Monthly Archives: January 2010

Fairy Tales and Nightmares 2


Like a bad sequel, the nightmare from yesterday continued today.

After telling myself that nothing is gonna get on my nerves today, I walked into the ward, determined to have a pleasant round, come what may.

Not so. What came was a very frantic daughter of a patient dying from malignancy. In a trembling voice, she said: (translated from Chinese)

“Doctor, you must let my father go home today. He knows he is dying and he wants to die at home! He said got pain here….” jabbing her pudgy fingers repeatedly at MY ribs!

I gently grabbed hold of her fingers and in a firm but gentle voice told her: “Do not touch me…!”

Truth be told, I dislike being touched, especially by shaking, trembling and panicky people with pudgy fingers.

Isn’t it a form of assault?

Anyway, on further inquiry, it turned out that the patient suddenly decided today he wants to go home and die. The daughter said he started speaking strange things and took it as a sign the end is near.

I immediately assigned a house officer to speed up the process of discharging the patient and assured the family members that the process will be done quickly and an ambulance with oxygen supply be made ready at the earliest to transport the patient home.

Unfortunately the patient had a chest tube attached to one side of his chest. I informed the family that it would take an hour at least to organize everything so that the chest tube can be removed before he could be let home. They said, “ok”.

The wife said “ok”

Another son said “ok”

Another daughter (they seem to appear from thin air), came up to me and asked me to re-ask the patient (her father) again if he really wants to go home! I replied, “it was your decision to take him home, so why the need to ask him?’

She said, “ok”, in between sobs.

Meanwhile, I reminded the whole family that 2 days ago, I did raise the issue of them taking the patient home as the prognosis was grave but they didn’t want to consider the matter. They all nodded in agreement.

And so, with a speed seldom seen in the civil service, the chest tube was removed and the paper work was done!

Meanwhile…..

This is where the plot thickens and the nightmare intensifies!

Meanwhile…another son (good grief…how big is this family anyway…?!) apparently went off to consult a Chinese deity and was informed by the deity (I didn’t ask which one) that his father would surely recover and even spend Chinese New Year, in the pink of health! And so he called his mother on the phone and relayed the ‘good news’!

Then the mother came up to me, just as I was about to leave the ward for my clinic downstairs and she said:

“Uh…doctor, can my hubby be kept here in the hospital?”

I almost ruptured a few arteries in my brain on hearing it.

“Why?”, I asked in a quiet even tone (remembering my vow not to let anything fray my nerves today).

“Well, my son consulted a deity just now and the deity said, my hubby will recover and definitely spend Chinese New Year! So we want to keep him here! Can ah? Can ah?”

“But we just took our his chest tube, made the ambulance arrangements, and did all the paper work!”, I replied.

“Oh….hmmm…so cannot keep him here hor?”, she asked again.

Good grief….

They decided to take him home.
I hate to contradict their deity but I seriously do not think the patient will be able to live till CNY.

Gaargh!!!! I have Acute Intensivus Distressus Syndrome (AIDS).

Fri, 290110 @ 2010

Fairy Tales and Nightmares


The nightmare began with a referral from a private hospital yesterday.

The referring physician assured me that the patient he intended to transfer over was ‘stable’. My 6th sense tells me I was fed with a mega-dose of fantasy but then again, working in a government hospital does not give me the liberty to turn down the referral and so, despite all my reservations, I accepted the transfer.

The patient came, 3 hours later, in an ambulance that my hospital have to send over (which is weird – don’t private hospitals have their own ambulance) despite the assurance by the referring physician that the patient would be sent over by their ambulance! She was anything but stable. Between the call and the arrival of the patient, she had a cardiac arrest, required CPR, was tubed and ventilated, semi-comatose, in shock, requiring inotropes and she was accompanied by an entourage of very angry family members (3 of whom were staff nurses in private medical centres!).

Sigh…

The patient was wheeled almost instantly passed the ER (which is not the norm), straight into the ward, which was another anomaly as she was supposed to go to the ICU. It didn’t matter really because the patient was so unstable and ill that she soon succumbed to her illness.

And then the nightmare intensified.
Family members vented their anger and frustrations.
They claimed the patient was transported late.
They said she was hit in the ER by a health care worker there.
They said the nurses in the ward were not attentive.
They claimed the doctors were slow to act.
They said the patient should have been in the ICU.
They said a whole lot of things.
They threatened the workers in the mortuary.
They threatened to write official complaint letters and sue.

Sigh…

It took a lot of calm mind and gentle palliation to diffuse the situation.
I slept little. My junior doctors slept even less.

This morning, my HO told me a bunch of fairy tales during round.
He reported non-existent lab results.
He couldn’t tell his right from his left.
He misinterpreted a CT brain film.
He presented the wrong history.
He got his patients mixed up.

He got on my nerve…

And then when round was over, I got a phone call from an irate relative of a patient who was just discharged.
She claimed her father was discharged prematurely.
She claimed we were putting her entire family in danger because her father has TB.
She claimed she was made to run around.
She said some nurses and doctors were rude to her.
She said the people at admission were horribly rude and inconsiderate.
She said she shouted at the ER so that she could get some attention.
She said her father should not be on certain medications.

I got an earful for 25 minutes (the radiation from the phone fried my right temporal region).
More calm mind and palliation and the irate relative was satisfied and all is well again.

A 2.5 hours class with students followed after that.
A few phone calls came during the class. One asked me to go pick up my new cheque book (I didn’t ask for one). Two sms asking to shelve a class till a much later date (might as well not have it). One call from a patient to triple confirm his appointment is indeed this afternoon at 4 pm.

And then, just as the class ended, another relative of a patient came asking for a final diagnosis.
He was nice, polite but persistent.
I didn’t have a final diagnosis as some things are still pending. He didn’t seem please.

Sigh…

I’m so tired, sleepy and my nerves are frayed.

I’ve got another class to take now.

Sigh…

What did the DG say again? “Doctors not overworked”, it seems.

Pah!

Thurs, 280110 @ 1400

Bad bad English


While waiting for a seminar room to be available for House Officers Teaching (HOT!) last week, I spotted this sign pasted on the wall in the place where free-for-all-staff PCs were placed.

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No point correcting the bad grammar and sentence structures. The best thing to do is to tear it down and burn it.
I wonder why people can’t get them proof-read before putting these embarrassing posters up.

Anyway, the teaching session did not materialize because:
1. the group using the seminar room claimed they booked it till 11.30 am (while we booked for 11 am) and refused to vacate.
2. up till 11.15 am, there was only one HO there who was the presenter.

It was a total waste of my time. Next time, just go read the CPG. No need for any teaching. In IMU, we call this Self Directed Learning.

Wed, 270110 @ 0800

Happiness is..


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Last Friday, I felt happy. :)

Happiness is seeing a patient 2 years down the road, making remarkable recovery in his health. When I first saw him 2 years ago, he weighed merely 45 kg, has a CD4 count of only 2 cells/uL (normal would be at least 400 and above) and his lungs were ravaged by tuberculosis. He was treated with anti-tuberculosis drugs and started on HAART (Highly Active Antiretroviral Therapy) for HIV.

Fast forward 2 years and he now weighs 68 kg, has a job, his CD4 count is 473 cells/uL and in the pink of health! :)

Happiness is seeing a woman, who was infected by her drug addict husband (before he died of HIV related complications) and left to fend for herself and raising her 6 children alone working as a cleaner.  She was started on HAART a couple of years ago and is doing well. Last Friday, she popped in looking very shy and very happy. In tow, was her new man, who despite knowing her status, choose to be with her and accepts her. They will be getting married soon. She just wanted me to meet her soon-to-be-hubby. :)

Happiness is hearing my youngest HIV+ patient knock on my door, coming in and saying, “thank you” in Tamil (because he is uneducated and could not speak any other language). Two years ago, at the age of 16, he presented with unrelenting fever and a swollen abdomen. Diagnosing him was a challenge but eventually he was diagnosed with HIV+ and lymphoma along with a host of other infections which fed on his immunity-challenged body.

Today, he is almost as tall as I am, and he is gaining weight with each subsequent visit to the clinic. Chemotherapy was given for his blood cancer and he responded. He is on HAART for HIV. I still do not know how he got infected at such a tender age (attempts at getting the history out of him always drew a blank) but it doesn’t matter.

His smile says it all. It says, “thank you and I am grateful”.

These are the best rewards of working as a physician. :)

Mon, 250110 @ 0700 (now, if only the gaji would come out earlier!!!)

Tasteless


Recently I received an email on FB from a dear friend and colleague:

Hi Jimbo,

Personally, I do find your blog facinating and educational.

However when I log into your website from UM, it will be blocked and the category that they have listed your site in is “Tasteless”. I was wondering who actually did the listing and whether you are aware of that. Other blogs which are blocked are listed as Personal sites and not all blogs even those hosted on blogspot are blocked.

Wondering what the policies are here. By the way, they have unblocked Facebook as University of Malaya is now also on Facebook!

My reply to him was that I am aware of the censorship by government-owned computer terminals since September 2008 though I can’t quite understand how my blog can be deemed ‘tasteless’.

Typical of the powers-that-be as usual. Even our esteemed Minister of Communications recently told us not to use FB or Twitter as they are considered ‘bad-influence-from-the-West’ (so’s wearing a tie, dear Minister but I see you are still on a leash…)

Oh well, I guess one man’s blog is another political party’s poison.

It doesn’t matter to me, really. I blog for fun and it helps to keep my sanity intact (just barely) and the day blogging becomes un-fun, I will just stop. No big deal. :)

And people who wants to read what I write can still access the blog outside of their workplace. So there…!

Wed, 200110 @ 0700

Forgetfulness


“Your son forgot to bring back his exercise books, color pencils and sharpener! Kek Sei Ngor la*”

* literal translation from Cantonese: Stress me to death.

That was the sms I received from my wife recently. Why does it always have to be MY son, when something goes wrong with him?!

Anyway, I just want to say that forgetfulness runs in my family.

My son has forgotten to bring home from the kinder or school,  loads of stuff over the years and we have spent a fortune replacing erasers, sharpeners, pencils, water containers etc, etc. When asked where are his stuff, the typical response would be, “I don’t know”.

The daughter is no better. Once she went off to school in her school uniform and came back without it! It’s not that she came back naked; she changed into her PE clothes and conveniently forgot to bring home her school uniform. The loss was not discovered until a few days later when she bugged her mummy for her school uniform! By then it was too late to look for them!

And another time, she took my very expensive original Carbonex 15 Yonex badminton racquet to school and came home sans the racquet! When asked where the racquet went, the response was the same, “I don’t know”!!!

Gaargh!!!!!

You know, I have a suspicion where my kids got their forgetfulness-gene from….

They got it from…

Errr….

I forgot.

:(

Tues, 190110 @ 0700