breather

yessss it's the long weekend! :D

just what i needed - started it all with a great call on thursday night - unbelievably good! :D
well, except for 2 things:
1) my attending REFUSED to let me do an evacuation - i was most upset!!!! no reason for refusing, it was a straightforward simple case!
2) my delivery wasn't the best, perineal tears up to the urethra and clitoris, OMG. thankfully the episiotomy repair wasn't epic, took me only 30 min. still, i hope she has no problems peeing!!!
cute baby though :D <3

enjoying myself muchly this weekend, going to have a rest and sleep till i have functional decline, hurhurrr!

oncology

... gynae-oncology, to be precise.

the patients are such sickies, and i fear that most of them won't make it.
it saddens me immensely when we prep the patient for op, hope for the best, and when we open up - tadah! tumour everywhere.

it just feels like such a waste, the intensive pre-op tests, the hopes and expectations, and i don't know, the feeling of being beaten before you've begun?

but thankfully, my bosses have much more experience than i do, and prof (being the awesome prof that he is!), will "roll up his sleeves and plunge elbow deep into the muck".
if i'm EVER having any gynae op, i'm definitely getting prof to be my surgeon!!!! sheer awesomeness!!!!

EBL for a certain Wertheim's was 6L - more than the blood volume of the patient! yet patient is still alive and kicking (not very well, but you get the idea). chances for this patient look good :D i am so amazed.

i used to wonder, who would ever want to do onco? but now, looking at my rotation through (obviously you need a heart of gold, think it's possible for me to grow one?) gynae-onco, i think it's a very worthwhile and fulfilling career path - i just don't know if i like it enough to want to reach elbow deep into the muck everyday! :\

leave is so good :)

i love being on leave! :D

the feeling of waking up late in the morning, with the sunlight and fresh air hitting your face, without needing to rush to hospital at the unearthly hours of the day, being able to actually eat breakfast slowly and read the papers instead of scarfing down cold food, being able to walk around my neighbourhood and appreciate being in the sun, not having nurses call me for the most irritating things, not having to update families, not having to deal with irritated radiologists, not having to deal with attendings and residents, eating home food, spending time with my family and friends, ahhhh.

LIFE IS BLISS ON LEAVE :D

servitude?

back to gynae wards - got to admit i'm relieved, i love obs but i feel more at home in gynae because it's so much easier!

more about my new ward in a bit when i'm more awake, had call last night and it was disastrous. patient expectations are rising higher and higher and we're just not able to deal with them.
i'm expected to drop everything and run to see premier patients for any minor problems, some of which are so utterly ridiculous!
eg. c/o pain but refuses to take painkillers
eg. c/o about the light in the room
eg. c/o about wind in abdomen but refuses meds

they just leave me with a really sour taste in my mouth when i'm expected to mollycoddle them. for goodness sakes!!!!

just yesterday on call, i had 2 cases from the same ward.
first:
lady post PFR/SSF, c/o severe pain "down there"
O/E: vulva not swollen, slightly tender to palpation. vaginal pack in situ
patient crying in pain and allergic to NSAIDS. so i order pethidine.
nurse runs around looking for the key to controlled drug cabinet.
meanwhile, husband comes out and shouts at me. reassure husband, run around looking for key too.
settle another patient, and am washing hands when husband comes out and shouts at me again because no one has seen patient in that 5 min.
hurry nurse up, finally gives jab 15 min after seeing patient.
spend next half hour holding patient's hand whilst she gaspes in pain and falls asleep from pethidine, all the while having to repeat explanation to family members who walk in and husband who shoots me pissed off/ suspicious looks.
demand to see attending who did surgery.

second:
patient post major op (cancer surgery), c/o pv bleeding 5 pads soaked POD 7.
speculum: copious HSF in vagina, evacuate as best as i can. no packing but placed on pad chart.
patient and husband appreciative

both cases left me with a great deal to think about:
1) post op pain is common. but we all have different pain thresholds. but you cannot expect meds to arrive STAT when you say there is pain!!!!!
if you want such wonderful service, pls go to a private doctor. i am but a mere cog in the wheels of the public hospitals, my dear patients.
shouting at me is not going to help hurry up the meds being served. also, you don't have to be so rude about it.

2) my dear patient, pls inform me earlier if you are having such a huge amount of discharge :( :( i was so worried!!!! thankfully it resolved.

3) i think we should treat all patients equally, subsidised or private. but i guess that's not possible

ok i'm not sure if i'm talking sense. had 1 hour of sleep last night, so been awake for about 36 hours other than that 1 hour of sleep. very tired.
more later (remind me about eye candy!!!!)

end of 2 months

i've reached the 2 month milestone of my first year of internship! that means my first posting is halfway through :D

and i'm surviving! i hope. hehe

so far it's not that bad. there are times when i just feel like running home away from the wards and not coming back, but i always force myself to stay.
and on call i feel like turning off my phone and staying in my call room to sleep but i force myself to answer the calls anyway, because well, i'm all the patients have isn't it?

then again, today i received cookies from a patient, i was SO SUPER TOUCHED :D
this patient is a doctor herself from another country, and i don't think i paid her particularly much attention, but i think she realised i was having a really tough time running 2 wards especially with a demanding resident. the gift cheered me up tonnes! :D

calls are coming thick and fast, once every 3/4 days for me right now. can't wait till my leave arrives!

last labour ward call i did- EXCITING STUFF :D
we'd 3 caesareans - 1 was almost a crash caesar because of a really bad decel on CTG. getting to scrub up 3 times that night was exhausting but a load of fun! :D plus the resident that night was one of my favourites, sweet and ever willing to teach despite her exhaustion. so i didn't mind waking up 1 hour earlier to pre-round the patients for her to make her work earlier, although i think it really wasn't very glamorous to fall asleep at the nursing counter. oh dear!

students in the wards now, i wish i could have time to teach them, but my current ward is so super busy that i barely have time for lunch, let alone to teach people! arghhhh.

well call cm again! need to sleep early.
but arghhh tour de france is on and i'm dying to watch! :(

sine curves

working life is like a sine curve (or a cosine curve, whichever rocks your socks).

i'm exhausted from running 2 wards by myself this last week, i get to work at 630 am and leave around 7 plus which not much chance to sit down in between save doing my millions of discharge summaries.
i know it's pretty easy to do my discharge summaries - there's a template! :D
but when i discharge close to 30 cases every morning (all must be done by 1130 am else the nurses get really really antsy and call me non-stop), on top of all the other things that need to be done in the wards like updating attendings/taking bloods/updating families/bringing CTGs down to be signed etc, it makes for one very stressed-out me.

at least one of my ward residents is this super nice lovely lady who doesn't need me to follow her around and is always patient.

i wish the same could be said of the guy resident in the other ward, who told me in no uncertain terms that he expects me to follow him around the whole morning to carry his files and scribble in them for his round. well, i don't mind doing that if i didn't have 2 wards to cover, thank you very much. he thinks i'm slacking off by not being there but the truth is, i'm still doing my NVD rounds in the other ward by the time he's finished with his rounds!
to top it off, he's quite a senior resident, moving on to the next level soon i think. so i feel really bad having to call him for anything i'm unsure of because he sounds rather disdainful. :\ just the other day i got scolded for making him come up to the ward to take consent from a patient - to be honest, in our guidebooks we're specifically told we can't take consent from patients in cases such as these, which is why i had to call him up. but he insists that i can take this consent and yelled at me and the nurses in the middle of the ward.

all these encounters with him have just left a really sour taste in my mouth whenever i see him, although if truth be told, i don't think he's that bad really. kind of naggy, but he's a good doctor i believe. i just wish that i wasn't running 2 wards so that i'd have time for all this!!!!

it's really crappified, this whole point about not having enough interns, and the workload distribution is rather uneven too. i think they've realised it because next month it's back to one person a ward, thankfully for whoever's coming up here.

then again, it's the last 2 days of hell running these 2 wards!!!! plus i'm on call tomorrow night too and with a not-so-friendly resident, booooo :(
wish me luck please!


but that doesn't mean there haven't been bright sparks throughout the days!
the nurses have been particularly nice, they help me as much as they can, and they tell me to leave early and that they'll call the on-call to do whatever comes after knock-off time because i think i'm really looking very haggard from all this stress (my friend was rather stunned when he saw me, said i looked very "mature". URGHHHHH). but that doesn't change the fact that mornings are really really bad, and getting several PPHs in the ward doesn't help to decrease my stress levels at all. oh well.

the other nice thing was meeting my previous attending in the lift with several CTGs to sign off, he just grabbed the whole bunch and signed them off for me! HOW NICE IS THAT????? i was so super touched! :D

good days and bad days, it's like a sine curve.
looking forward to leave like nothing before.
wish me luck!

1 month into my job!

1 month (and a week!) into my job, i've had fabulous days and awful-it's-all-going-down-the-drain-and-i-want-to-cry-so-badly days. but i'm surviving, oh yes i am :D

to whoever's following my blog, i am so honoured, really i am! can't believe anyone would want to read what i write, so thank you :D

just finished my 7th call on sat morning, dealing with (some) private patients really makes my blood boil. first you refuse all painkiller jabs, then you complain of pain, what do you expect me to do? to put my hand on you and say, "oh you're healed!" :( :( this boggles the mind.

plus there was a violent patient on my call too, scary stuff. lucky they called in 4 hunky young policemen (hahahaha eye candy for my weary eyes!) to escort the patient down. oh dearie me. my attending for the night came out of the room waving his hands in the air and clutching at his hair, wailing about why this had to happen to him. HAHAHA.

had dinner at 2 am, urghhhh stomach rumbled loudly all the way till then! but at least i had time to change at eat dinner at 2 am, hehe. so that's something to be grateful for!

had to call my resident to set a plug, one that i kept missing :( poor lady, i think she was going to cry! and my resident came, took one look at her and said, "oh look, there is a HUGE vein here, so BIG." and proceeded to glare at me as though i was some idiot, as if i didn't feel bad enough already, thanks. RARRRRR. and then, she proceeded to MISS THAT VERY HUGE BIG VEIN herself. WOWEEEE. i didn't know whether to laugh or cry at the patient's bedside!!!!! OMG.
in the end she picked an antecubital vein to poke (one that i could have gotten, arghhh). and she left me there with the patient who was complaining that she couldn't bend her elbow :( :( uh-oh i felt so super bad. arghhhh.

but morning came! and i had time for breakfast with the other interns, who were all as tired and weary as i was- coffee from the small cafe downstairs is a great perk me up! :D

survival rounds in the morning were madeness, i discharged 12 patients from one ward on top of doing post-natal rounds (patients that the resident didn't see! arghhh) and had to run up to the private ward to settle all kinds of ridiculous things. ARGHHHHHH.

managed to leave at 230 pm post-call, picked up my ringing phone on the train home only to hear one of my fellow interns in tears due to backstabbing from nurses and another intern. OH DEAR :( :( :( the poor girl!

ah this has been a depressing post, calls are generally depressing, ah well.
but i have to say that i love my new ward (we changeover every 2 weeks), and my onco attending is amazingly nice :D i adore him to bits and pieces!!!!
remind me to blog about labour ward next time! :D

quick update

thus ends my 1st week in the labour ward! i have done 3 episiotomies, delivered a baby, seen an IUD (saddest thing ever), seen a cord prolapse, endured loads of shittiness and made friends with the residents.

the 2 residents on my side are SUPER NICE :D i am so thankful to them! esp when i bung the iv cannulae (we have to set 18 G ones, arghhh), they will willingly do it for me. super nice :D

got to go to the OR to assist in a caesar, SO EXCITING. the senior resident laughed at me when i jumped as they ripped the membranes and the liquor gushed all over my hand. hahahaha. clearly i have not assisted in a caesar before! but it was SO EXCITING, esp when i had to "cpr" the abdomen to push the baby out! :D of course, i ended of with blood all over my shoes and pants. arghhh. thankfully i'm not washing them though :P

i think i love deliveries, nothing beats them!!! :D

have finished my 3 calls in 6 days, that was exhausting and i hope i dont' have another set coming up that fast :\ esp since i had a patient with a stroke on the call and i had to call a neurologist from another hospital about the patient, which was hell because i had to call the other hospital 5 times before getting a human being to talk to me. ARGH. plus there were 2 AMA discharges on my call, one at 8 pm, and one at 2 am. so i had to type all the whole discharge summary!!! :\ oh gosh. but i think it's still better than having the patient desat on me as per my sunday call. eeks.

remind me to write about the cord prolapse another day!

i hate calls :(

had my 2nd call on thursday in the labour ward this time round, i barely survived! :\

(for your info: a call is when you work all day and then go on "call" at night, so that the rest of the team can sleep in peace. in short, you (and the others on call) are left holding the fort at the hospital till daybreak when the rest arrive at the hospital again, ready and refreshed to begin a new day! my weekday calls are from 430 pm to 8 am, weekend from 730 am to 1230 pm the next day, depending.)

labour ward is so so tough, i barely know enough to scribe in the case notes and the loud ticking away of the CTG machine makes it really hard for me to hear what the residents are saying when reporting their VE/CTG findings. plus the masks we're all wearing means i can't lipread to save my life either. :\
thankfully, this being a medical profession, means that the senior doctors are usually a bit more understanding once they find out i wear hearing aids! :) the only thing i need to learn now is to start pointing out that i do wear hearing aids. sigh.

did my first episiotomy repair (with lots of begging to get another resident to come supervise me, he isn't a very nice fellow but i didn't have a choice- those on my side were all in the OR for a crash caesar :\) thankfully it went quite well, wasn't a very big tear. so that's well and good! :D
managed to do it quite quick, must say that the pelvic trainer session we had was super useful!!!! :D

both the senior residents were super nice and patient with me and my slowness, they patiently dragged the tables outside the rooms and yelled their orders into my ears while attempting to teach me. plus my JRs were fabulous, doing the plugs i failed without complaining much and showing me how to do cord blood pHs.

i felt so bad!!!! :\ esp when i failed 8 out of the 10 plugs i set :( i keep bunging the veins, i really really need more practice. thank God my friend, G, was on call with me, so i could ask her for some help here and there.
it was even worse when she had to go to the OR to help with a crash caesar and i was the only one left in the ward of 24 beds :\ tonnes of paperwork, harried midwives and nurses, scared/irritated/pained/grouchy/demanding patients to see! oh my.

the midwives were fantastic, they asked me to dilute all the penicillins and hang up the drips before i slept at 445 so i wouldn't have to wake up at 5 plus to give all the drips, they'd do it themselves. SO NICE. when they heard i needed to do deliveries, they instantly pulled me into a room to observe a delivery that was ongoing (unfortunately, i had to leave early to go do paperwork for a crash caesar. arghhhhh). but i was so touched :D

G and i were so depressed on call, we started a countdown timer to the end of call! we wanted to watch american idol, but sadly, we had work to do just as it started :( oh well.

it was my last day in the same day admits clinic and the ward, i was honestly rather sad to go! :\ the ward nurses have been super nice to me :D today a patient had a hamper of fruit delivered to the ward, and the nurses wanted to give us some fruit, but S and i agreed they'd done far more than us, so we had a banana each. hehe :D so cute, i love the nurses. and there wasn't much work to do on the last day as well :D

took off at 245 post-call, fell asleep while standing on the train, waiting for the bus, riding the escalator down - so dangerous! in the end i cabbed home from the train station as it was pouring and i was so tired. ooph.

having 3 calls in the next 6 days, hope i survive without making major mistakes!

first call

thus ends my first call - on a sunday, no less!

thankfully, my good call luck seems to be holding! :D must really give thanks that every plug and blood i took (except one, and even my JR couldn't set that!) was really easily done and most were on the first try! :D was still feeling extremely demoralised after thurs where i failed every single one but this is proof that there is a God out there for He must really have heard my pleas :D

but then again, to put things in perspective - i was on my feet from 730 am to 640 pm, the only sitting down was doing discharges. :\
i only got to eat "lunch" at 9 pm - i am so slow at doing stuff! :( thankfully the nurses were all v nice and understanding as to why i was so lousy and useless and they were telling me to stop being so frazzled and to take my time. hahaha i love nurses!!!! :D

my phone stopped ringing around 9 pm, and i managed to bathe and squeeze in about 4 hours of sleep overall in between running to see a new patient with CA cervix (and also HIV positive, super scary drawing bloods, i double-gloved and tried to use as few needles as possible!) who's Hb was 4.6 - had to call for emergency bloods and monitor her closely, and another septic patient with an intra-abdominal abscess for urgent CT scan (there was no end of fighting between the nurses and the radiologist - the nurses insisted she was to be NBM but the radiologist insisted on oral contrast - so i solved it by calling the attending in charge, who was super nice and even sounded appreciative that i called to update him. whew!) :D

went off post-call at 330 pm, my dad had to text me to tell me to go home! thankfully my friend protected me from the nurses by saying i was post-call and forcibly shooing me out of the ward so they wouldn't ask me to do anymore work. very very thankful for that.

so i survived my first call in the peripheral wards, next call is come thursday in the labour ward! hopefully i get to see a couple of deliveries and i get to learn episiotomy repair :D

day 4

surgical masks are the best things ever!

well, maybe not, but compared to suffocating behind the n95, i have no complains about wearing a puny surgical mask, at least i get to breathe :D

thought i would feel better after celebrating my birthday yesterday (a mid-week pick me up!), but no, i'm just as tired today :(



covered my friend's ward today since she was post-call, that just means that i ran the usual ward i'm in by myself!



today was a really crap day at bloods, i failed every single blood and plug i had, it's really depressing. i think mentally i was defeated before i even tried drawing the last blood! :(

thankfully thankfully thankfully, when i called the junior resident (JR), he came bustling down right away and helped me clear tonnes of the work in the ward, he's so super fast!!! i think knowing what to do helps you do it fast, and the experience really helps.



i felt so lousy next to him, but he kindly reassured me that it was normal and he started out like that too, and that at the end of 1 year i'd be like him. :D

i hope so too, i hope so too!!!! keeping my fingers crossed :)



anwyay work wise today wasn't so bad, because we had intern teaching session (that my ward partner and i fell asleep during, such is the heavy work of our ward that we're super tired out). rather embarrassing that we were sleeping in front of the nurse manager :\ i hope she didn't think we were insulting her, we were really just tired out :(



it's really hard to get away from the ward, we tried to leave but the nurses just kept asking us to do things, and it's hard to turn them down as well cos you feel guilty. :\



i had this patient who came in for a minor op, supposed to be home by evening, but nooooo, she bled and bled and bled when we removed the ribbon gauze. the JR was rather shocked too, i think, because it wasn't expected at all. in the end, 3 JRs and 1 senior resident came down to review her whilst i ran around doing other things. my knees are black from kneeling by the patient's bedsides for various things! but that's the least of my complaints haha.



the saddest thing today was this young lady who came in for an abortion, because of foetal anomaly. she was alright all through my taking consent, attempting to draw blood (and failing rather miserably!), but when i inserted the cervagem, she started crying. it wasn't from the pain, but from the sadness. i felt so so bad for her. they're sending the foetus for post-mortem and doing an extensive workup on her as well, but i think it's really quite traumatic and she really wanted this baby i think. you could see the sadness in her eyes, somehow. her husband was really lovely, being supportive and everything, but i could see his sorrow as well.

sometimes life isn't fair, and i think this couple would really have made quite a good pair of parents. the lady really reminds me of one of my friends. i hope they find peace, somehow

it's only day 3!

in my friend's words, " DAMN SHAG".

we're all drop dead tired after day 3 - at least on days 1 and 2 you had adrenaline to keep you going but on day 3 it's really bad cos everything hits you at one go - the lack of rest, the stress, the expectations that you should know enough of what's going on, the work piling up etc.

my job has suddenly expanded, seems that my intern buddy neglected to tell me quite a few things about day surgery!!! so it resulted in the junior resident being rather unhappy with me, thinking i was shirking my duties. :\ took me rather alot of groveling and apologising profusely on that point! i can't really blame her :\
but at least she was nice enough to teach me what i should do, and when i had to call her for help later on she answered quite happily (i guess since i'm relieving her of her job, hahaha)

today was hectic, rushed through same day admits clinic and went upstairs to help my friend out, and on walking into the ward, the nurses grabbed me and showed me what they wanted me to do - the WHOLE COUNTER was filled with files! :( :( :(
as if that wasn't enough, they then plonked 5 files into my hands and said these needed to be discharged by noon. and i got there at 10 plus! :\
plus the other intern was dealing with a dangerously ill patient so it was up to me to get the work done :\
had to send an emergency SOS out to all my friends, and i am SO SUPER GRATEFUL to those who came to help me out! :D :D :D I LOVE YOU ALL, REALLY REALLY REALLY!!!
between the 3 of them, they cleared the discharges, updated the attendings, dealth with a pleural effusion and calmed the nurses whilst i clerked the new cases and set plugs.

but well, the 2 of us in the ward eventually only had lunch at 330 pm :( :( at least we got lunch so i can't really complain i guess! still, it's not joke drinking less than 500 ml of water the whole day.

had a good chat with a patient today whilst setting a plug and asking about her decision for a PCN (percutaneous nephrostomy). she's so sweet! :) it's things like this that really make me happy, patient care is right up there.

on the sad side, saw an aborted foetus :( :( my friend and i were curious so we opened the box, and OMG, i was so so sad after i saw it. it was tiny, about a hand's size, if curled in foetal position it could probably fit into a large palm. it was all red and jelly like, but you could see the ribs, the clavicles, the ears, the perfectly formed fingers and toes, the white jelly of the umbilical cord. it was a perfect baby :( :( :(
it's at times like this i wish i was an objector to abortions, but i've thought it over alot and asked a few people on this, including my family. and i think i'll stick to non-objector for now, but we'll see how it goes in the future.

on the other bad side, my exams in september have been cancelled due to swine flu :( :( :( oh well!

post first day of work

i am so tired i feel like dropping to the ground. having spent 11 hours running around cluelessly in an N95 mask breathing in carbon dioxide doesn't really help much either.

i suppose that's why i dropped off to dreamland on the way home and missed my stop! :(

first day wasn't that bad, i was high on adrenaline and fear, managed to turn up at the hospital at 7 am only to find myself locked out of day surgery and spent a good 10 min wandering around before getting a call from the nurse wondering if i was coming! after explaining that well, i was rather lost, she came out to get me very nicely. OOPS.

had all of ONE patient whom my boss efficiently clerked and bustled up to the OT before i even realised what was going on! :\ oh no i hope i know what to do tomorrow else i will be placing my fat neck on the chopping block. urlp.

after that i was scurried up to a ward to help out and i was even more clueless - i did my first cervagem insertion, my first doptone, my first consent taking and blood transfusion and giving iv antibiotics all by myself (with loads and loads of help from the nurses!!!!). OMG.

my friend and i were so stressed out and we only got to eat lunch at 3 pm (which is good, compared to what i hear from my other friends - eating a sandwhich in the lift on the way to exit rounds, having nothing to eat or drink till 9 pm at night, HORRORS).

but i'm thankful for the work, i could be out of a job right now and desperately looking for one. i could be one of my classmates who failed. i could be someone who never made it to medical school. so i am deeply thankful that though slave work this may be, i am here.

alright now i have said the requisite deep stuff (hahahaha) i shall now talk about some stupider stuff.

1. the bloody n95 mask is like a face sauna and gives me a heat rash. plus it removes all my painstaking applied makeup!!!! :( i am most unhappy with the last point, obviously. haha

2. i am possibly the dumbest intern ever, when a patient's potassium levels came back as 3.2 (normal is 3.5 to 5), i said, OH LEAVE IT. and all the nurses promptly crowded around me in shock and horror and ordered me to write down and order for mist KCl. oops. so being the good girl i am (hahaha), i did so meekly.

3. on reaching the canteen, all of us interns promptly held up our n95 masks and fanned ourselves for air! so funny. one small kid was staring at us very intently, i can't tell if he was horrified or amused.

4. all the former interns (stopped from moving onto the next rotation thanks to H1N1), promptly disappeared at some point in the day and were uncontactable. hrmmm. i suspect they all went out for either lunch or karaoke!!!!! tskkkk. but who's to blame them? ;)

5. when you're as dumb/blur/clueless as i am, the nurses are really really your best friends :)
I LOVE NURSES!!!!!