The jittery senior

Post call today, had a real bad night.

Got a decompressive craniectomy at 0130H and case dragged on all the way till 0600H. It was an alleged MVA with sustained massive extradural & subdural frontal-temporal-parietal bleed with midline shift which required urgent decompression. Initially pt was hemodynamically unstable, showed signs of early coning but luckily, managed to control his BP with inotropes and titrating sevoflurane. MAC was only kept at around 0.5-0.6 as he was really sensitive to the agent.

Surgeon repetitively asked for blood transfusion as there was some bleeding when she was doing the craniectomy. ABG done intraoperative shows that HB-15g/dl !! Reassured her that pt is ok and had finally insist that I”m not transfusing as the HB levels are more than adequate. Don’t really understand why surgeons always wanan transfuse the moment patient starts bleeding, even when it’s a little? There are always other choices of fluids before opting for blood transfusion, no I’m not denying the role of blood transfusion when necessary but, again when it’s necessary according to the patient’s response, but not according to the surgeon’s need.

Postcall passover was the best, with the oncall person interogating & probing me as if I was a first poster. Again, from surgical team, a patient with chronic AF on warfarin was posted for laparoscopic end sigmoid colostomy. INR was 1.96 when posted, according to the intern who posted, it was actually 5.x when pt was admitted and after several FFP transfusions they manage to bring it down. And they actually had another 4 units of FFP to be brought into OT for transfusion. Case was postponed for some reasons and they specifically requested the case to be done 2 days later, so well strictly speaking the jittery person whom I passed over to don’t even have to do that case.

She asked whether patient was referred to medical team, whether surgical bridged the pt with clexane which I really don’t know. I agree it’s important but it doesn’t change my anesthetic plans after all, so I didn’t ask. She could always asked the primary team if she wants to know but not probing me like a junior intern. I don’t care if u’re OCD but that doesn’t mean you can probe me that way. Different ppl has different style, and don’t expect me to do things the way you do. Respect ppl the way you want to be respected. Ask nicely if you want to know. Don’t let it out on ppl just because u’re scared to do such cases, it’s irritating, and please don’t get so jittery when things doesn’t go the way u want, just chill and get things done! And I wonder why ppl even group you as a senior..

Sleep DR- anesthestist

It has been really long since I last blogged, in fact it was more than a year ago. Decided to start blogging again as I’ve embarked on a new journey in my career and I figured out this blog would really be helpful in venting out frustrations along the way and maybe, just maybe as tips for my juniors in the future.

I have chosen anesthesia as my specialty training since I completed my 2 years internship in 2012. This year I applied for the anesthesia residency offered by one of the local university in Malaysia and was accepted into the programme. Thank God for the blessings! Before I was accepted into the programme, I sat for the MCAI ( membership of college of anesthesia Ireland ) MCQ exam and by God’s grace I passed the exam as well. Will be going for the part 2 osce/soe exam this coming october. 

 And as I’ve entered residency, I had to transfer to s bigger hospital as my previous hospital was only a district hospital so it’s inadequate for training. So finally I’m back at the state hospital which is really near my house and which I have anticipated all these years but all the excitement died off almost instantly when I started working there. Ppl tend to look down on others coming from a smaller hospital, passing relatively nasty comments along the way and even dictating me what to do and what not to do. Mind you they are just supporting staffs but not specialists but well i guess this is part & parcel when we shift to a new working enviroment. Of course they are some really nice individuals that I met along the way.

 Most ppl will ask this by now, why anesthesia? Ain’t it boring, putting ppl to sleep then charting vitals every few minutes? And some ppl even have the impression that anesthetist are the laziest doctors, as they’ll be with their sudokus, phones whatever you name it. Truth is an anesthetist do much more than just putting a patient to sleep. Once someone is under anesthesia, the general well being of that patient will be under the care of an anesthetist, which includes titrating doses of anesthetic agents, adjusting settings of the ventilator used, giving adequate pain killers along the way. Don’t think that you won’t feel any pain just because u’re unconscious. An anesthetist is also usually in charge of providing intensive care in the ICU, so now who’s the lazy dr? My reason of choosing anesthesia? It used to be because of the post call day off that I get and also able to work in a air-conditioned area most of the time, im kinda heat intolerant. But after getting to know anesthesia, I love how the way I can help allevate pain, the way intensive care helps critically ill patients to slowly recover and getting back to their daily lives. 
 One of the days I’ll write about what I love most, regional anesthesia. Till then.

Goodbye 2013, Hello 2014

It has really been quite a while since I last wrote, in fact I had to reset my wordpress password to log in again. That shows how long I haven’t been around.

Overall 2013 is a good year, got engaged to a wonderful woman, and work wise, gained much more experience I ever could with a new boss that got transfered in after her promotion.

It’s gonna be a short one as I would need some time to recharge my writing juice, so cheers to a better 2014!

Fruitful 2012

Hello all! It has really been a long time, last blogged in early march this year. Last day of the year, as per my own tradition in the past of coming up with a whole list of new year resolutions. Instead of stating new year resolutions, I would rather find out what have I achieved in 2012. Let’s start shall we?

1. Finished HOship, or rather internship. 2 years of ups & downs, torturing from crazy bosses, during the journey, got to know some really nice colleagues, worked as a team and work was done really fast. Joinned anaesthesia as a medical officer and decided that this would be my path. Love & enjoy what I do everyday now, bosses are great, can’t ask for more at work.

2. Managed to kick off some bad habits, became a better & healthier person

3. Proposed to Miss and she said YES! Now having headache picking dates for our ROM, nah I’m not complaining. What else can I ask for when the love of my life agrees to marry me?

4. Got a few more gadgets, got my first car, not a BMW or Benz, but it’s safer to travel around with, and I don’t have to worry about the car shaking when speeding =P

That’s about it I guess, looking back there is only 4 but heck, better than none right?

2 main things I wanna do in the coming year. Lose weight! Haha yeah finally this is on my new year resolution list, and start studying and apply for anaesthesia post graduate programme end of the year, despite chances of getting it is low due to my experience, but no harm trying.

Here’s to a great 2012, I’ve learnt a lot and will be a wiser, healthier and better person in the coming 2013.

Wishing everyone a good year ahead. Till then!

Hiatus

Decided to come back from the long hiatus I took from blogging. Actually I can’t remember when I last blogged.

Am off today, so I have some extra time to spare. In my 5th posting now, another few more months to go before completing housemanship. The ministry has changed our working system into shift system, which has been debated again & again in major newspaper, in daily conversations between consultants, specialists and medical officers.

My opinion? Just like everything else, it has it’s own pros & cons. Of course one will learn less. Comparing how I worked in my medical posting and juniors in medical posting, it’s a world difference. There was only once I went back at 5pm, which was my last day in that department. Now those working day shift will be getting ready to go back once it reaches 4.45pm. When asked about certain patients, their answers will be like nurses, ermm I’m not sure because I’m night shift/day shift. It’s disheartening to hear such answers from people who are doctors. Well I wouldn’t elaborate much on that, as I guessed most of you would have read that from the papers. As a houseman myself of course in some ways I do support the system. What I like most is the post call off. According to the rules, one go back the next morning about 8am after passing over whatever stuff that needed to be passed on, but as usual, in reality that wouldn’t happen.So, for my hospital, I usually get to go back latest by noon, compared to my earlier horsemanship days, this is just a blessing for my exhausted mind & body, what more can I ask for?

For my fellow housemans who just started working, please don’t complain so much, all of us went through the same shit stress you are going through now, and the shit we ate stress level we had during the earlier days was much worse than today I believe. And we don’t have post call off, and now 2 HK ( hari kelepasan )  per week to start off with. It’s just 2 years, bite hard and it’ll be over in no time, and learn as much as you can, because after 2 years, the person deciding will be you.

I love my job now, in a department where I put people to sleep everyday, make their pain go away and patients I see are mostly comatose or semi comatose, the feeling when I  get when they gradually recover and when their pain is relieved is just so satisfying. Always hated being on call until I came into this department, but well I still don’t like being on call but at least I love what I’m doing now =)

Will write again very soon about the previous department that I hated so much, even though I get to see new lives everyday but the emotional stress and senior colleagues I have to deal with daily are such a burden. We shall keep that for another day.

On another hand, finally I got myself a iMac, been eyeing on it for so darn long. 27″ of awesomeness makes me happy everyday =D

Till then peeps..

O&G

Finally the most dreaded awaited day has arrived. Will be entering O&G tomorrow.

I never seem to understand, why do we have to work 7 days a week with only minimal rest? What happened to the labor law that states a maximum 70 hours work per week? Or we medical interns are not even considered as humans so we’re not protected by the law? Our medical officers/specialists always say : ” we went through that during our housemanship, so all of you should go through the same thing. Don’t complain too much. ”

Why? Why should we? I understand that we need very good training to become a good doctor in the future, but when you’ve worked for more than 30 hours straight, I don’t think anyone normal can learn anything at all.

It’s just a rant, letters has been written, complains made but nothing has been done. Everyone just pass down to their junior, bite hard and suffer for 2 years and you’re done with it. Fact is, nobody bothers about changing things at all, we malaysians are just too comfortable with the current system. Hopefully with the implementation of the new shift system, there will be some changes, but wait a minute, I doubt so. Most specialists will modify the system to their own liking and at the end of the day, at the expense of their slaves interns. Who doesn’t want free cheap labor?

Goodbye to another 4 months of my life. Till then..

Krabi

Ever since AirAsia’s business started blooming, lots of people are traveling very frequently. I took chance of this and visited Krabi, a small province in southern thailand which I’ve wanted to go for a long time after receiving some pics in a forward mail a few years back.

Went there with the miss, as a short getaway for both of us and also to celebrate my birthday together. I was expecting more from the island, as I wanted a total getaway but instead we were greeted with tonnes of tourists even on a off peak season, can’t imagine the crowd there during the peak season.

Landed in Krabi international airport in the afternoon around 2 plus, hotel representative was already waiting for us at the arrival hall after we cleared immigration. We were ushered off to the hotel, took about 40 mins to reach. Checked in, took a short rest and went walking around. Had some below par seafood for dinner at a beachside restaurant, was a bit to the pricey side, well you pay for the enviroment. We went island hopping which includes the famous Koh Phi Phi island on the 2nd day, did some snokerling, had some good time walking by the beach and when we reached the hotel around 4pm we were simply too dehydrated and tired to do anything else. Had dinner, and dozed off by 10pm. Day 3, we went for hot stream bath, elephant ride + jungle trekking and a short visit to the tiger temple. We read that if you manage to climb the 1297 steps up, you’ll be well rewarded with a magnificent scenery overlooking the whole island. Well I tried but not even 100 steps before giving up, miss tried about 200+ steps, we were simply too exhausted as that was our last stop of the day. As for our last day, we slept for a little longer, enjoyed our breakfast, did some packing and left for the airport. Didn’t get any souvenirs as both of us were just too lazy to go out again to shop. Don’t get me wrong, I did enjoy the trip, the sun, beach and sea water. It was real good to have a rest without getting any calls from the hospital staff. =)

All 3 pics above taken during island hopping on Day 2

1297 steps to the top ( it’s not as easy as u think )Taken by the miss @ about step 200++, that building is still under construction

 Sorry for the poor quality pics, all taken using iPhone, as I was too lazy to take with my cam thinking of the post processing work, but I still have a few good shots, will save it for another day. My seniors used to tell me working life is very different and most of the time it sucks, I choose not to believe them in the past, but now I’m with them 100%. Haven’t been shooting much every since I started working. Sigh..

 Have 2 Every-Other-Day (EOD) calls starting from tomorrow. Hopefully all 3 calls will be peaceful.

The 1 year mark

As usual, time flies. I’m in my 11th month of housemanship, and yes I was lazy for the past 3 months, so there was no entries at all. Instead of entering O&G, I went into orthopedics.

Yes I deal with rotten, foul smelling legs almost on a day to day basis, there are patients who deserve our care but most of the time, patients with diabetic foot ulcers deserve some good lecturing because they don’t take care of their own foot and they expect us to do so. They’ll skip their daily dressings, and when asked why, their answer would be : DR, kaki dah bersih, sudah pulih, tak payah cuci sudah.. and when you look at their foot, pus are oozing out at the slightest touch. There goes their sudah bersih.

Few days back, when I was in minor OT, there was a patient who was sent down because of an infected ulcer, and oh my what a sight to behold when we prep him for wound debridement. His wound was full of maggots, yes MAGGOTS crawling in & out enjoying their new found home. When asked, he claimed that he goes to a nearby clinic for daily dressing without fail but why would his leg be that bad if it’s washed daily? I can’t say whether it’s his fault or it’s our own health care staff who didn’t do their job properly?

And about fractures, I see that almost everyday too. I’ve had my fair share of close fractures, which most of the time can be treated conservatively, meaning using the plaster of paris after reduction if it’s displaced, and open fractures which usually require immediate would debridement & stabilization of the fractured bone. In my hospital setting, we usually will debride the wound, and use a temporary ext fixator before we proceed with a permanent locking nail, screw or plate. We only have 2 OTs running during office hours and after 5pm, it’ll only be 1 left for emergency cases.

Life was kinda good for the past 3 months, as the HOD was a really nice person to work with. I will never forget his kind words & teachings in OT. From the person who wasn’t a weeny bit interested in orthopedics, somehow now I’m quite interested in it, but I still HATE diabetic foot ulcers, the smell is just so ‘unforgettable’

I still have another month to go before I leave for O&G, I did thought of doing ortho for my masters but well it’s a pity I have a prolapsed L5/S1 intervertebrae disc so it’s kinda impossible for me to stand for long hours in the OT. Well, at least I did learn a lot from my current boss and even though I’m not going to specialize in this field, I have no regrets.

Will be going for a short holiday to Krabi next week as it’s my birthday, time to have some self reward after working for a year eh? =) Will write soon, this time for real I hope. Till then peeps..

The 6th month mark

Just realized today how time really shoot pass us when we’re busy, it has been 6 months plus since I became a slave started working. And yes I haven’t blogged for 3 months, last entry was on the last day of 2010.

Life is better currently, 3rd month in my surgical posting, I get weekend offs if I’m not on call and I get to go home on weekdays by 5pm if I finish my work on time. I guess this is a luxury for all house officers, but all of these will be over soon once I finish this posting end of next month, it’ll be back to working 7 days a week, 14-16 hours a day not inclusive of on call hours.  Recalling when first started working, life was disastrous in medical posting, but after 2-3 months down the line, my body started getting used to the stress and my mind started getting used to the daily harsh scoldings being threw around by the MOs and specialist. I guess it’s all about getting used to and making it a life routine for all of us. So for those who have yet started their housemanship, be prepared mentally & physically, no matter how harsh life will be for the first few weeks/months, bite hard and bear it for it’ll all be fine real soon.

I did have thoughts of giving up on blogging totally but after reading my mentor’s blog the other day, I chose to keep this blog as many years later, maybe I’ll find some humor in reading back what I went through during my younger days, how I started in this life long journey.

Will write as time permits, till then..

 

 

 

Goodbye 2010

Time flies… This time last year I was still a medical student in ukraine, and I still remember it was snowing the whole day on new year eve.. Gosh now I realize how much I miss that place which I’ve been complaining for the past few years.

I joined the real working world end of August this year and ever since my social life kinda ended. I leave for work before the sun rises, and finish work after the sun sets. It doesn’t make much difference to me because whenever I’m outside the hospital it’s dark. Think of it on the negative side, it’s kinda pathetic right? We in the health sector work around the clock to save ppl’s life and in the end sometimes we get scolded by unreasonable patients and not forgetting we lose our very own social life. At times, I do ask myself is all these worth my sacrifices?

This year today I don’t think I would want to have any new year resolution other than doing well in my career and getting my much needed holidays whenever possible. Thank god in the new posting, the boss is more understanding and less strict. I learnt a lot from the previous boss, despite the fact he’s a cruel dictator but I can’t deny the things that he taught me are so useful and it’ll help me in everywhere that I go. I haven’t got the opportunity to thank him personally yet, maybe I will do it one fine day. I think he did a good job in training me for the past 4 months.

On the personal side, it’s not time to elaborate so much yet but I’ll talk about it when it’s time. I hope this time I made the right choice, simply because I don’t really have the luxury to choose again and again.

Happy new year 2011 peeps, wishing all of you a great year ahead, and may all your new year resolutions come true! Time to get back to my much deserving long weekend break =)