to manage him as a patient with flail chest. My colleagues saw the video and agreed with me that patient had flail chest and subsequent repeat chest radiographs showed rib fractures over my "alleged" flail segment. I'm glad I did not change my diagnosis because I know what I saw with MY OWN EYES, for goodness sake. But I just went own with my work, and I didn't show the old man the subsequent films that showed the fractures. It was enough for me to know that I was right. The worse part was that my colleagues did not stand up for me eventhough they saw the flail segment and chose to remain silent. Maybe they knew the old man's ways enough to just not be bothered with him too much.

Then there was a 72-year-old woman who was just recently discharged well from our ward after an anterior resection for colorectal cancer. She presented during my call with acute renal failure needing dialysis on the same day. She gave me a history of hematuria (blood in the urine) for one-week which lead me to a working diagnosis of urolithiasis with obstructive uropathy causing the hematuria and renal failure. So medical took over her for dialysis and she came back after a week to our surgical ward. During our grand ward round on Friday, my boss got the history of vaginal discharge with blood from the patient's daughter instead and proceeded to do a speculum examination. The patient indeed had foul-smelling vaginal discharge. He proceeded to the working diagnosis that patient had a pelvic collection causing the vaginal discharge and started scolding me for missing that history and ordered for an ultrasound scan for the patient. He gave a long lecture regarding proper history-taking. I was thinking hard how the pelvic collection became vaginal discharge and caused the renal failure. The following day, my colleague who did the ultrasound abdomen reported that he did not find any pelvic collection, but he found multiple renal stones instead! Muahahaha! The old man just glared at my colleague and proceeded to the next bed.

Then my call on Thursday was a nightmare. I was looking forward to my free weekend going into that call but the demise of a 33-year-old lady with septic shock and severe diabetic ketoacidosis will forever haunt me. She was referred to surgery for a back abscess and during admission her blood sugar was sky high and her vitals showed that she was septic. For some reason that was missed during her admission and she was left acidotic for 12hours and finally she deteriorated needing intubation. She was ventilated in the ward during my call, so my colleague passed over her case to me. She was so ill that she asystoled several hours post-intubation. I resuscitated her and did CPR for a record 1hr, but I could not save her. Her 5 young children were wailing and crying outside the curtain while we were resuscitating her. And when I finally gave up on her heart, I squatted at her bedside where her lifeless body laid, angry at the inadequate care she received, angry that I could not save her and frustrated because I did not know how to tell her husband and 5 children outside the curtain. I composed myself and pulled open the curtain slowly and looked for the husband. When we made eye contact, he just knew, and he broke down.

After that incident, I was so shaken that I could not sleep and I had several bouts of breathlessness. The following post-call working day, I felt numb and I couldn't keep my food down. And I had the worst headache in my life. And when I related the incident to my only confidant of a colleague, I was close to tears but I just had to hold it back and move on, because I had other patients depending on me. Luckily my parents called me that evening and just hearing their voices made me feel better. I went home that evening, took a quick shower and collapsed on the bed. Now the headache is gone, but the heartache is still palpable.

Smile

I noticed that I've not been smiling. It's easier to not smile actually. And I know that I have a stern face. So I have been wearing surgical mask in the ward. It's my way to have a little privacy when my life (which is my work) revolves around people; patients and their irritating relatives.

But tomorrow I want to smile and evoke that pleasant feeling that we all have inside, so that I'll enjoy my work more. Wish me luck.

Child's play

This 40yo man suffered a heart attack and was treated with streptokinase. 2 hours after the treatment, he was referred to me in the middle of the night with sudden drop of GCS. Urgent CT brain showed a massive left intraventricular bleed. OMG poor guy. The heart attack would have killed him but the treatment killed him instead. Intracranial bleed is a known side effect of streptokinase. No surgery could be done for him because of the streptokinase which was a huge risk of bleeding intraoperatively and because of the recent cardiac event. Basically he was sentenced to death. He asystoled twice and revived and hung on until the following day, when he expired in the ICU.

I'm counting down to my holiday 20 DECEMBER 2008. I'm just so tired of the continuous work and stressors at the moment. I'm now looking forward to my transfer to the Casualty Department in January 2009. After a lot of soul-searching, I've decided that I want to make the move and get on with my life. I've done the old-fashion tabulation of "pros" and "cons" of moving to the Casualty Department.

Cons
1) I'll miss ward work terribly, something that I'm actually quite good at
2) I'll definitely miss being oncall and attending to emergency surgical cases
3) I'll miss Mr. V and my colleagues whom I've grown fond of
4) I have to work shifts in Casualty department :( I prefer office hours and fixed oncalls

Pros
1) I'll get to do more postmortems!
2) It's been my intention from the start to get emergency department experience for my "back-up" future plan if my forensic aspiration doesn't work out
3) No more pesky relatives to deal with! (This is the bit I hate the most working in the wards)
4) I'll be able to take leave before CNY 2009 for a trip to Hong Kong with my housemate!
5) No need to work under Dragon King anymore haha and with my collegues who have blind loyalty (I love them but...)

So with my child's play tabulation of "pros" and "cons", I've decided my future for the next 6 months at least. :) I'm happy, so now I'll officially stop my stress-induced binging spree for the past 3 days with my low-fat marble chess cake from 7-Heaven. Yummy.

My first real-time flail chest. Coolness. Not cool for the poor man, I know.

My first blog award

Thank you for this award, jojo of mojo. My first ever blog award of any kind. It's very cute. :) Good thing that you liked my photos, my source of entertainment during my long hours at work.

And now to perpetuate the spirit of the award:

1. Post the award on your blog.
2. Link me for giving it to you.
3. Link the originating post here.
4. Pass the award on to five more deserving people.
5. Post these rules for your recipients.

I would love award this to:

• BREN
• jemima
• nemesis-on-fire
• phatelara
• karen eva

Baby eats coin

One of the lighter moments of my work in the surgical outpatient. A 1-year-old boy who swallowed a coin. Child is bright and active. Our scopes are out of commision at the moment, so my boss said to wait it out. "He won't die" he said briefly after just glancing at the film. "If we have our scopes, we could attempt to take it out." The baby was laughing and flapping his hands. Oh well.

Every bipolar

I'm feeling down today. Must be that phase of my bipolarity. Or maybe because I'm oncall, but I love to work. Maybe because I'm disappointed with the people around me, but I've known better like since forever. Maybe because I'm lonely, but I've been lonelier. Maybe because I'm cutting down on my caffeine, but I don't have other withdrawal symptoms. No, no, it must be that phase of my bipolarity.

Telupid 2nd time around

The medical camp at Telupid this time around was well-organized and very efficient. We saw about 500 patients on the first day but didn't feel the load at all. The second session the following morning was a slower day, only about 150 patients. The medical team consisted of a pediatrician, ENT surgeon, opthalmologist, dermatologist, gynecologist and 5 GPs and medical officers. So the screening part was pretty easy. Ear complaint, ENT referral. Some menstrual complaints, gyne referral. Sexually active ladies, PAP smear and breast exams. I received referrals as well (haha!) just because I was the sole representative of the general hospital in Sandakan, the nearest referral hospital to Telupid, especially all the surgical cases! All I did was provide them with our clinic timing and op days, and usual elective op waiting time. :) I even had to reduce a 3rd degree hemorrhoid of an 81yo man on a dirty mattress on the floor. Luckily I stashed a few pairs of gloves from the hospital before the camp. :) Overall, I felt the vilagers in Telupid were healthy and way, way better off than villagers in Pensiangan and Paitan. Most of the ladies have yearly PAP smears, many men on regular follow-up for hypertension at the nearest clinic. I seriously did not see a single case of scabies during this camp, only a few by my colleagues. BIG suprise. When I was in Paitan, almost all the children had scabies.

A limb for a fish

This man who can't speak Malay, English or anything local Sabahan but claimed he was a Bajau (a local ethnic group here in Sabah) came to the casualty with his right leg missing. "Sorry ma'am, no English" he said in a very thick Tagalog accent. Duh. Anyways, he claimed (2nd hand story from the paramedics who grilled him about the event that cost him his leg) that 3 barrels of oil exploded below his house when a neighbour's children were playing with fire nearby. He and his friend were near the house when the explosion occured. He lost his leg and his friend had a very big laceration wound also on his leg with shrapnels embedded in his flesh. No one else was apparently injured in the "explosion"). STUPID LIE. How can he only suffer a missing leg with no other injuries on his body and his friend too a local wound on his leg with such a huge explosion? I think they were "fishing" with dynamites. Whatever. "Mana kaki kau?" I asked. I heard a paramedic across the resuscitation hall mumbled, "Sudah dimakan ikan".


I'm going for a medical camp in Telupid this weekend! I'm so excited. I need to break this continuous work mode and get out. I usually don't enjoy meeting new people that much, especially when I have to meet people in my field outside working hours. It's intrusive of my personal time. But I'm so impressed by the commitment of the organizing leader of this very massive outreach programme that I'm actually very eager to meet this very old and wise surgeon again. He was also the organizing chairman for another camp 2 years back which I had the priviledge to be a part of. Will be leaving Sandakan 5am on Saturday and back late Sunday evening. Because I'm actually traveling from Sandakan, I only have to spend one night at the camp site. The main group will be traveling from KK, starting their journey around 3pm on Friday, so they have to stay an extra night before the actual programme in Telupid.


Thinking back about the whole MOs and department placement thingy, it's funny that the whole situation is complicated only by the MOs. As MOs, our job is to serve and interest 2nd priority. Another MO who wants my place in the surgical department was trying to "psycho" me yesterday. She was asking whether I really wanted to pursue surgery, and that she would have a big pair of shoes to fill when we swap department in January, how I've become my surgeon's pet, how all the staff in the ward loves to be oncall with me because despite how busy the calls get, I'm the most calm and collected, and I never get crossed with the nurses, how thorough my reviews are, etc. I know she wants to pursue surgery, I know that and that's the main reason why I'm not going to protest this swap that the hospital director decided. I would feel very guilty if I consciously prevent another colleague from being in the field he or she wants to pursue. I would sacrifice that eventhough I really want to stay put for many reasons, just because I know she wants to do surgery and I don't.


"Do you want to leave?" my specialist asked me during a hemicolectomy after I told him the news. "I don't know really what I want to do, so I can't say whether I want or not want to leave." I didn't want to say "yes" outright because I wanted to stay but I know I shouldn't. And I didn't want to say "no" outright because I felt that if I did, he would intervene on my behalf, which I didn't want. So I'm going to just leave everything to fate, OMG, and see where I'll be in 2 months time. Wherever that it, I'll go on. I'll be alright. I just pray that I'll be happy and useful and learning.

Wishful thinking

Having a complicated mind is difficult enough. Couple that with an unsettled heart and an antagonistic gut feeling. Blend that together and what do one get? Bouts of depression, fear, uncertainty and heartache.

I tell you wishful thinking is a powerful thing.

I wasn't feeling very happy for the past couple of weeks because of the fatigue and continuous work. I was also being hypersensitive, subconsciously rebelious just because, and generally bitchy just because.

So last night I couldn't sleep and was thinking very intently of changing certain aspects of my current situation, the most drastic was changing department. Just thinking very intently. Didn't make any solid plans.

Then this morning, around 8am, doing my daily ward round with the team, the hospital director just dropped a bombshell on me. She said I would be transfered to the Casualty Department in January!

I must have looked a shade paler or something because my colleague C, quickly patted me on my back and consoled me with what he must assumed was a bad news.

I was shocked because I wished it and it happened!

All that is amazing but the problem now is that I'm very sad that I have to leave the department. My complicated mind tells me that it's the right thing to do to move on, to pursue what I want to do, to give other MOs a chance to be in the department they want, and to be rid of one of stressors in my life at the moment. But my unsettled heart is trying to keep me in the department. I've come to be comfortable with the people and work, and despite the battery, I've learnt to enjoy the experience.

My gut instinct wants me to plunge. To take risks.

I don't know what I want. It's my own fault for my dilemma now.

Uterus, oncall and stupid people fighting over ciggies

It is days like today that I hate having a uterus. I'm oncall again and I'm bleeding torrentially. Good thing I'm not having bad cramps just on and off colicky discomfort. Luckily weather has been cool with light showers for the past 2 weeks. That makes my general demeanor borderline pleasant.

After my wonderful pair of Clarks was stolen from the hospital operation theatre changing room, my brown Hush Puppies pair has finally broken down on me. 2 nights ago during my call, a very busy one, halfway running between the 3rd and 5th floor attending to 2 trauma patients, my Hush Puppies sandals literally fell apart simultaneously. As the cases were emergencies and no time to attend to my shoes, I just grabbed a strip of the broadest elastoplast and tapped my battered sandals together and continued running furiously to prepare an assaulted thallasemic with hypersplenism suspected of intraabdominal bleed for an emergency laparatomy. Turned out the spleen was lacerated. Spleen removed. 2+1. Then on the 5th floor, a 16yo girl who was hit by a 3-tonne lorry I suspected internal bleeding as well because of the bruising on her abdomen. Bedside scan nothing. Proceeded with urgent CT, nothing. Lucky girl.

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My entry was interrupted by a referral. A 24yo man assaulted with a parang over his head. A HUGE, DEEP laceration wound with active bleeders. It is so messed up I can't find the bleeder in casualty and had to just pack it up. He's now waiting for OT call for a proper inspection and toilet and suturing in OT under general anesthesia. His Hb dropped from 11.8 to 7.3 in a couple of hours. And guess what the altercation was about... CIGARETTES! Yes fucking ciggies. I told you people here are stupid. He's illegal immigrant by the way. This is the thing here everyday. All these illegals fighting messing each other up and coming to the hospital using up our resources. Sigh. I just do my job as a health care provider, but personally, I'm very pissed off with their recklessness.

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Post-publish:

Intra-op of the idiot who got slashed by a parang over an argument about ciggies. A 5mm layer of his skull was incised with his scalp. My first.