I babble, I ramble, and I rattle

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 And it is no longer valid!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’.

Venue: Bandar Sri Damansara Club

Date: 5 June 2010

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Anjali is my MO’s daughter whom he adores like nothing else. When I worked with him, he would regularly update me on the latest videos or pictures of Anjali. About 3 weeks ago, he asked me to make sure that I am not working or on call on 5/6/2010. One week later, I received the invitation card.

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The food was great and we had Paddle Pop ice cream for dessert! ** Please don’t ask how many I had.

The party packs were only given to children but since it was already quite late and there were no new arrivals (most importantly, we made sure our big boss had left the party ), me and Jen helped ourselves to the goodies. While taking our picture, my MO commented, “Nobody is going to believe that you guys are doctors.”

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Ahem… That certainly was the case when I went to do my hair the other day. “A doctor???” was the response that I received when I answered the stylist’s question.

Funny thing was, that day I went out wearing my scrubs (I was post call and couldn’t be bothered to shower or change my clothes when I left the hospital that day) and people actually thought I regularly wear it to go out?

Date: 23 May 2010

Venue: Futebol City, Kepong

Our big boss, a big football fan, started a futsal tournament for all the Emergency Departments in hospitals in Selangor. Our hospital lost the cups (one for male, one female) last year.

This year, with the mission to bring home the trophies, she decided to send the house officers to represent the female team.

The best thing was that none of us had played football or futsal before.I myself had never ever participated in any sporting event prior to this. Yes, I was once active in karate-do (please do feel free to laugh at me. I can hardly swing my nunchaku properly now without ending up hitting myself. ) and regularly went hiking or jungle trekking especially when I was in Dublin. I might also have played paintball twice when I was in Penang but that was it. Those were the only outdoor physical activities that I’ve ever done in my entire life. My co-curriculum activities in school were limited to debates, poetry recitals, song writing and quizzes. Like I always say, “I’m sporting, not sporty.” :lol”

Anyway, with a total of 3 practice sessions and 1 friendly match which we lost 1-10 to the other team (I myself only attended one of the sessions ), we headed to the tournament venue with the hospital van.

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Being called for our match was like being sent to a death sentence. We were probably the only team which didn’t bother warming up or practicing prior to the match. We were definitely the only team spending our time gossiping around as if we were out for a picnic.

My teammates at the beginning of the first match… We were all screaming to go home.

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Needless to say, our performance was bad. We were beaten by Hospital Selayang 4-0.

Our coach…

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I didn’t play during the first match but they sent me in during the second one which ended up in a draw. They then sent me again in subsequent matches. We lost by a penalty shoot out during semi final and managed to lose by only 2 goals during the 3rd place (re)match against Hospital Selayang. My right hand was kicked during that match and I ended up with a swollen hand which I could not fully grip or hyperextend for 2 days.

We sent two male teams for the tournament. Team B made it to the final and emerged champion!!! Boss was so happy that we finally managed to bring the trophy home, she forgot to hand it over to the team during the closing ceremony… They took pictures with her holding the trophy!

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The female team with our coaches (far left and right, back row) and impromptu manager for the day (white t-shirt).

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The female team + male team B…

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More pics on my Facebook.

Someone had been stealing my packet Milo for the past few weeks. When I am on call, I usually would either bring Milo from home or buy them at the canteen when I go there for late breakfast or early lunch. Then I would keep them in the doctors’ pantry. However, most of the time, by the time I wanted to drink them, they would be missing from the fridge.

The last straw was when I lost TWO packets of Milo in less than 3 hours for the SECOND time in less than a week!!! That was it!

The next thing I know, I was heading to the local pharmacy to get medication X (obviously not the real name… I’m not giving you guys any ideas, ok? ) which is a very potent laxative, usually used for pre-operative bowel cleansing.

The pharmacist was baffled as to why I was looking for that specific type of laxative. She tried offering me other options but I firmly said no. The moment she found what I was looking for (fortunately she had one last bottle in stock), I could not help but to express my glee and told her my plans.

Pharmacist: This is a very potent laxative…

Me: Yes, I know. That was why I specifically looked for this and not other laxatives.

Pharmacist: I hope you know what you’re doing. This laxative is usually used for…

Me: Trust me. I’m a doctor. I know what I’m doing. (Boy, I had never ever felt that good when making that statement0)

Pharmacist: …

Me: Yes, I know how potent this laxative is. We usually use it for bowel cleansing prior to operations and endoscopes.

Pharmacist: Just don’t put too much in the drinks, ok?

Me: We’ll see.

I will not explain how I did it but I did put medication X in 2 packets of Milo which I purposely left in the fridge in the same pantry. Strangely enough, the drinks didn’t go missing as soon as I expected… As if the thief knew that I was going to sabotage him/ her.

However, today, both of them are gone. I couldn’t help from making a big announcement to the department of my ‘achievement’. They promised to look out for who has been down with diarrhoea today. I don’t care anymore. I am not interested to know who the thief is. I only know that whoever the thief was, he should have learned his lesson.

Happy diarrhoea, Mr Thief.

My mum’s name is Sabariah. My boss’ name is also Sabariah.

At work, people have been calling me Sabariah Junior because they say I do look like my boss. I always replied, “I AM Sabariah Junior because my mum’s name is also Sabariah.”

Some people actually thought that I am really my boss’ daughter.

Basically every single person who works in ED had at least once commented that I look like my Head of Department… Though most of them had commented more than 20 times, I guess.

Almost every day people would pretend to be shocked to see me in the evening or working on weekends because they thought I was Dr Sabariah and thought that I was doing rounds.

When I attempted to do some procedures, they would say, “Of course you can do it. Boss is really good with procedures.”

When boss was away, they would make comments like, “Eh, I thought you’re attending a meeting in Melaka?”

Even the new registrar told me that he almost reported to me on his first day of work because he thought I was Dr Sabariah.

Of course, Dr Sabariah herself is aware of these talks. According to my friends, before I joined the department, she did comment that the house officer who looks like her was joining the team.

So… Do we really resemble each other? I let you decide.

** Sorry for the selection of pictures. I rarely had myself photographed it was so difficult to find a decent picture of myself (that is actually the only picture of me that I can find in the computer. ). As for my boss’ picture, I’ve only had one occasion to take pictures of her and I was too shy to take a proper shot of her.

From left: my mum, me, my ‘mum’ at work

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By the way, earlier today, Eki asked what had happened to me to change so much from the person he knew when we worked together; i.e. from someone who is very patient with patients (HAHAHA!!! Eki, since when???) to someone who seems to be losing her cool.

To start with, I do have a short temper. I’ve always wondered how I’ve been able to keep my temper under control since I started working.

Secondly, I AM losing my patience dealing with the not-so-sick people who think that they’re at the verge of death especially when they start bragging about their political connections, academic qualifications or working experience.

Thirdly, I just realised a few hours ago that since starting this new rotation, I hardly get any afternoon & evening to myself. I would either be on call, post call (hence I would spend the entire day sleeping) or doing the evening shift (i.e. 2pm until 11pm and the next day I would be on call again so I would go to bed as soon as I get home around midnight). Granted, we do get one day off every week but that is only one day.

When I worked in the wards, at least I would be free after 2pm (though sometimes I was only able to go back after 3pm – 4pm) on weekends and when I was not on call, I finished work at 7pm.

The working time is about the same but the fact that I don’t get to spend many evenings doing stupid stuff on the computer or just idling around probably did contribute to the change in my attitude at work. Yes, I have changed. If you haven’t noticed, lately I’ve been regularly whining on my blog and also on my Facebook (for those who are my friends on Facebook).

*sigh*

Ok, enough complaining for today. Time to go to bed. I have a very long day tomorrow.

It was 4.30am on Saturday.

I had just settled all my patients in the yellow zone and was about to lay my head on the counter my MO suggested that I help out in the green zone. Exhausted and extremely sleepy (I had been working since 7am the day before!), I reluctantly agreed and dragged myself to the dreaded zone called ‘green’ where all sorts of weird people who suddenly decides in the middle of the night that they have an ‘emergency’ case needing medical attention. I’ve seen many patients who have been having the condition (swelling/ skin lesions/ etc) for many weeks or months and suddenly decided that they needed to go to the emergency department instead of the normal clinic.

There were still those who had registered at 1.45am but not yet seen by the doctors. I called one number.

The moment the door was opened, I tried to be as close to my usual (less sleepy, less tired) self… Smiling, I greeted them good morning and asked how they were and asked the elderly gentleman what had brought him to the hospital so early in the morning. I then apologised for the long waiting hours.

Very systematically, the elderly gentleman who was an imam somewhere listed down his problems… (1) back pain for 1 week, (2) unable to pass motion for 3 days and (3) occasionally unable to pass urine satisfactorily but claims has been followed up in HUSM in Kelantan for that problem. He is currently visiting his children in the Klang Valley.

After examining him, it was obvious that what he had was only some muscle pain and the inability to pass motion was probably due to change in diet as he had just come visiting a few days ago. Consulting my MO, she agreed and asked me to discharge with the necessary medications.

Me being me, I took the trouble to explain to the gentleman as well as his son and daughter (I don’t know which one was his child… the other was the spouse) what our impression was and told them not to worry too much. If he doesn’t get better, he can come to the hospital again. However, my mistake was in suggesting them to go to the private practice for a shorter waiting time.

I pitied the uncle who had to wait for more than two hours just to get some stupid medications that you can actually buy from the pharmacy yourselves. I expressed my concern that since he also complained that he was unable to sleep due to the pain, he might as well spend the nights and mornings at home trying to get some rest instead of sitting on an uncomfortable chair in the hospital, waiting to be seen by the doctor but it went unappreciated.

The son and daughter accused me of turning away patients from the hospital and requested for a referral to the specialist.

Still patiently, I explained to them that even if I do give a referral to the specialist (which specialist anyway? We don’t have a specialist dealing with simple muscle pain!), the clinic would most probably give a 2-month appointment instead of seeing him immediately.

Now, THAT honest advise of mine really riled them up. They started accusing me of being rude… not smiling (hello!!! I thought I grinned as if I was getting paid RM100 to see one patient instead of having to work for 36 hours to get that measly amount of money when they walked in) and not being nice to them as well as trying to turn them away from the hospital.

Still nicely, I explained to them that the reason I suggested going to the private was because I didn’t want him to wait for a long time just for some medications that are freely available outside.

His daughter then said, “We don’t mind waiting. Haven’t we waited for a long time today?”

While at the same time, the son said, “Why is this department called the EMERGENCY and TRAUMA department if you have to wait for 3 hours to see the doctor?”

I was so tempted to say that it was because some most people who came to our department actually had NO medical emergencies. For example… We’ve seen a patient with a simple paper cut asking if he needs some suture to close up the wound. We’ve also seen people with history of accident 3-5 years ago suddenly came to ED complaining of some pain which is not even at the site of previous injury. I have personally seen one lady who had history of heavy menses and already under O&G follow up… Came because she was having her normal menses which was not heavy at all!!! You have no idea how ridiculous some of the complaints are. Sit in the green zone for 1 day and you’ll see what I mean. Basically, many came to get MC.

I was also tempted to rub it in by saying things like, “If the back pain has been there for 1 week, why on earth do you have to come today at 1.45am? Couldn’t it wait until tomorrow morning?”

Since both appeared to be extremely angry at me, I just kept quiet… Letting them vent out their frustrations.

Then the son said, “So when can we see the specialist? 2 weeks”

I was speechless. I thought I already explained that even if I did refer to a specialist, they might only give an appointment at least 6 weeks from the day they go the clinic due to the long waiting list. Perhaps they were not listening earlier on. I explained again.

By then they were already raising their voice to me, accusing me of being rude and had no compassion towards those who were ill (i.e. their father). The daughter kept saying things that I was supposed to console/ comfort them and give then assurance when they’re worried about their father but what I did was completely the opposite. They said I didn’t care about their father. They said I was a bad doctor.

They then RUDELY walked out from the room with their father (he was on a wheelchair but he could actually walk) who all the time remained quiet with the threats to complain to the hospital director and the media. “Do you think we’re stupid? We can complain to the press and the hospital director,” said the son while walking out while I heard the daughter muttering, “You can be rude to us but we can complain.”

Me? Rude? When? Did I ever raise my voice? Did I ever ignore them during that consultation? Didn’t I continue to smile (though a sad one) and gave them my full attention despite all the accusations that they threw at me? Most importantly, didn’t I explain to them regarding their father’s condition? Didn’t I take the time to assure them that it was nothing and would probably go away in a few days and that we were giving him some medications to relieve the pain even though there were still 30 patients outside waiting to be seen?

One thing for sure, they should have been very grateful that it was me that saw him that morning. I am not trying to brag but I am STILL one of the nicer ones around though I worry that I might become worse if I have to deal with these kind of people every single day for the next three months. I still explain to patients regarding their problems and their impressions instead of sending them out as soon as the medications have been prescribed.

I am not a saint. I do make sarcastic remarks to patients every now and then. I even scolded a patient once (he had not been taking his medications for many weeks). But for this particular case, I was extremely upset to be accused as such because I was being extremely nice to them. I didn’t even make a single statement to offend them and yet they accused me of being rude?

I wasn’t stupid too. Needless to say, that morning, I greeted the arrival of our ED sister with an incident report (it is our way to complain about patients). Though not as effective as going to the press or complaining to some big shot somewhere which the patients can do, the incident report does (sometimes) do wonders to the doctors’ psychological well being. As for me, I have this blog. Doing the incident report was just a way to protect myself just in case they do decide to go and report me to someone.

You think I give a damn? I think not!

Being post call on 12/5/2010, I followed the ambulance again. Apparently a young lady fell in the bathroom and was unable to get up (or something like that).

To start with, we were running short of ambulances. We only had three and received two calls at the same time. I followed the first ambulance which was headed to Mutiara Damansara. The second ambulance had to go to Rawang to attend to an elderly gentleman who had a fall in his house. Looking through the call notes, I couldn’t help but wonder how can a young lady (I don’t remember the exact age but she was in the early 20s) fall in the bathroom and needs an ambulance to go to the hospital unless she is in severe pain or actually attempted suicide (yes, I have an overactive imagination)?

Secondly, the person who gave us the direction to the place was obviously the typical female who doesn’t know how to give directions. I bet she can’t read maps too! Obviously, the MA – medical assistant (I was actually just tagging him around… he’s the one who does most of the work during ambulance calls) – had a hard time trying not to laugh as I went on and on cursing all females who can’t read maps or give directions (especially those with terrible sense of direction) as if I am not a female myself – which he was quick to point out.

In the end, we decided to wait at the side of the road and wait for someone who was with the patient to guide us to the place. Suspiciously the van which came to guide us the way looked like one that is used for shooting films/ drama. I pointed it out to the MA. Almost immediately, he put on a face mask and advised me to do the same.

Guess what? We ended up in a shooting scene for Habil & Qabil (I don’t know if it’s a movie or drama series… I don’t care). A young girl (I am very sure she wasn’t even 20 years old) was sitting at the side of the corner shop lot, looking sick. She said she felt dizzy earlier on and almost fainted but she was feeling better already.

It was all I could do not to show my anger on the scene.

1.  She skipped her breakfast and everybody at the set knew that. Couldn’t they try giving her some food first and let her rest for a while to see if she gets better? I know for a fact that even school teachers know how to handle such cases. Oh wait. Perhaps filmmakers in Malaysia are not so educated and don’t have much common sense. Hence the stupid movies (with ridiculous acting by the actors) that they produce every year.

2. They had so many vehicles (vans and cars and more cars… especially expensive ones) among them. Couldn’t they just bring her to the hospital instead of calling the ambulance???

3. She was an actor too, wasn’t she? In my opinion, most actors in Malaysia have little (if any) talent for acting but every single person in Malaysia especially those who have started working knows how to act sick to get an MC.

Hold on… They wanted to use our ambulance for their scene!!! One of them actually talked to our driver and asked if they could film us carrying the actor into the ambulance and drive away.

I was on the verge of losing my temper and I was already crossing the thin line between being annoyed to outright rude. Good thing earlier on the MA advised me to put on a face mask just in case these people were filming or taking pictures because we might get into trouble later. At least, with the mask on, it would be slightly more difficult for them to identify us should they decide to lodge a complaint against us.

My point is… These film makers are misusing the health service. They wasted our time and resources. I felt like hitting them on the head with the heavy emergency kit that I had to carry and THEN bring them to the hospital.

I do watch movies… but rarely Malaysian. I do recognise some international celebrities… but I am ignorant to who is who in Malaysia.

So if you want to brag to me that you have Abby Abadi with you? Fine. Go ahead. But don’t expect me to drop my jaw and go speechless. I don’t care about artists and filmmakers especially those who are from Malaysia. They may be rich and they may be famous but I don’t fancy them. I’d pay more attention to small kids playing kites by the beach or fishing by the river… Anytime.

N.B.: Abby was there. I recognised her despite the ugly wig and dress. Perhaps she was playing the part of a mad witch or something like that. The ambulance driver confirmed that it was her by asking those on the scene if it was Abby. I was too angry (as well as tired and grumpy due to the lack of sleep) to look around if there was any other famous actors there.

I know this is one day late… But who cares! Happy nurses day!!!

It was a merry day yesterday despite me being post call and only managed to get an hour of sleep nap that night (and that’s already considered VERY lucky!). At 7am, somebody came with a HUGE hamper for the nurses in ED.

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For the first time ever, I saw Aboy in his official uniform! Usually, he would just wear the ED uniform instead of the staff male nurse uniform. Aboy is one of my favourite male nurses in the hospital (not that there are many, to start with. ). The others would be Shahlan and Vijay. Aboy’s most famous quote would be, “I’m NOT a staff nurse. I’m a male nurse. ” Yes, Aboy… Whatever.

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I splurged for them yesterday. Bought FIVE Secret Recipe cakes for them. It WAS a lot of money but I think they deserved it. They were the ones who really helped me to survive in the hospital especially during my early days of working when there were not many house officers around.

For 6B & PAC nurses… Thank you for being my friends when I had none. Thank you for supporting me from below when I was hit from above. Thank you for being there for me even when my own colleagues back-stabbed me (thank you for purposely giving one of them a hard time too ). Thank you for the physical, moral and emotional support that you’ve all given me when I was still struggling with the system and the people involved. Thank you for buying me dinner when you knew I was too busy to find my own (they bought me Mc Donald’s!!!). Most importantly, thank you for teaching me all the things that you’ve taught me. You trained and initiated me into the service. You were one of the best staff nurses teams I’ve come across.

For 4A nurses… Thank you for all the help you’ve given me when I was there. It was tough when there were not enough house officers around especially that time when I was alone. Thank you for all the assistance that you’ve provided. Thank you for all the midnight and early morning favours that you’ve done for me. Thank you for the shuffling of patients (in the same ward or to the other wards) that you have to do at the wee hours of the morning when I needed to send patients up from ED. Thank you for pushing the patients around at 7am (their ‘holy’ time of passing over report to the next shift when no one… not even specialists… could disturb them) to arrange for beds upon my requests especially when that involved transferring patients to other wards and accepting new ones from ED. Thank you for still obliging to my pleas even though I am no longer in the same department.

*** I think current medical HOs – especially those posted to ED under medical or doing ED calls – are useless when it comes to arranging beds for patients. I still need to do that myself. ***

For 4c nurses… Thank you for the good times we’ve had together in that ward everybody called the Angel of Death. It would have been very hard for me to survive my extended stay in the ward (yes, I still blame Dr Phang for that. He promised that I could go to PKKN after spending 2 weeks there but decided that he needed me to ‘train’ the new HOs there. ) if not for you guys who had learned the hard way to look on the bright side of life despite the bleak future of the patients in the ward and shared the experience with me. It was tough dealing with the patients themselves and their over-concerned family members. You made it sound like fun. Of course, if it wasn’t for Dr Anila, Dr Cheng, Farid & Intan, it wouldn’t be half as fun. I miss doing our, “Dr Nuraini noted” or “Dr Farid noted” or even “Staff nurse Zila noted” jokes.

For the ED nurses… Even though I’ve only joined ED for 2 weeks, our relationship had started 3 months ago when I was the medical team representative in ED. I could never thank you guys enough for all your help during the peak season of dengue fever when I almost became a robot when it came to dengue fever clerking and management (also many thanks to the previous ED HOs who helped me to review the blood results when I was still struggling to see all the new patients who just came in). Thank you for getting me the folders in the middle of the night or even early in the morning when I was too exhausted to walk around. I knew you guys were tired too. Thank you for helping me find my way in the dark when I was first stationed in ED. Thank you for allowing me to conquer that one particular computer at the nursing counter whenever I was on call in ED even though when I went to the counter, you were already using that one computer that you knew I liked (because of the location and chair). 

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To all the nurses that I’ve had the pleasure working with… Happy Nurses Day!

By the way, I would also like to wish my mum a very happy (and very belated) mother’s day.  I was on call on that day and came back late the next day (hence spent the entire day evening sleeping). I was on call again on Tuesday and only came back yesterday. I’m on call again tomorrow. <sigh>

Two guys were shot.

One, a middle aged Malay male, said to be an active intravenous drug abuser was under the influence of drugs and was said to be attacking innocent people with parang. The other one, an innocent young Indian chap who happened to be at the wrong place at the wrong time. Both received a bullet each from the police who was firing in the dark.

Who was at fault? You tell me. What actually happened? I don’t know. If this doesn’t appear in the news, perhaps I’m making this up. Just assume the above said incident never happened.

By the way, being post call, I followed wherever the ambulance went to this morning (though usually I spent my post call days sleeping in the Medical Emergency Call Centre – which is an awesome high-tech place in the hospital that not many are aware of its existence – being in the place gives the feeling that you’re in a control tower of some sort. ).

There was a case of snatch thief. The interesting thing about that case was… Someone who was driving his car saw the incident and decided to hit the thief with his car. Unfortunately, the thief managed to run away into the bushes with his parang. I know this is bad and as a doctor I shouldn’t be saying this… But I wished he had hit the person harder, with a (much) higher speed and caused a more serious injury to the bad guy. By the way, it was the victim who needed the ambulance to go to the hospital… Not the thief.

Almost on a daily basis, we would hear complaints from the public that the services at the government hospitals are slow and they have to wait for a very long time to see the doctor.

Several years ago (I really can’t recall the exact year), a controversy erupted when a doctor was caught reading a newspaper when there were still many patients waiting to be seen outside. I didn’t blame him back then and I still don’t blame him for what he did. Sometimes patients make you sick… Really sick of seeing them.

Had anyone considered the fact that at least 70% (from my rough estimation) of those presenting to the emergency department actually have no medical emergencies at all? Many of them just wanted an MC so that they don’t have to go to work.

What about the public’s responsibility in taking care of their own health? If you have diabetes or hypertension or any other medical illness and already prescribed with some medications (the amount of which can sometimes be quite overwhelming), would you please take them regularly? If only Malaysians know how to comply to their medications, I think the burden on the emergency departments can be reduced by up to 30%!

Some of the ‘ridiculous’ cases that I’ve seen in ED:

1. A lady with a known case of uterine fibroid, already under O&G follow up and started on some medication to control her heavy menses. Her menses stopped 3 months ago. Came back to ED because she started having menses again (which is not heavy at all!!!).

2. A young chap with history of falling of the motorcycle THREE years ago… Came back to ED because his fingers felt somewhat numb when he woke up that morning.

3. A teacher with no medical illness who had spent the entire night marking her students’ works complained that she had been having neck pain when she woke up that morning.

4. An elderly lady with non-bleeding, reducible haemorrhoid, already under surgical follow up and scheduled to be seen in the SOPD that very morning at 8am just had to go to the ED at 5am that same morning because she was worried about her (still reducible) haemorrhoid.

5. A mother who brought her 1 year old daughter to ED because she claimed that her daughter was not taking orally well and had several episodes of vomiting (no vomiting was observed during her stay in the observation ward). She insisted that we give the daughter an intravenous fluid drip which to me was ridiculous as she was very well hydrated. When the IV line was dislodged, we asked if she could drink… We really wanted to discharge her. Mother insisted that we set another line (note that it was very difficult to get the line… The very experienced staff nurse had to poke her 3x to get the first line) for continuation of IV fluid. She insisted that her daughter couldn’t drink but I did see her drinking from the bottle TWICE earlier on (I’m sure she finished at least half the bottle). It took us another 2 attempts to get the second line. Oh, well… some parents are really quite strange.

6. One guy who appeared to be extremely well, came to fever centre at 5am. Annoyed, my opening statement (instead of the usual greetings) was, “Give me ONE good reason why you have to come at 5am… Just ONE… GOOD REASON.” He had already seen a private doctor 1 week before that and given some antibiotics as well as other medications. His fever and sore throat had already resolved many days before but he was still having some minor coughing, hence he had to come at 5am. I only saw him just before 6am. He then requested for MC. Feeling generous, I offered him a time slip from 5am until 7am, which was expectedly refused by him.

Don’t even get me started on those who defaulted their medications or follow up and came back with uncontrolled diabetes or hypertension… Or those who have already been advised for fluid restriction because they have heart failure but they think they are smarter than us and decided that they’ve been ‘cured’ of their heart problem, hence never followed our advise to control their fluid intake just to come back with swollen legs and difficulty in breathing?

Or those who actually have follow up dates in other hospitals but came to our hospital anyway because they thought we might have better service? Flattering thought… But useless. It would only cause more harm than good as some specialised treatment would be delayed. 99% of the time, we ended up referring them back to their previous hospitals because we don’t have the specialties specific to their illnesses.

Apart from ‘difficult’ patients, we also have to deal with stupid GPs. Examples of ridiculous referrals from private GP:

1. Persistent giddiness & symptomatic anaemia for investigation –> When asked further, the patient admitted to skipping meals in the morning and would have giddiness (not that frequent, anyway) in the afternoon and sometimes would get some palpitation and sweating. Resolved when she takes her lunch. Any clown can tell you it’s because of hypoglycaemia. I even knew that since I was still in secondary school. Anaemia-wise, she was as pink as any healthy person could get (in fact, I was paler than her), her haemoglobin level was 12 and I don’t think she had any symptoms of anaemia.

2. IM Cephalexin 500mg stat given (I didn’t know Cephalexin can be given intramuscularly!) but fever persists. Kindly do the needful.

–> Cephalexin is an antibiotic, you idiot GP (or is it a medical student doing locum?)! Of course it would not have any immediate effect. Note that the patient only started to have fever that morning and went to the GP in the afternoon.

3. To rule out dengue fever –> patient’s platelet level (done in the private clinic itself) was 240!!! Yes, we’ve seen one or two dengue cases with normal platelet level but when you see a normal platelet level, it is highly unlikely to be dengue fever especially if the level is >200. Perhaps it was another example of medical student doing locum in ED.

4. Kindly do a throat swab to rule out H1N1 –> we receive A LOT of referrals like this. We don’t rule out anymore. We just treat.

Manning the fever centre can really drive you crazy as people come with the slightest feeling of unwellness just to get MC or to request for a throat swab. I’ve come across several referrals from private GPs to do troat swab but the most ridiculous has to be this one: Patient’s friend is suspected to have H1N1. Kindly do a throat swab for this patient to rule out H1N1. The patient did not even have fever or cough or any other symptoms of any illness!!!

Many people came to our fever centre requesting for throat swabs because they are scared they might have H1N1. When we tell them we don’t do throat swabs, they get angry. They pay only RM1 and expects us to do a test which costs almost RM200 just because they are worried about that illness which most of the time is self limiting?

I myself am quite sure I would have been positive for H1N1 once if I were to do the stupid swab. It was a weird kind of flu… Symptoms that fit the stories of those who have been confirmed with the illness. I didn’t even take Tamiflu but I completely recovered 3 days later. I could have done the swab myself if I wanted to (we have unlimited supply of the equipment in my ward – the infectious disease ward) but why should I? It is a waste of money & resources. The swabbing part is extremely easy… But the cost? Has anyone ever thought of that? I’m not sure how much exactly the cost is for one throat swab but I know it is between RM150 to RM200.

As of 30/4/2010, we already have 54 (FIFTY FOUR! No kidding!) deaths in Malaysia due to dengue fever this year. H1N1 deaths? I don’t know the exact figure but in my hospital alone it is still zero as compared to several deaths due to dengue fever. Now, YOU tell me, which one is more scary… H1N1 or dengue fever?

Many parents actually bring their sons and daughters at 3am in the morning claiming that the children had been having fever since 12 midnight. They do have paracetamol at home but had done nothing to try to bring down the temperature. 3 hours of fever… What do you think we’d do? We’d just discharge with paracetamol anyway. I pity those sleepy kids who had been dragged out of their beds in the middle of the night by their inconsiderate parents just because the parents wanted MC so that they don’t have to go to work the next day.

If the above stories are not ridiculous enough for you, my dear readers… A policeman brought his wife who had recent history of gastric ulcer (it was just a Forrest III ulcer, no big deal), already under SOPD follow up and insisted for her admission because he had to go to work and there’s no one to look after her at home. He kept stressing that he was a policeman. SO WHAT??? Since when has the hospital turn into a nursery?

Sometimes, I wish I can say what my MOs love to say… LET THEM WAIT until they decide to abscond.

Some advice to the general public:

1. Do not go to the hospital requesting for throat swab. We will be very angry. Throat swab is a waste of taxpayer’s money and it does not change the management since it takes some time to get the result back. The principle now is just to treat. We don’t confirm the infection. Throat swabs are only done for patients who require admission to the ward.

2.If your children develop fever in the middle of the night, don’t panic. Given them some paracetamol (a.k.a Panadol). Bring them to the clinic/ hospital first thing in the morning. No need to drag them out from bed at 3am. In fact, if the children are not vomiting away or having severe diarrhoea or difficulty in breathing or bad sore throat or any other worrying symptoms, you can safely treat them at home with paracetamol. If fever persists until the 3rd day, bring them to the hospital. We’ll check the blood for dengue infection (the blood parameters would be normal in the first 2 days of infection).

3. If you think that your illness/ problem is not an emergency case, e.g. a paper cut (yes! There was a patient with paper cut on his finger, came to ED and asked if we needed to suture his (extremely superficial) wound) or having some muscle pain (we see this problem a lot in ED), please do not waste your time and ours in ED.

4. If your intention is mainly for MC, please don’t bother coming to the hospital. At most, we would only give you a time slip.

5. Please be patient and wait for your turn. You might be needing the service more than other clowns do but if they came before you (in the same category of urgency), we need to entertain them first.