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

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.

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.

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.

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.

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?

Of EMed (2)

if you ignore the crazy long lists of patients, the a&e is really a fun place to see all the weirdest cases ("patient complained of a tingling sensation in fingers after touching atm about an hour ago") and patients. had a full day at the p3 area last night (on tuesday it was eerily empty) and what an assortment of patients it was that came in through the door!

to start off the shift, we had an rta patient who refused to pull down his pants because he wasn't wearing any underwear. he didn't speak english so we were initially puzzled at all his gesturing and pointing. it was hilarious. eventually we got a translator to tell him it'll just be him and the doctor and that it was necessary to check his leg (he c/o pain over left hip and thigh.)

then we had a pretty hotel staff who had fainted while at work. her referral from her gp (from a very famous chain of clinics) was unreadable. the piece of paper came in a series of strokes and dots and at one part, something that looked like a drawing of a heart! she was very pleasant and demure, and was a bit embarrassed when d.c. tested her upper arm strength.

there was also a jc girl who sprained her ankle after falling down the stairs. she came in on a wheelchair reading her economics lecture notes, and of course uncle just had to talk to her, and he started to explain the economics - of bgr.

some unpleasantness came about when we had trouble admitting a patient. i can't say much here, only to say that there's a limit doctors can do in helping someone and ensuring they stay healthy. sometimes the consultation ends in the signing of the AOR form, and all that's left is to lift up a small prayer that the patient will not make a turn for the worse.

that's all for now. gotta head back down to hotel o.n.e. soon. another night ahead. heh.

Of EMed (1)

a super long tutorial makes for a super happy emed kid. heh.

Of The Weekend

the anatomy of a crazy weekend:

saturday
wake up - dance class - lunch - nap - leave for hospital - start shift

sunday
end shift - nap - brunch - church - dinner

to round up the weekend, i got emails bringing bad news about our apartment in la (sounds like they're trying to cheat us) and hearing other things that i didn't want to hear.

as it is, at the end of service, the worship team chose to sing this wonderful song by reuben morgan:

One Day
More than I could hope or dream of
You have poured Your favour on me
One day in the house of God is
Better than a thousand days in the world

So blessed, I can't contain it
So much, I've got to give it away,
Your love has taught me to live now
You are more than enough for me
Lord, You're more than enough for me

He's more than enough for me indeed.

Of Night Calls

all quiet on the western front for now, so taking a break to read from the trusty e med handbook.
just found out that the grand ol' dame's computer system blocks facebook...because it's classified under the "personals and dating" category. like, huh? no fun one.

Of Late

watching the juniors in the er now gives me a glimpse as to how much we've grown (clinically, i mean) this past one year. they are fairly lost (but finding their way round quickly) and are clueless about many medical conditions. not only that, they are still very sensitised.

case in point: young foreign worker found collapsed at worksite, apparently electrocuted. arrived in the er asystolic. after half and hour of resuscitation, the doctors called it, and i saw the shock on their faces as everything was turned off. one exclaimed, "but he's too young!" i just didn't know what to say when i heard that.

central hospital's emergency is sometimes closed several times a day, and during that time, all ambulances are diverted to the grand ol' dame. not surprisingly the p2 area becomes quite crowded, and the patients resign themselves to a long wait. what i found interesting was the various ways that the patients occupied themselves. most slept but there were those extroverts who struck up a conversation with the person in the next trolley, those who read (reader's digest and novels) and a young man who must have finished half a book of soduku while waiting.

since the staff are so busy, we medical students act as nannies, making sure patients don't fall out of the trolley trying to get to the toilet. some demented patients have no idea where they are and attempt to climb out. we tell them that they're in a hospital and they calm down a bit, but we know very well that in an hour's time, they'll be trying their very best to escape again.

"idol gives back" featured one of my favourite songs, from the musical Rent! here it is.

Seasons of Love

Five hundred twenty five thousand six hundred minutes,
Five hundred twenty five thousand moments so dear.
Five hundred twenty five thousand six hundred minutes
How do you measure, measure a year?
In daylights, in sunsets, in midnights, in cups of coffee.
In inches, in miles, in laughter, in strife.
In Five hundred twenty five thousand six hundred minutes
How do you measure a year in the life?
How about love? How about love? How about love? Measure in love.
Seasons of love.

Five hundred twenty five thousand six hundred minutes!
Five hundred twenty five thousand journeys to plan.
Five hundred twenty five thousand six hundred minutes
How can you measure the life of a woman or man?
In truths that she learned, or in times that he cried.
In bridges he burned, or the way that she died.

It's time now to sing out,
though the story never ends let's celebrate remember a year in the life of friends.
Remember the love! Remember the love! Remember the love!
Measure in love. Seasons of love! Seasons of love.

A Toast

here's to e med!

Wow

a better turn of events today - something unexpected but good enough to remedy last night's displeasure.

watched the bucket list today. touching film which stars heavyweights jack nicholson and morgan freeman. it's about two men given less than a year to live because of advanced cancer, trying to live out the remainder of their lives with meaning. they make out a list of things to achieve before they kick the bucket (hence the title of the movie) and set out to do it. along the way, their contrasting life histories and priorities come to a head, but is resolved, tragically and touchingly, when one of them dies.

nothing much to comment on the two leads (like, hello?) as they were predictably awesome - restrained, joyful, bitter and contemplative all at the right time. i loved the digs at nicholson's personal life ("been married four times but i still loved the single life" and "i've been making money since i was 17 and have been pretty good at it") but the plot is kinda predictable and the characterisation cliched (rich, atheistic, unrefined white versus a poor, intelligent, religious black) so that was a bit disappointing for me. otherwise a pretty good film -- i'll give it 3 stars.

Culture Vulture

had the opportunity to immerse in some cultural stuff last weekend.


first up was giselle at fort canning park. it's something like ballet under the stars, where you bring your mats and food and enjoy the ballet. the ang mohs really made it into a big outing, with bottles of wine and picnic baskets containing delicious looking food. there's nothing quite enchanting to watch a ballet in a park at night, with the cool wind blowing through one's hair. xia haiying was amazing as the ill-fated giselle, who gets cheated in love but who eventually forgives the jerk. as a dancer she's outstanding (i always think that the easier you make a dance look, the better a dance you are) and as a performer she evoked appropriate emotion. i really felt quite sorry for her as giselle danced away at the end, condemned to be a wili for eternity. heh.


then it was sam hui's concert. went only because my parents like his songs, which are all in cheem cantonese and are thus all greek to me. i enjoyed the audience banter, especially that of his younger brother. it was hilarious and sent the entire stadium roaring with laughter. what amused me was the group of middle aged women who were obviously long time fans. they were armed with their signs, song requests and gifts (wooden sculptures, bouquets, stuffed toys) all ready to please him. and when he came down to the audience to shake hands, their screams of adoration would probably have made their daughters blush! what a sight.

and on sunday, it was we will rock you. coming from a non-queen fan, i must say it was amazing! the story sucks of course (really bad and cheesy plot about a time in the future when music is banned) but i don't think queen fans will care for a meaningful story. it was a riot, what with the hilarious digs ("victoria beckham saved us!") and local references ("sorry lah!" and "this suit is not from armani, it's from bugis street.") the cast was pretty good, but what a gem mig ayesa was! he came in third in the search for a new lead singer for inxs, and it's clear why. i've never heard such a fantastic voice 'live' before, and it really blew me away. on top of that, he's a good dancer. i had fun, and even this young caucasian kid who stood up in his seat at the end of the performance and started doing a mini john travolta thing. haha. a must watch!

**

some other stuff: honestly, some people need to be shaken up a bit. it's not the first time this person has done this, not to me but to a whole lot of people. it's not just basic courtesy, it's also responsibility, and if a someone can't even do that, i think it's very sad. c'mon, grow up already.