That 4AM talk with God

It was 4 AM in the morning. I get to rest much earlier than I usually get to during my oncalls. I’ve just completed my Isyak prayers at 330AM and examined a gentleman who was assaulted in that early hours of the morning. The observation area had a few patients which would require a review later.

I curled up on my cold oncall bed with a thin blanket to cover half of me. I didn’t even bother to get another layer because well – I rarely get to catch a nap during my calls. Not even a towel for I fear my quick shower would be cut short by a phone call and I’d have to run out wet to pick up the phone before it stops ringing. I left the lights to the bathroom on and stared at the dark ceiling. I liked the quietness of the room.That calming effect it brings so I could just rearrange my thoughts as I figure out what to do with a difficult case. Or a rare one if it ever comes in.

I remembered literally ‘talking to Allah” begging for Him to allow me a few minutes of rest  -at least for the next hour – since He controls Time. I even made a twinky promise that He could send in as many resus cases He wanted after 7 Am if I could rest for a while. I was not feeling well myself. I badly wanted to swallow an antihistamine to ease the stuffiness but knowing its horrible somnolence effect on me – I had to think twice. Should I compromise sound judgement in making medical related decisions or just suffer as a sick human being. I chose the latter.

Indeed if only I’ve managed to really shut off – it would’ve been a great 2 hours of non interrupted rest. On the contrary, I was constantly switching my positions.. having delusions of hearing the phone ring or my assistants calling my name. At times, I’d felt a sudden rush of palpitations and I’d be checking my pulse to see if they are regular. I even have thoughts of ‘could it possibly be thyrotoxicosis? ‘ but nehhh.. I’m not getting any slimmer so it couldn’t be.

Before I know it, the azan for Subuh was already in the air. Time to get up, brush my teeth, wash my face and wait for my 1st ‘promised’ critical case to come through the door.

the word is hectic

My schedule has been very hectic lately and honest be told, I am not getting any younger to tahan being oncall. Gosh – need a way out of this. Ha ha.

Yesterday, we had a meeting discussing mortality cases that occur within the department. Indeed, there was a lot to learn. My brain was theoretically searching for the files in my brain on certain subject matters. for instance, how is a U wave formed and all those things.Ironically, nak jadi specialist ko kena back to basics sebenarnya.. like mitochondria punya level sorta thing. Then only you can talk about journals and scholarly articles. Kalau basic pun susah nak grasp – how can I understand HFOV or BILEVEL vent settings right?

Apart from being in the hospital, I also went to court for the first time. Its considered a milestone for any medical officer I suppose. It means you’ve been around long enough to treat criminals or have their DNA taken or something. In other words, you’ve seen enough of the ugly things that happens around you  – shielded from the public. It’s like sampai satu tahap you know a felon is faking an asthma attack just so he could breath the fresh air out of his cell by making a visit to the hospital. Cam y lah…

On a different note – I saw a bouquet of flowers dying on one of our lockers in the room. I am tempted to bring them home but I have yet to ask for permission. From the receiver. Fresh flowers often reminds me of the time I studied in Manchester. There, fresh flowers are cheap and affordable – sold at ASDA or TESCO. I’d often buy them once in a fortnight and have them on my window sill for they are so pretty to look at and some smells nice too. How I miss the pretty sight of carnations and scent of a rose ..

Speaking of flowers – my new stamp collection came through the post. pics in the next entry.

 

Nice demeanor

A colleague of a specialized discipline from a different hospital passed a comment to me today. He said,

” wow.. you guys are pretty ‘relaxed’ for someone who is part of the anaesthetic team “

When he said you guys – it was referring to me and my one and only working partner in the field – and when he said we were relaxed.. I kinda knew what he meant. That means in face of obstacles and unpopular circumstances in the operation theatre – my partner and I rarely exhibit aggressive behaviors like screaming or rolling our eyes at the surgical team and stuff. Or cancel a scheduled elective list like it can be done tomorrow sorta thing without a two way and mutual discussion.

My determination to maintain a cool hat and ‘being nice’ to other people stemmed from when I was a houseman in Kuching. One particular oncall night stood out. I was in my 5th posting as a surgical houseman (HO) and I was posted to the neurosurgical ward. I was oncall with a very motivated and nice Neurosurgical Medical Officer (MO). At the same time, coincidentally – most of the other Medical Officers of various discipline that night including the Anaesthesia Team had genes of a Saint. Everyone was so damn nice, polite and kind to each other which was evident during referrals. Even to this little non significant HO!!!! As a HO I felt confident, safe and urge to do more for my patients. I wanted to please these kind MOs working with me that night. Anaes required at least 2 large bore branula, I gave them 3. You want me to trace the result STAT .. I will bug the lab technician to run it fast. My MO even sat with me at the pantry while we have our quick 5 min meal and asked if I had prayed – he did not have to cause he is not muslim but he did! Although most of our patients that night were critical and semi-dying – none died and hung on to the dear life until the coming morning. I couldn’t help leaving work the next day at 7PM thinking how nice the world of medicine would be for the patients if everyone can work well with each other and stress more on them rather than thinking, “ayo.. that lioness is oncall ah.. susahlah nak refer” or ” aiyo.. she likes to marah people one.. you lah refer” and the game of ping-pong begins in ED.

When I became an MO myself in the Anaesthesia department – I find that by being accommodating – people can cooperate and work better with you. As an anaes MO at the time especially when working in ICU, I’d be receiving referrals to intubate a difficult patient or asking for a ventilator or to review a potential ICU patient in the emergency unit or wards. When we are ‘friends’ with those from other disciplines, it is easier to discuss options and demands. It is easier to refer earlier for the health and safety of the patient. It is easier for these friends to understand why the operations needs a certain amount of blood products or why ICU cannot accept a patient. There’d be less bickering and pointing fingers. Plus, naturally we would want to do more for our ‘friends’ kan. And we want our friends to have an equally good call.

On top of that, if we exhibit concern and educate our supporting staff accordingly, it is easier to get a message across.To share and idea or sentiment. Thus reinforces on patient care. If the environment is conducive and pleasing, we will then be able to see how various people of different levels respond – the lazy ones left behind but the opportunist would learn more and better themselves. I will hear more of my porters being able to report to me saying ‘hey doc.. this patients white cells are high’ instead of just collecting the results and staple them. I am always happy when my nurses are able to point out a patients potassium level is deranged when the results reach them first and not just file them for us to review later. I am more delighted when my medical assistants with many years of experience are able to guide me through a difficult process – medicolegal aspects of things and such.

I hope to keep this ‘menyenangkan demeanor‘ around for long time. I’m no angel. I have lost my temper before – I have raised my voice before towards staff, patients and relatives but towards late.. the incidence have decreased tremendously. Perhaps I’m getting old.

A toast to a nice demeanor. cheers.

An unfavourable outcome

I started my new year with a business trip to Lombok. Neh.. I wish.

Instead it started with me being oncall.

Assisting people in diagnosing their medical illness and while at it, solving their social issues. Honestly, if one decides to step their foot in the emergency unit – it must be for a very serious and urgent matter. Hence, they must be prepared for the outcome of the visit such as

  • for admission to stabilise the condition or observation
  • for a follow up consultation in the respective specialised clinic
  • transfer to a tertiary centre with relevant expertise, should they need one

Therefore, it is heartbreaking and at times frustrating when after the length of procedures and test we do prior to the above 3 solutions, you suddenly say

  • I want to be admitted at a private hospital – do they not realize that a similar battery of tests and investigations will be repeated at the private centre.. membazirlah test yg dibuat earlier from the RM1 payment.
  • I can’t be admitted to the hospital now – my birds at home needs to be taken care of or someone needs to cook dinner for my 25 year old son ..
  • or you did not honour the follow-up appointment we got for you the week after and make a return visit to the emergency unit – saying the previous ER doc that saw you did NOTHING and yet we found a referral letter folded neatly in between you BP trend notebook dated a year ago!
  • you refuse transfer to the best hospital (which is conveniently only 45 minutes away) because it would be difficult for your relatives to visit you – like hellooo.. if your distant relatives want to visit you, do it when you are well or during festive seasons..

So yes – nak sembuh pun I kena merayu masuk wad. 

And I haven’t even listed the grandiose, bongkak statements some patients make regarding the health that Allah bestowed upon them. Perhaps I shall leave you with one ..

“Tak payahlah nak cuci2 darah doctor, tengok saya nih umur masih panjang dan sihat”

(there’s no need for a dialysis doc, look at me, look at how I am still very much alive”

Yet your Urea is a freaking 51, Creatinine a horrifying >900, potassium of 6.2 and an acidotic blood gas? And you came to the emergency unit for being lethargic. *sigh*

Being Oncall. Part of the responsibility really.. like it or not. Yet hygiene and beauty is a must. My oncall bag – part 2

.. Now its time to have a sneak peek into my toiletries bag for oncall.

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  1. SKII Facial Treatment Cleansing Gel – this is part of my most expensive hygiene products I have on my vanity. The SKII product. I also have the Pitera Miracle Water Essence. But its not something that I would bring to work.
  2. Sleeping eye cover – just in case I have to leave the room lights on after a dose of horror stories of ghost that haunts the hospital.
  3. INTIMATE pantyliners. I have been getting them in boxes lately as I find them very comfortable to wear. No need to wear double.
  4. Face mask from SASA. On a good postcall day, if my colleagues allow me an hour rest.. I’d do a mini facial early morning before I meet the public again for another round of work.
  5. Face cottons and cotton buds
  6. Mini toothpaste
  7. Toothbrush
  8. The red pouch to hold it all in
  9. REXONA deodorant to freshen up
  10. Contact lense multipurpose solution and case
  11. Mini shower gel and hair shampoo – although I rarely shampoo during oncall.
  12. CLINELLE Eye Bright – helps to reduce eye bags, dark circles and fine lines
  13. CLINELLE purifying toner – a satisfying substitute for SKII Treatment Essence
  14. ELLGY Corns & Warts treatment solution  – key is persistence they say

 

Yup, enough hygiene for a medical doctor to wade through her day.