Monday, May 05, 2008
Wrapping Up And Looking Ahead
[why didn't blogger save the post before my browser hanged?! argh!!]
part one
anyway, i'm going to miss the hotel o.n.e. DEM. like, really really miss it. the people, the patients, the "work". yes, it's "work" because students have it easy there - my main job was to set plugs, take blood, and serve the occasional biscuit and milo to hungry patients. none of the "please do not crowd inside my resus room -- only one visitor at a time, not five!" or "i have already explained to your brother/sister, so you should speak to him/her, there's no need to raise your voice at me!" or trying hard not to upset the delicate balance of beds upstairs. i still recall the night where there were no icu beds and the resus was overflowing. haha.
for my part, i'm glad that i am now pretty comfortable with setting plugs and catheterising patients. considering i had done no more than five plugs and had only one extremely embarrassing catheterisation ("it usually doesn't take half an hour") under my belt before i entered this posting, i think that's great. heh.
and who could forget the varied patient encounters? from the sad (old man who lives alone coming in for scabies) to the funny (mdm sing-song, mr i-filled-up-a-feedback-form-praising-you) to the annoying (son who refused to budge from the consult and who glared at the attending doctor with an open look of distrust), i think i can safely say they were probably the most memorable, compared to other postings.
of course, what i miss most would be the doctors. this is the first department where almost everyone was so willing to teach and talk to us. by letting us shadow them from patient to patient, i learnt more than just medical facts. i saw lots of pr skills (man do you need it in the a&e), practical tips (ie ways to *ahem* save time) and kuoli tricks. from the most senior/famous people to the MOs, i was touched and amazed at the spontaneity of teaching. even the busy nurses would grin at us and say "hello". that's what i call a positive experience. heh.
part two
i have these few days as a breather before i fly off to the states. shall be doing 3 weeks in surgical critical care at cedars sinai (aka the britney spears hospital) and followed by 2.5 weeks of traveling. will be doing a little jaunt in and outside california, before flying to new york, new york. am most excited about that part of the trip. nearly hyperventilated when i saw the list of shows on broadway. i want to watch ALL of them! but oh well, based on recommendations and personal interest, i've narrowed the list down to only five(!) shows:
musicals: jersey boys, billy elliot, wicked
plays: cat on a hot tin roof (starring james earl jones!!)
off broadway: john lithgow - stories by heart
i want to watch the musicals because...well, i love musicals. totally dig them. les miz got me hooked and i've been on a roll ever since. i missed the chance of watching nathan lane and matthew broderick in the producers when i was in london, so i mustn't let that happen this time. the two plays are equally enticing - james earl jones in a tennessee williams play and the fantastic john lithgow recounting his early influences as an actor. one word - wow.
seems that billy elliot's already sold out, and tickets to jersey boys are going fast! will have to try my luck at the discount booth (many thanks, dr s-!). before that, i'll have to convince my travelling companions that we must, must, MUST catch something on broadway. heh.
cryptic notes to self
1) much tolerance required
2) such curious creatures they are
ignore me. they're just little notes to remind myself of the frivolity of my (perceived) youth.
it's back to the packing. here's to the land of the free!
* mumbled at 10:32 PM
part one
anyway, i'm going to miss the hotel o.n.e. DEM. like, really really miss it. the people, the patients, the "work". yes, it's "work" because students have it easy there - my main job was to set plugs, take blood, and serve the occasional biscuit and milo to hungry patients. none of the "please do not crowd inside my resus room -- only one visitor at a time, not five!" or "i have already explained to your brother/sister, so you should speak to him/her, there's no need to raise your voice at me!" or trying hard not to upset the delicate balance of beds upstairs. i still recall the night where there were no icu beds and the resus was overflowing. haha.
for my part, i'm glad that i am now pretty comfortable with setting plugs and catheterising patients. considering i had done no more than five plugs and had only one extremely embarrassing catheterisation ("it usually doesn't take half an hour") under my belt before i entered this posting, i think that's great. heh.
and who could forget the varied patient encounters? from the sad (old man who lives alone coming in for scabies) to the funny (mdm sing-song, mr i-filled-up-a-feedback-form-praising-you) to the annoying (son who refused to budge from the consult and who glared at the attending doctor with an open look of distrust), i think i can safely say they were probably the most memorable, compared to other postings.
of course, what i miss most would be the doctors. this is the first department where almost everyone was so willing to teach and talk to us. by letting us shadow them from patient to patient, i learnt more than just medical facts. i saw lots of pr skills (man do you need it in the a&e), practical tips (ie ways to *ahem* save time) and kuoli tricks. from the most senior/famous people to the MOs, i was touched and amazed at the spontaneity of teaching. even the busy nurses would grin at us and say "hello". that's what i call a positive experience. heh.
part two
i have these few days as a breather before i fly off to the states. shall be doing 3 weeks in surgical critical care at cedars sinai (aka the britney spears hospital) and followed by 2.5 weeks of traveling. will be doing a little jaunt in and outside california, before flying to new york, new york. am most excited about that part of the trip. nearly hyperventilated when i saw the list of shows on broadway. i want to watch ALL of them! but oh well, based on recommendations and personal interest, i've narrowed the list down to only five(!) shows:
musicals: jersey boys, billy elliot, wicked
plays: cat on a hot tin roof (starring james earl jones!!)
off broadway: john lithgow - stories by heart
i want to watch the musicals because...well, i love musicals. totally dig them. les miz got me hooked and i've been on a roll ever since. i missed the chance of watching nathan lane and matthew broderick in the producers when i was in london, so i mustn't let that happen this time. the two plays are equally enticing - james earl jones in a tennessee williams play and the fantastic john lithgow recounting his early influences as an actor. one word - wow.
seems that billy elliot's already sold out, and tickets to jersey boys are going fast! will have to try my luck at the discount booth (many thanks, dr s-!). before that, i'll have to convince my travelling companions that we must, must, MUST catch something on broadway. heh.
cryptic notes to self
1) much tolerance required
2) such curious creatures they are
ignore me. they're just little notes to remind myself of the frivolity of my (perceived) youth.
it's back to the packing. here's to the land of the free!
* mumbled at 10:32 PM
Monday, April 28, 2008
No Greater Love
some background first: i've been helping out with the hfmd screening at church these past few weeks, and so have missed praise & worship for some time. not only that, i've been feeling a little dry, and to top if off, the events of the past few weeks haven't been exactly uplifting (see previous post).
so it was more than just a pleasant surprise when pastor gabriel announced before service started that darlene zschech would be leading worship!
what an amazing p&w it was!! the songs (salvation is here - at the cross - nothing but the blood - how great is our God - healer - Hosanna), the music, the singing. during worship, i cried. not bawled, but yes i did shed a few tears. i cried as the frustrations of the elective planning fell away, as the uncertainties melted, as i was reminded that i am still, and will always be, Daddy's little girl.
because it had totally slipped my mind that i was serving for 4th service hfmd, and i was frantic when i saw the roster the night before as i was supposed to rush down for the afternoon shift at hotel o.n.e. after service. i didn't want to be late so i called people and tried to swap duties.
if i had managed to change duties, i would probably have made it to hotel o.n.e. much earlier. well, i wasn't successful, but what was in store for me was precisely what Daddy knew i needed most. thus preserved, i had those precious minutes of fantastic worship which i will treasure. precious because i'm leaving for the states soon, and not only am i going to miss hillsong united's concert in singapore, i'm also going to miss the p&w that i love for 5 sundays.
to end this post, here's the one and only darlene zschech:
At the cross I bow my knee
Where Your blood was shed for me
There's no greater love than this
You have overcome the grave
Your Glory fills the highest place
What can separate me now?
You tore the veil
You made a way
When You said that it is done
* mumbled at 12:23 AM
so it was more than just a pleasant surprise when pastor gabriel announced before service started that darlene zschech would be leading worship!
what an amazing p&w it was!! the songs (salvation is here - at the cross - nothing but the blood - how great is our God - healer - Hosanna), the music, the singing. during worship, i cried. not bawled, but yes i did shed a few tears. i cried as the frustrations of the elective planning fell away, as the uncertainties melted, as i was reminded that i am still, and will always be, Daddy's little girl.
because it had totally slipped my mind that i was serving for 4th service hfmd, and i was frantic when i saw the roster the night before as i was supposed to rush down for the afternoon shift at hotel o.n.e. after service. i didn't want to be late so i called people and tried to swap duties.
if i had managed to change duties, i would probably have made it to hotel o.n.e. much earlier. well, i wasn't successful, but what was in store for me was precisely what Daddy knew i needed most. thus preserved, i had those precious minutes of fantastic worship which i will treasure. precious because i'm leaving for the states soon, and not only am i going to miss hillsong united's concert in singapore, i'm also going to miss the p&w that i love for 5 sundays.
to end this post, here's the one and only darlene zschech:
At the cross I bow my knee
Where Your blood was shed for me
There's no greater love than this
You have overcome the grave
Your Glory fills the highest place
What can separate me now?
You tore the veil
You made a way
When You said that it is done
* mumbled at 12:23 AM
Saturday, April 26, 2008
Speechless...
...with anger that is. when somebody p*sses you off big time and points a finger at you, what do you do? what do you say? i know my limits, and i know my limits are being tested now. any more, and things will come apart at the seams.
a few of you have asked me on facebook what's wrong. thanks for your concern. i'm not at liberty to furnish the whole story now because there are too many questions and a number of people involved. and also because i don't like to whine like some people to the whole world so that half the class knows only one side of the story. these people give us only children a bad name. but yes, thanks, i really appreciate it.
i wished blogger had a password-protect function. then i can rant as much as i want.
* mumbled at 10:56 PM
a few of you have asked me on facebook what's wrong. thanks for your concern. i'm not at liberty to furnish the whole story now because there are too many questions and a number of people involved. and also because i don't like to whine like some people to the whole world so that half the class knows only one side of the story. these people give us only children a bad name. but yes, thanks, i really appreciate it.
i wished blogger had a password-protect function. then i can rant as much as i want.
* mumbled at 10:56 PM
Thursday, April 24, 2008
Of EMed (6)
summary of today (a&e is giving me blogger's diarrhoea!)
1) hepatic flap. my first. jaundiced patient with a history of alcoholic liver cirrhosis, came in for a fall at home. he was totally zonked out, so likely stage 1 or 2 hepatic encephalopathy. he even has inversed sleep patterns! wow.
2) posterior dislocation and elbow dislocation. not in the same patient of course, but two patients who came in at the same time. stayed with the elbow dislocation, who's a judoka in junior college. took him some time to be sedated, and even then he was able to tap the mo's hand pretty firmly when the mo was reducing it, all the while with his eyes half open. haha. i love watching reductions with the accompanying "conscious sedation". m&rs are such wonderful things - simple but very effective. and the conscious sedations make the patients so loopy that it's really hilarious to watch. (i'm starting to sound pretty unsympathetic am i?) but nothing can beat watching a kid come out of ketamine haze. heh.
3) trauma team activation. pretty standard - drunk tourist knocked down by lorry, but it was the details of the activation that got me thinking. shan't elaborate too much here because they aren't pleasant stuff.
off day tomorrow. time to tie up loose ends for the overseas elective, and to attend care group. i miss it.
* mumbled at 10:53 PM
1) hepatic flap. my first. jaundiced patient with a history of alcoholic liver cirrhosis, came in for a fall at home. he was totally zonked out, so likely stage 1 or 2 hepatic encephalopathy. he even has inversed sleep patterns! wow.
2) posterior dislocation and elbow dislocation. not in the same patient of course, but two patients who came in at the same time. stayed with the elbow dislocation, who's a judoka in junior college. took him some time to be sedated, and even then he was able to tap the mo's hand pretty firmly when the mo was reducing it, all the while with his eyes half open. haha. i love watching reductions with the accompanying "conscious sedation". m&rs are such wonderful things - simple but very effective. and the conscious sedations make the patients so loopy that it's really hilarious to watch. (i'm starting to sound pretty unsympathetic am i?) but nothing can beat watching a kid come out of ketamine haze. heh.
3) trauma team activation. pretty standard - drunk tourist knocked down by lorry, but it was the details of the activation that got me thinking. shan't elaborate too much here because they aren't pleasant stuff.
off day tomorrow. time to tie up loose ends for the overseas elective, and to attend care group. i miss it.
* mumbled at 10:53 PM
Wednesday, April 23, 2008
Of EMed (5)...
...and more things. spent some time yesterday reading through old entries and realised that this blog has degenerated into nothing more than a record of my days in medicine. so dry and uninteresting, unlike other blogs out there. anyways.
the madness
these two days in the ed have been madness. even though hotel f.o.u.r. was open, we were swamped with patients. it was patients, patients everywhere - in rows of three between the panels, in the corridors, in wheelchairs because there were no more trolleys... resus was overflowing with up to eight or nine patients squeezed into that tiny area. so what, you might ask, is worse than having many patients? what was worse were the anxious and irritable relatives who entered the p2 area in droves and refused to leave. i saw the poor security guard do many shuttle runs between the two main entrances to the ed trying to stop the relatives from rushing in despite being told to wait outside.
as for those who made it past the guard, they either hovered around their sick relatives and interrupted the consultation or went round demanding that they be seen first. one woman i saw stood in the middle of the sea of patients and yelled at a nurse, saying, "i've been here two hours!" like, has she been to an a&e before? since when was a 2 hour wait considered long? did she think the doctors were hiding in a comfortable room somewhere, sipping tea from porcelain cups and listening to smooth jazz while the a&e overflowed with patients? argh.
and so the sad thing about being a medical student is that we aren't qualified to help. we can't help the doctors see the patients, type in consult notes or examine them - anything to help clear the queue faster. if anything, we probably slowed them down because they had to explain to us certain things and watch us inexperienced blood suckers take blood or set lines. felt really useless, especially when i saw the constant stream of patients wheeled in.
what's amazing, however, is that the docs still took time to teach us. they were all partially crazed, eyeballs bulging, from the nonstop work, but they managed to explain details coherently to us. hats off to them man.
VVIPs or otherwise
cases wise, it's been quite a field day (or rather, days) for us. first thing when i walked into resus yesterday, i had to perform cpr on a patient brought in initially for urosepsis but who subsequently developed a massive anterior infarct. then we handled a standby case of a man with severe sob, who turned out to be the ex - of -. (haha did you think i'd reveal his identity?) mumbler's first brush with a vvip; jaw kinda of dropped when told by dr -. yeesh, not a vip but a very very important person. and to think i was calling him "uncle" the whole time. goodness.
saw a patient with suspected hiv today, who came in for a painful inguinal swelling. ex-ivda who had so badly damaged his veins that they had to set a line in his neck. he was cachexic (with temporalis wasting) despite reporting loa for only four days. white cell count was high (26!!) but lymphocytes within normal limits. still, the suspicion was high so i think they went ahead to test him.
as one doctor said, things always come in twos. an hour later, a man was brought in for a heart attack, and it turned out that he was hiv positive, but hadn't told any of the attending doctors. fortunately for the computerised records, which documented visits to the cdc. whew!
and to round up the day (it was only a 4 hour shift!!) we saw a patient who had a horrific crush injury after a one ton metal bar fell on his hand. there was partial amputation of his hand and various parts of his fingers, so we could see the bones and tendons that tenuously held the two halves of his hand together. it was likely that he would need an amputation of the distal phalange on one of his fingers, but the worst case scenario was having that on 3 of his fingers. hand mo said it'd be long op, so they're probably still operating on him right now. hope it goes fine!
american idol
just because it was andrew lloyd webber night, i decided to watch american idol and sit through it. haven't been able to that the past few seasons and since i knew the material tonight better, i thought i'd enjoy it. was pretty impressed with syesha's and david's rendition of webber's hits, but was absolutely dismayed with jason's "memory" and brooke's "you must love me." since you've made it so far in this competition, surely you'd want to research more on your songs and try and sound better than this?! can't believe they totally destroyed the songs. and i didn't share the judges' enthusiasm about david cook's "music of the night." thought that he actually could sing it well, but the magic wasn't there at all.
to hear what magic is, follow this link. this is a tape of a live performance featuring the original phantom, michael crawford. his voice gives me goosebumps. now that is magic.
so ends my one and only ai post, only because alw is a genius. heh.
* mumbled at 6:23 PM
the madness
these two days in the ed have been madness. even though hotel f.o.u.r. was open, we were swamped with patients. it was patients, patients everywhere - in rows of three between the panels, in the corridors, in wheelchairs because there were no more trolleys... resus was overflowing with up to eight or nine patients squeezed into that tiny area. so what, you might ask, is worse than having many patients? what was worse were the anxious and irritable relatives who entered the p2 area in droves and refused to leave. i saw the poor security guard do many shuttle runs between the two main entrances to the ed trying to stop the relatives from rushing in despite being told to wait outside.
as for those who made it past the guard, they either hovered around their sick relatives and interrupted the consultation or went round demanding that they be seen first. one woman i saw stood in the middle of the sea of patients and yelled at a nurse, saying, "i've been here two hours!" like, has she been to an a&e before? since when was a 2 hour wait considered long? did she think the doctors were hiding in a comfortable room somewhere, sipping tea from porcelain cups and listening to smooth jazz while the a&e overflowed with patients? argh.
and so the sad thing about being a medical student is that we aren't qualified to help. we can't help the doctors see the patients, type in consult notes or examine them - anything to help clear the queue faster. if anything, we probably slowed them down because they had to explain to us certain things and watch us inexperienced blood suckers take blood or set lines. felt really useless, especially when i saw the constant stream of patients wheeled in.
what's amazing, however, is that the docs still took time to teach us. they were all partially crazed, eyeballs bulging, from the nonstop work, but they managed to explain details coherently to us. hats off to them man.
VVIPs or otherwise
cases wise, it's been quite a field day (or rather, days) for us. first thing when i walked into resus yesterday, i had to perform cpr on a patient brought in initially for urosepsis but who subsequently developed a massive anterior infarct. then we handled a standby case of a man with severe sob, who turned out to be the ex - of -. (haha did you think i'd reveal his identity?) mumbler's first brush with a vvip; jaw kinda of dropped when told by dr -. yeesh, not a vip but a very very important person. and to think i was calling him "uncle" the whole time. goodness.
saw a patient with suspected hiv today, who came in for a painful inguinal swelling. ex-ivda who had so badly damaged his veins that they had to set a line in his neck. he was cachexic (with temporalis wasting) despite reporting loa for only four days. white cell count was high (26!!) but lymphocytes within normal limits. still, the suspicion was high so i think they went ahead to test him.
as one doctor said, things always come in twos. an hour later, a man was brought in for a heart attack, and it turned out that he was hiv positive, but hadn't told any of the attending doctors. fortunately for the computerised records, which documented visits to the cdc. whew!
and to round up the day (it was only a 4 hour shift!!) we saw a patient who had a horrific crush injury after a one ton metal bar fell on his hand. there was partial amputation of his hand and various parts of his fingers, so we could see the bones and tendons that tenuously held the two halves of his hand together. it was likely that he would need an amputation of the distal phalange on one of his fingers, but the worst case scenario was having that on 3 of his fingers. hand mo said it'd be long op, so they're probably still operating on him right now. hope it goes fine!
american idol
just because it was andrew lloyd webber night, i decided to watch american idol and sit through it. haven't been able to that the past few seasons and since i knew the material tonight better, i thought i'd enjoy it. was pretty impressed with syesha's and david's rendition of webber's hits, but was absolutely dismayed with jason's "memory" and brooke's "you must love me." since you've made it so far in this competition, surely you'd want to research more on your songs and try and sound better than this?! can't believe they totally destroyed the songs. and i didn't share the judges' enthusiasm about david cook's "music of the night." thought that he actually could sing it well, but the magic wasn't there at all.
to hear what magic is, follow this link. this is a tape of a live performance featuring the original phantom, michael crawford. his voice gives me goosebumps. now that is magic.
so ends my one and only ai post, only because alw is a genius. heh.
* mumbled at 6:23 PM
Monday, April 21, 2008
Of EMed (4)
nothing much last night - had the standard cases of vomiting, chest pain, breathlessness. some flurry of activity occurred when a standby was called for a patient in status (epilepticus) and a russian patient, whose only english word was "cold", came in for haemetemesis. got to do some t&s, catheterisations and lots of blood taking. still need more practise in setting plugs - i managed to set a green one last night after failing two blue ones, how ironic. granted, i was successful because the patient was a young, albeit whiny army boy while the other two were older folk, and one of whom kept wincing in pain when the needle was in. like, from the first poke she was already hissing and clenching her teeth. to cut a long story short, i harm-ed and so asked dr s- for help. sigh.
and talking about the whiny guy, he presented with blood in his vomitus after an all night drinking binge. said he started at 11 the night before and lasted till 4 in the morning, and drank a couple of martell's. during the consult, he kept checking his watch and sighing about how he had to report to camp soon and that his friends were waiting for him outside etc etc. it wasn't his first time at the er for such a problem, but he made quite a big fuss when told about the possibility that he might have to be observed. like, whatever. it's not as if the medical staff were waiting for him to turn up!
forgot to mention about the man with scabies we saw on friday night. from afar, we spotted him scratching his legs furiously and moaning in pain. we approached him and saw that with each scratch, a whole lot of skin flakes fluttered onto the bed and the floor below. his skin was all red and bloody from all that scratching. needless to say, we were both repulsed and full of pity for him. he said he lived alone, and when i took a look at the address, it wasn't in a good part of town. it's so tough with patients from such backgrounds - this gentleman actually bore the itch for over a month before coming in to hotel o.n.e. for some weird chest pain. i'm not sure how his follow-up is going to be like, but i certainly hope he somehow gets rid of the scabies in his home.
anyway, the latest batch of urine bags has been a giving us a problem - they leak. first time i did a cath alone, it was with a faulty bag, how exciting. heard of one patient who ended up changing like three or four bags because they all leaked. haha. it's like some russian roulette now, seeing who gets the leaky urine bag. heh.
* mumbled at 5:56 PM
and talking about the whiny guy, he presented with blood in his vomitus after an all night drinking binge. said he started at 11 the night before and lasted till 4 in the morning, and drank a couple of martell's. during the consult, he kept checking his watch and sighing about how he had to report to camp soon and that his friends were waiting for him outside etc etc. it wasn't his first time at the er for such a problem, but he made quite a big fuss when told about the possibility that he might have to be observed. like, whatever. it's not as if the medical staff were waiting for him to turn up!
forgot to mention about the man with scabies we saw on friday night. from afar, we spotted him scratching his legs furiously and moaning in pain. we approached him and saw that with each scratch, a whole lot of skin flakes fluttered onto the bed and the floor below. his skin was all red and bloody from all that scratching. needless to say, we were both repulsed and full of pity for him. he said he lived alone, and when i took a look at the address, it wasn't in a good part of town. it's so tough with patients from such backgrounds - this gentleman actually bore the itch for over a month before coming in to hotel o.n.e. for some weird chest pain. i'm not sure how his follow-up is going to be like, but i certainly hope he somehow gets rid of the scabies in his home.
anyway, the latest batch of urine bags has been a giving us a problem - they leak. first time i did a cath alone, it was with a faulty bag, how exciting. heard of one patient who ended up changing like three or four bags because they all leaked. haha. it's like some russian roulette now, seeing who gets the leaky urine bag. heh.
* mumbled at 5:56 PM
Sunday, April 20, 2008
Of EMed (3)
my, are the posts coming in fast and furious.
resus was pretty busy on friday night. had an ami in one panel and then five minutes later another was wheeled in, much to the dismay of the doctors involved. one thing i've noticed about ami patients is that some of them don't seem to realise the severity of the situation. ami is one of those "run of the mill" emergency cases where the management and protocols are like reflexes to the medical staff so if you get treated early, you'll get a "run of the mill" outcome - a discharge after three days. before the days of pci (percutaneous coronary intervention ie balloons, stents, etc) and thrombolytic therapy, i doubt the survival rate of a heart attack was as high as it is now.
so it is a bit surprising that some patients either refuse treatment or request a delay in it, citing reasons such as "an important meeting tomorrow." it can be one of two things - denial, or the sad state of our lives in the present world, where losing our jobs strikes greater fear in us than losing our lives. each time i've had to resist the urge to shake the patient and say,"sir! if you don't get treated now, there will be NO tomorrow!"
almost all will eventually consent to treatment, but i've read the casenotes of one who went through four ami without agreeing to intervention. amazing.
had a bit of fun in the p2 area when a woman was wheeled in. she's apparently a frequent visitor of our hotel, and knows all the medical staff. she had all those buddhist prayer beads and some round contraption that chimed, and she went from nurse to doctor to medical student reading palms. she broke into song several times ("three, four, buckle my shoe" and the ever popular 上海滩) and made interesting phone calls ("darling are you coming to pick me up?" and then suddenly "what do you mean, mm? i'm not staying!") even more hilarious was her reaction to a moaning, confused patient - a loud and emphatic "diam!!" which of course did nothing to stop him from moaning.
i wonder who will come through the doors tonight?
* mumbled at 9:53 AM
resus was pretty busy on friday night. had an ami in one panel and then five minutes later another was wheeled in, much to the dismay of the doctors involved. one thing i've noticed about ami patients is that some of them don't seem to realise the severity of the situation. ami is one of those "run of the mill" emergency cases where the management and protocols are like reflexes to the medical staff so if you get treated early, you'll get a "run of the mill" outcome - a discharge after three days. before the days of pci (percutaneous coronary intervention ie balloons, stents, etc) and thrombolytic therapy, i doubt the survival rate of a heart attack was as high as it is now.
so it is a bit surprising that some patients either refuse treatment or request a delay in it, citing reasons such as "an important meeting tomorrow." it can be one of two things - denial, or the sad state of our lives in the present world, where losing our jobs strikes greater fear in us than losing our lives. each time i've had to resist the urge to shake the patient and say,"sir! if you don't get treated now, there will be NO tomorrow!"
almost all will eventually consent to treatment, but i've read the casenotes of one who went through four ami without agreeing to intervention. amazing.
had a bit of fun in the p2 area when a woman was wheeled in. she's apparently a frequent visitor of our hotel, and knows all the medical staff. she had all those buddhist prayer beads and some round contraption that chimed, and she went from nurse to doctor to medical student reading palms. she broke into song several times ("three, four, buckle my shoe" and the ever popular 上海滩) and made interesting phone calls ("darling are you coming to pick me up?" and then suddenly "what do you mean, mm? i'm not staying!") even more hilarious was her reaction to a moaning, confused patient - a loud and emphatic "diam!!" which of course did nothing to stop him from moaning.
i wonder who will come through the doors tonight?
* mumbled at 9:53 AM