I babble, I ramble, and I rattle

After 7 months of working in the emergency department (3 months as a medical doctor & 4 months as an ED doctor), it was really hard to leave the place where the faces are so familiar and the nurses and medical assistants are like my own brothers and sisters. Now I am confined to the 8th floor… which felt like a fairytale land up above the hospital… full of screaming kids.

It definitely is a real test to my patience.

Almost went nuts on the first day itself, no thanks to a very extremely loud 10 year old boy who would scream at the top of his lungs (you know… the mind blowing high frequency scream that you hear in horror movies) the moment he saw us and would scream even louder when we touched (very lightly) his limbs without even poking him.

Oh, god… Please give me strength to deal with these little people.

I hate paediatrics.

** I just realised that this post has been sitting in my draft folder for a month already. **

Date: 24 July 2010

Venue: Kuantan Futsal Centre, Bandar Indera Mahkota, Kuantan

We were initially supposed to attend a disaster drill competition on Friday (MIREX 2010), then go for the futsal tournament on Saturday. However, due to some reasons, we didn’t have to go for the first event, only the latter. Therefore, we received no allocation for accommodation and transportation expenses to go to Kuantan.

However, we were invited to the dinner held at Pantai Balok that evening. They were having barbeque… I definitely saw HUGE prawns and crabs. Unfortunately there were so many selfish people who decided to crowd the barbecue pit and just stay there. Many of us ended up not eating anything and actually went out to look for dinner elsewhere.

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Early the next morning, we made our way to the venue of the tournament which was roughly about 40 minutes away from our given accommodation. I, however, managed to get a place to stay (at a friend’s relative’s house) at a place much closer to the venue… to be exact, about 3 minutes drive. Funny thing was, I was completely unaware of that until the next morning when our team manager gave me the direction to the place.

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Apparently last year, our hospital was the first runner up in the same tournament. The moment I discovered this fact, I started having palpitations. No wonder people were giving us serious looks. We had a reputation to hold.

We decided to have a group photo before the games started.

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Without these people realising it, they actually ‘queued’ according to their numbers.

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During the quarter final, a member of our team broke her hand. I had no idea how she managed to fracture her radius, but she did. And I couldn’t resist laughing at her, saying that she already has osteoporosis.

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It was a really pleasant surprise to meet my college friend, Effa, at the tournament. She represented her hospital from Kota Bharu, Kelantan.

Me and Effa.

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We defeated the team from Hospital Selayang (which defeated us TWICE during the 2nd Selangor ED Futsal Tournament in May 2010) and made it to the final. Damn, I almost had an anxiety attack playing against them. The memory of being defeated twice by them and the injury to my hand (it has completely recovered without any medical intervention, thank you very much) kept bugging me like crazy during the match. Call it post traumatic stress disorder.

Unfortunately, we lost the final game to… errmmm… was it Hospital Kajang? I don’t remember anymore.

The guys didn’t even make it to the semi final.

Anyway, we had another group picture (but most of us, especially the guys had already left the place) while waiting for the VIPs to arrive for the award ceremony.

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And finally… I added another medal to my collection. Now I have a total of TWO medals (the other one was from a paintball tournament which I joined during college) so you guys can’t say I’m a nerd anymore.

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Yes, it’s unbelievable. I have NEVER EVER played any sports in my entire life. And yet I’ve joined TWO futsal tournaments during my 4 months stay in the Emergency Department… And actually won the games.

Good times… Good fun. No, I don’t plan to play futsal again.

So… It has been almost a month since I last posted anything here, eh?

Life has been busy. So many things have changed for the past 1 month… So many things had happened. I sank into a deep dark hole for while, just to be lifted up to ground level again; if not slightly higher.

I have good friends. And life has been good though far from perfect.

Personal life aside, yesterday I was given an assignment by my big boss. This foreigner sustained a deep laceration wound over the nose after being hit by a grinder at work. Initially we planned to refer him to plastic surgery so that he could retain his good looks but subsequently our big boss decided to give me the pressure honour to become a ‘part time plastic surgeon’.

Before and after 14 stitches with fine suture.

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Took me an hour to finish the job, using only ONE suture (damn, I’m proud of being able to only use one instead of two… Our department is already running out of money) for all the 14 fine stitches.

The sutures were inspected by 3 of my bosses. Verdict? Quite good but there is still room for improvement. Not too bad considering I have not had any practice since last year. The potential to become a plastic surgeon is there. No thanks.

By the way, tomorrow I’m going to Kuantan for a futsal tournament. Yes. Me. Futsal.

** For those who don’t know me personally, I have NEVER EVER played any kind of sports in my entire life. I don’t know how I got myself involved in this futsal team. And guess what? I only attended the training sessions ONCE… And that was today, when I was feeling half dead being post call.

I was post call again (was on call on Wednesday and Friday).

But it was DD’s wedding. DD has been my neighbour and friend ever since I can remember. Even her mother is my mum’s good friend and her sister my brother’s friend. I had no excuse to miss the wedding. Besides, it was an opportunity to meet old school friends whom I have not met for ages.

Everybody were either showing off their bulging tummies or their babies while I gave out free medical advices and consultation which simply reminded me that I have no life apart from being a doctor. Sad, isn’t it? Well… What to do. I live a pathetic life.

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It was a good gathering and it surely felt like a dream meeting all those people that I met. And I’m going back to my real life work tomorrow. No more (outside) social life for me for the time being. Good thing the ED family is a big happy family.

I was post call. Despite being sleepy and exhausted, I knew I had to go out. It has been a long time since I last had a proper outing with my friends.

When my colleagues at work asked me if I wanted to join them for (seafood) dinner by the beach, I almost shouted, “YES, I’M COMING WITH YOU GUYS!!!”

When they mentioned Pantai Jeram, I was clueless. Since I had no idea where the place was, I decided to go with them from the hospital. Little did I know I had been there before (to the same restaurant) with my family (and I even blogged about it!!! ).

Since we left the hospital early to avoid the rush hour traffic, we arrived a bit too early to order our food. Hence we took the opportunity for a stroll by the beach.

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We then returned to the restaurant… Ordered our meals… And started to dig in.

We had fish, prawn, squid & crab for dinner. Yummy!

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Tummy filled to the brim, we headed back to the (dirty) beach. We just didn’t feel like going home yet.

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There were broken glasses everywhere on the beach but we had more than enough paramedics around! There was nothing to worry (yeah, that was the joke of the day)!

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It wasn’t until dark when we finally left the place. Some of them wanted to go to i-City in Shah Alam (it’s famous for the bright light decoration around the area which they initially put up for Christmas last year) but me, CCY and Nas decided to call it a day. We went back to the hospital so that I could take my car and drive home. Apparently the rest only returned home at almost midnight.

Needless to say, I simply ‘collapsed’ the moment I reached home that night… And I was on call again the next day.

Had a very bad call last night.

The red (critical) zone is usually very quiet when I am on duty there. However, last night was a completely different story.

At 10.15pm, we received a call to inform us that a polytrauma (accident) case was coming and code blue was activated.

* code blue is the code to call when there is a major trauma case whereby multiple departments (i.e. general surgery, orthopaedics, neurosurgery, anaesthesiology, ENT & dental) will be called for standby and they would attend to the cases together with the ED team as soon as the patient arrives.

At 10.20pm, while we were still waiting for the major trauma case, we received another call that another accident case was coming in.

Then all hell broke loose.

The two accident cases arrived simultaneously, closely followed by a neurosurgical case from Hospital Klang… Then I just lost track of what other cases came in. It was truly a chaotic period in our red zone.

Everything went in a blur. I remember having to run to the blood bank for blood products… I remember having to bag a patient before passing it over to my friend and intubated another patient… Then I went back to bagging the first one… Then had to do CPR on another one… And back to bagging the first one… I can’t even remember what I did to whom and who suffered what injury.

I was extremely grateful that the orthopaedic house officer on call was a good friend of mine who did not mind helping me out from taking blood (the paramedics were too busy to help us with that) to doing CPR and bagging the patient. The surgical house officer simply disappeared.

Don’t let me start ranting about these new generation of housemen! When I was in the surgical department, I was the one who ran for bloods when there was a trauma patient with intraabdominal injury. I helped the ED team do CPR, take blood, set lines and whatever other things that I could help. After all, the patient was mine too. Nowadays, the ED team does everything. The orthopaedics and surgical housemen are usually nowhere to be seen.

Anyway, since code blue had already been activated, all the respective teams were already in the red zone when another accident case was pushed in. Instead of being attended by the ED team, he was first attended by the anaesthesiology specialist, followed by the ENT medical officer! Then we just sort of yelled, “Code blue! Code blue!” (without having to go through the call centre)

It was as if we were having a party in the ED… a TRAUMA party.

The others left as soon as they have done their parts but it took us much longer to settle our parts… i.e arranging for beds, stabilising the patients and sending them up to the wards/ ICU. It was not until at 4am when we finally realised that we had not documented anything on the first accident patient that we attended to… Even though other departments (that was involved in the code blue management) had already signed in their notes.

It was so hectic my MO didn’t even realised that there was a neurosurgical case (who was attended by me) and that our second accident victim had already went up to the ward.

Needless to say, I was a bit ‘off’ this morning as my usual post-call euphoria was a bit more compared to the usual one and I was smiling, laughing and dancing away despite having a bad call. My MO commented, “Nuni, you’re nuts! Are you sure you didn’t take anything (substances like drugs)???”

One of the accident cases last night was an interesting one… One car tried to avoid something (the victims were attended to in the yellow zone) and skidded before overturning several times into the other lane. Another car from the opposite direction crashed into the previous car and according to the driver of the second car (also sent to yellow zone), the first car ‘flew’. He did not remember anything else. He was clinically relatively stable. However, his friend who was sitting at the front passenger’s seat was sent to red zone. He died.

To make things more exciting, seeing that there was an accident and an ambulance was already there attending to the victims, a motorcyclist decided to slow down to have a look at the car registration number so that he could buy a winning lottery number scene and was hit by another car. I think he was triaged to green zone.

Moral of the story? Do not slow down when you see an accident. You might get involved in one yourself.

I had a very bad start today that I don’t even feel like writing about what went wrong.

Anyway, it was 9pm and I had not eaten anything since 1pm. I was hungry, I was tired and I was definitely moody and cranky.

Deciding that I deserved a short break from seeing all the ‘emergency’ cases in our ED, I went to the vending machine to get myself a drink. Little did I know that there were impatient relatives waiting over there.

Seeing that I was dressed as a doctor (duh, the stupid white coat and the stethoscope around my neck was a dead giveaway… there was no need to see my huge name tag to identify me as a doctor), they started ‘attacking’ me.

A: Why is the door to room 1 locked??? (room 1 is the secondary triage room… where they decide on the priority level of patients in the green zone)

Me: I would have no idea. But  they will call your name when it is your turn.

A: I’ve waited a long time. Why is the door locked???

Me: (talking VERY nicely) Could you please wait? They will definitely call you by name when it is your turn.

A: What if my father dies here?

Me: (already VERY annoyed) I don’t think he’s dying. If he is, they would have sent him to the other zone over that side (pointing towards the red zone). Besides, your dad looks really well (I waved at the elderly gentleman sitting on the wheelchair and he cheerfully smiled and waved back at me) and does not seem to have any medical emergencies.

I then pretended to go back to work and took a back way to the primary triage counter to find out why room 1 was locked and to inform the MAs that there are some really angry relatives outside the room. They informed me that the nurse in charge of secondary triage had already finished her shift and really needed a toilet break after the long hours (it has been a crazy day in our ED today) – hence left the place slightly earlier – and the one who was supposed to replace her at 9pm was already inside… Getting ready to call in patients (she would first need to start the computer, log in to her account, etc). I peeked inside the room. Indeed, she was already inside.

“How long have those people been waiting outside?” I asked them.

They simply laughed. “5 minutes,” was the answer that I get.

I really don’t understand this. If they could have waited until 9pm to bring their relatives to the hospital, why couldn’t they wait for another few minutes before they are seen by any medical personnel? If your dad didn’t die during the many hours spent waiting for you to bring him to the hospital, I’m sure he wouldn’t die during the 5 minutes spent waiting to be seen at the secondary triage.

The same thing has been happening over and over again. Many of these people have been having their illness for days, weeks and even months and they never bothered going to the clinic early. Instead, they choose to go to the hospital in the middle of the night and starts complaining about the waiting time. I’ve heard the statement, “Why is this department called the emergency department if we have to wait for a long time to see the doctor?” so many times I’ve lost count. At least 70% of them DO NOT have an emergency AT ALL.

Why couldn’t they go to any of the many government clinics during the day? Why couldn’t they visit the numerous GPs if they really think they have a medical emergency? Why do these people have to make our lives miserable?

Yes, ED is driving me nuts, especially when I have to handle green zone. Even my friends noticed that. My mood has been very volatile lately. God help me from screaming at these jokers (as one of my MOs like to call them). I need a break.

N.B.: I have so far managed to keep my temper under control. I have not scolded anyone. In fact I treated everyone as if they were my only patients… All smiles and allowing them to take my precious time by explaining in detail (if required) regarding their illnesses. They may be rude to me but I just smiled and ‘patiently’ spoke softly to them. After all, they are SUPPOSED to be sick and need my utmost caring attention. SO FAR. But it might not last for long. I just hope it would last long enough until I finish this posting.

People always say that a doctor’s handwriting is so bad that only another doctor can read his handwriting. This is certainly NOT true. A doctor’s handwriting is SO EXTREMELY bad that no one, not even another doctor can read it.

I remember one referral that was written in squiggly lines similar to my medical MO’s handwriting. Since I could not interpret the content of the letter, I showed it to the said MO.

MO: Of course I can read this. It’s similar to my handwriting

Me: Yes, exactly the reason why I asked you to read it.

MO: …

Me: Any problem?

MO: Arrrggghhh!!! I can’t read this!!!

Me: That is how we feel about your handwriting too.

Most of the time, we just ignore those referral letters. There’s simply no point bursting our brains trying to decipher the codes. It’s much easier to ask the patients themselves what had brought them to the clinics and why did the doctors there asked them to come to the hospital.

Besides, most of the referrals are useless anyway. I’m not trying to brag but my referral letters (as a trainee doctor) are much better than those that I’ve come across (supposedly written by experienced doctors but nowadays you can’t really be very sure as even medical students are illegally doing locum in clinics).

Recently, I came across this one interesting referral from a nearby government clinic. The provisional diagnosis (from the clinic) was that the patient had a silent myocardial infarction; i.e. a heart attack. Indeed, it was really a heart attack and we immediately started him on thrombolytic therapy the moment he was sent to our red zone.

While observing him who was cheerfully talking to our staff and laughing away, I read the referral letter again. At the bottom of the note, I saw something weird… “Pt (patient) wants to die on his own!”

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I seriously could not read it in any other way. I showed it to my friends and MOs and they also came to the same conclusion. It was really weird that a doctor should write something like that… And even if it is true, why would the patient need the referral letter and even come to the hospital?

Suddenly one MO had a sudden enlightenment on the puzzling referral letter. The word was DRIVE… not DIE. So it should read, “Patient wants to DRIVE on his own.”

Meaning that he only refused transportation by ambulance; not that he wanted to die.

It was brief… lasting for about 10 minutes. But it was a bad one. Good thing it didn’t last long.

First we saw how the canopy for our fever centre ‘flew’ across the road. Fortunately, the wind calmed down (albeit only a little) before the structure had the chance to cross the wall and fall to the ground level where the car park is.

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A few minutes later, a very anxious and stunned family drove in for shelter. A tree had fallen right in front of their car when they were on the road. Apart from some small cut, they suffered no other injuries. Yes, we gave them hospital clothes and blankets the moment they arrived as they were soaked to the skin. They were extremely lucky that the tree fell in front of them… not on top of them. Imagine the horror if the latter happened.

** At the time of the incident, I was stationed at the triage counter and not on regular duties as I was supposed to be on call that night. **

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Reminds me of the storm back in 2003 when almost all the students’ cars parked at the UiTM hostels in section 18, Shah Alam were smashed by the big trees along the road. That storm collapsed the roof of a nearby wholesale market. I myself was driving around in circles trying to find my way to Section 7 to fetch Kona from her kindergarten… The roads were either flooded or blocked by fallen trees.

If some of you remember, some time ago, I wrote about attending the ACLS course when I was still in college.

I finally received my ACLS certificate of competence (which I passed in May 2008) today. Due to some unforeseen circumstances the organising committee was not able to prepare the certificate when I was still in Penang. Intermittently I would call them enquiring about the certificate (more like twice a year. ). Arrangements were made for me to collect the paper or for them to send it to me but cancelled or forgotten.

After all these years… I finally received it today! And it is no longer valid! I can no longer brag that I am officially competent for advanced cardiac life support.

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No, I have no intention in renewing it, unless forced to, thank you very much.

Come to think of it, I still have one pending certificate of competence. I passed (for the 3rd time) my Basic Life Support course last year and I have not received the certificate (the IC number that they typed on the paper was someone else’s). I should remind the sister in charge about it again. On the other hand, it would be a good fun when I receive the certificate after it has already ‘expired’.