I'm an idiot...

I'm back in Queen this week and next...and then i'm off to Gold Coast for a week...woohoo!! now would be a good time to have that remote control 'God' gave to Adam Sandler in the movie 'Click' and fast forward this 2 weeks...yea well, wishful thinking....

Anyway, i was on call again yesterday...had an empty bed...coz the uncle on that bed had died the day before...somebody punctured his lung during a pleural tap...boss said we hastened his death coz he was on his way anyway....the morning was quite uneventful, except for procedures... afternoon was busier...one patient went for tracheostomy...another went for 3-phase CT abdomen... thank God i'm on call..so i didn't have to escort...hehe...but one of the patient desaturated...and boss did lung recruitment on him...instead of improving, his lungs got worse...his saturation dropped even further... so we had to sedate and paralyse him to take over his ventilation...boss asked to call his relatives to inform DIL...urgh!! i hate informing DIL...

So i told the patient's mother and sister that he was deteriorating fast and he might not make it through the night...and boss and i actually expected it as well..and i thought to myself, this guy is only 27, younger than i am..sigh...but then we dialysed him and extracted 3L and then plasma exchanged him...and guess what? a MIRACLE happened!!! his saturation improved from 80+ to 95%...and his blood gases improved...oxygenation improved...and he survived through the night...and boss came this morning and said, there is a God after all...hmmm...WTH??!!

Anyway, about 5pm, i went down to check on some ventilated patients in FMA...then a medical MO showed me a 75 year-old Chinese lady with premorbid history of hypertension, diabetes and chronic kidney disease...she presented with upper gastrointestinal bleeding, anaemia and uraemia...he was worried about his patient...coz she might need dialysis that night itself...he said he was showing me the patient in case they referred for ICU admission for dialysis at night..i was like, WTH!! admit her now while i have an available bed and dialyse her ASAP...urea was almost 50, creatinine was 600 over plus she was already encephalopathic...and the nephro team said KIV for dialysis coming morning if urea and creatinine increasing trend...WTH!!! want to wait until patient collapse only come begging for ICU bed is it? then only wanna dialyse the patient when she's on triple inotrope is it?

So i brought her into ICU...initially couldn't set the central line and dialysis catheter coz the initial coagulation profile was abnormal...so had to transfuse fresh frozen plasma first..i repeated a coagulation profile on admission to ICU...it was bloody normal!!! wasted the FFP..and my time... and patient's time as well..coz she was acidotic and uraemic..and she was having some arrhythmia...anyway, finally got to work with setting all the necessary lines..but i gave aunty 50 mcg IV fentanyl and 3mg IV dormicum...and she went apnoeic for a while..i was an idiot...could actually see her saturation dropped from 100% to 50% plus within 5 seconds...i was like, bring the intubation trolley..put her on high flow mask..and i was slapping aunty on the shoulder and chest to wake her up...then about 5 seconds later, her saturation picked up to 100% and she was snoring...phew!!! she did look like a difficult intubation...obese, short neck, double chin and all..anyway, put in all the lines and called the dialysis staff to get her started on dialysis...

She only started her dialysis about 1am...and her chest x-ray was done around that time as well..when the film came back it was about 2am...i looked at it and thought..oh shit!!! i was actually worried that i may have cause a pneumothorax when i inserted the central line...and then there was an artifact on the film caused by some appendages which made me thought that aunty might be having pneumothorax...although her saturation was 100% all the while..blood pressure was high..blood gases were excellent...but i was an idiot..and i was paranoid...and i had no one else to ask...but i was worried she might collapse...coz another aunty developed shortness of breath but we managed to settle her...so i didn't want another problem...so i thought, ok, i'll try to aspirate and see if air comes out...so i did, 3 times..but nothing came out..so i guess it wasn't pneumothorax after all..and i was praying hard that i wouldn't puncture her lung and cause another pulmonary haemorrhage...anyway, by 4am aunty was still well and alive..and i (and my nurses) were about ready to collapse anytime soon...so i went to sleep..telling my nurse if the aunty desaturated, just yell...

When boss came this morning, i showed him aunty's chest x-ray and like a fortune teller, he asked me if the patient had a reservoir bag on her...the high flow mask she was on had a reservoir bag...i felt like a total idiot...embarassed to the max...thank God i didn't end up killing that aunty...sigh... moral of the story...don't ever put patients on high flow mask if you're inserting a central line and doing an x-ray on her...it will only lead to more trouble if you're the only medical officer awake at 3am in the morning and you can't differentiate a reservoir bag from a pneumothorax on a chest x-ray...i'm an idiot!!!

Shopping Saturday...

So i finally slept before the clock struck 3am..i think...put my alarm at 11am...but lazed in my bed till 12 noon before i finally dragged my butt out of bed and went downstairs to work on my elliptical trainer.. yea yea, i know..it's been a while since i last worked out...i'm turning into a blob of fat...that's why i told myself that i had to start working out again...managed to work out for 1/2 hour...boy, i'm so unfit de... i actually felt woozy halfway through my workout...maybe i was a bit hypoglycaemic...so i stopped halfway and ate some biscuits and drank some sweet drinks...felt better after that...would have loved to stretch my work out to 45 mins but i'm getting soft...sigh...

After i bathed, i decided that today would be shopping saturday for me...well, i had nothing else to do and staying at home was proving to be too hot on a warm day like today...so i drove to Warisan Square and started walking...i think i'm becoming agoraphobic...coz i actually felt uncomfortable being in public space...but i braved through the crowd anyhow (thank God there wasn't really much of a crowd despite it being a saturday)...bought myself a chocolate/peanut butter waffle and munched while i window-shopped...Charles & Keith was having their end of season clearance sale..and most of the shoes and bags were on 40-70% discount...saw a dinner bag that i liked a lot which cost rm69...oh well, didn't really need a dinner bag and it wasn't exactly super cheap... saw a few pair of heels that looked very nice too...but the problem with having Cinderella's feet is that most shoes are made for her stepsisters' feet...;P

So i went over to Padini Concept Store where i know there'll always be size 3 or 4 shoes left during sale...looked around for tops and dresses...nothing caught my fancy...i used to be a clothes person...i don't know since when i developed a fetish for shoes...and bags...so i ended up trying a few pair of shoes...most of them looked quite good but i go for comfort as well...the last pair of shoes i bought, it was quite a disaster...totally killed my feet..so in the end, i chose a white pair of heels..and i could fit into size 3...comfortably...yea, i know...i don't really have a need for a new pair of heels...but i guess i just needed the retail therapy that my che advocates...so anyway, here are some pics of my new white heels...

Fate?

These days, i've been having a strange urge to be like "Emma"...you know the one from Jane Austen's book? So the other day i was talking to a girl friend on facebook...well, actually we were just leaving messages on each other's wall...and a brilliant (hopefully) idea struck me...i asked her if she was interested to get to know a pilot friend of mine who's based in Singapore...coz she's currently in Singapore for some training till end of the year...

So today i was talking to my pilot friend...and i asked him if he was interested to get to know a hot babe girl friend of mine...i asked him to add her on facebook...so he looked at my list of friends on facebook and suddenly he asked me...eh, this girl from Samad? i said..er..i think so...can't remember for sure...my pilot friend was from Samad as well...turned out, he kind of knew her back in school...and he remembered her...i'm not sure if she remembers him though...coz i didn't tell her that my pilot friend used to go to Samad...hehe...

Well, well...now if that isn't fate....of course, i musn't get too excited yet...coz they have yet to meet each other again...though this 'cupid' can only do so much...the rest is really up to them...but i'm keeping my fingers crossed...i think my "Emma" complex is stemming from the fact that since i can't seem to find my own Mr Right, so i'm gonna help others do so...i know...warped logic..but since when did logic and i ever gel? I'm rambling...it's 2am after all...yet i'm not sleepy...who needs coffee to stay awake?

Good call...

I had a very very good call last night...:)...haven't had one for God knows how long...i only had one admission which came in during office hours..and i only had 5 patients in the ICU...ahhh...this was as good as it gets...i even manage to watch 5 episodes of 'House' in the MO room's computer... and slept the whole night through...

Well, there was an incident though..nothing extraordinary...that PTB uncle in isolation 1 threw a tantrum...i guess when you're 70, then you start acting like a 7 year-old again...he soiled his linen but he refused to let the nurses clean and change him...so the nurse called me..but i didn't make things any better..coz apparently he was angry at me for poking him many times earlier in the afternoon...was trying to set a peripheral line coz his central line was due to be removed...and his veins weren't the easiest to set a line on...so i had to get another senior nurse to calm him down...and finally they managed to settle him...i guess geriatrics is definitely out of my list...

Finished my passover round before 9am...left the hospital and went to Damai for breakfast...my favourite Thai style beef noodles...then i went to the bank to change my ATM card into a visa debit card...i was expecting it to take a few days or so...but i got it change on the spot...hmm, banks are getting more efficient these days...well, now i don't have to worry about running out of money when i go to Gold Coast next month...

Came home...did some online bill payments...then slept the whole day...sigh..i'm turning into a pig... sleeping off all my free time...not that i have anything productive to do anyway...well, i could have cleaned the house since there's cell meeting at my place tonight...hmmm, i think sleep is a better option...hehe...;)

Harry Potter and the Half Blood Prince...

So i dragged myself out of bed this morning and went to church...a bit late...but i made it there...i guess i was glad that i went...Pastor said a few things that kinda touched my heart...or perhaps being in the presence of God always bring tears to my eyes...

Anyway, had dim sum at Pacific Sutera for lunch...then went to watch the latest Harry Potter instalment...the Half Blood Prince...well...one word...draggy...it lasted almost 2 1/2 hours...and i was glad when it was over...coz i really needed to go to the bathroom...i guess this one tried to stick as closely to the book as possible...they got the gist of it...but somehow, it lacked the excitement i experienced when i was reading the book...i mean, i probably took a few days to finish the book...but i wanted to keep reading coz the way the plot unfolded kept me on the edge...perhaps since i already know the story, it has lost its excitement and i kept wondering when was it going to end...and i didn't even cry when Dumbledore died...i cried when i read the book...i think..it was quite a long time ago...my memory's getting a bit fuzzy...

Few things i found quite nauseating though...the Ron and that girl (can't remember her name..no not Hermione..the other desperate one...) and all their snogging....and the Cormac trying to get Hermione's attention scenes...eeww!!! Luna Lovegood was an interesting character though...love her fashion sense, hehe...and at the end...when Dumbledore was killed...i thought i remembered that Harry was petrified which was why he couldn't do anything to help Dumbledore...and when Dumbledore died, the spell was broken then only Harry was free to go after Severus Snape and the rest of the Death Eaters...but then again, perhaps my memory is failing me....

Still, i guess if you are a Potter fan, you'd still have watched it at least once...though i still prefer the book...and when the last instalment finally opens in the cinema, i'm sure i'll still go watch it even if i may get disenchanted again...

Just a bit off track...saw the Twilight Saga: The New Moon's trailer while waiting outside the cinema...dang! they changed the scene where Laurent (and i never knew he was black) was trying to attack Bella...they were supposed to be in some clearing..not outside Jacob's house...and i take it back...the actor who plays Edward Cullen...doesn't justify the character's supposed gorgeousness...i guess only a real vampire can look as good as Edward Cullen..hehe...

Oh no!!!...

WTH!!! Khalil's Timeless Live in HK 2009 concert tickets were open for sales yesterday morning since 10am and i only found out about it like more than 12 hours later..dang!!! so much for being his no.1 fan...and i slept my whole Saturday off when i could have bought a tic on a good seat...i'm actually online now checking out his tickets...and the most expensive tickets only left those with side seats and quite far from the stage..:(...

Now i'm contemplating whether i should still just get the HKD480 ticket for 27/8/09 although the best i can get is a side seat and i'd probably only get to see Khalil from like 200m away....and i still need to spend money on buying air tics (that's another rm600)...and spend money for accomodation while i'm in HK (probably another rm600 as well)...so much money just so i can see Khalil sing from maybe 200m away or more...maybe i'm not that crazy after all..maybe i'll just wait till when i go to HK in december..hopefully he'll have another concert when i'm there....but really, Khalil sure has very willing fans...1st day and all the good tickets have been taken...maybe i should have join his fan club earlier and get good tickets when the sales were open to his fan club members.. missed opportunity!!!

Sigh...will Khalil ever hold a concert in Malaysia? I'll definitely be attending it if he ever comes to Malaysia to hold a concert...crap! now i'll lose sleep over this...

Drowning our sorrows in music...

Elaine and Siang Lin came to KK on Thursday evening...they were going back to Muar for Elaine's friend's wedding...and so ngam, i'm post-call and pre-call...so when the two ah lians get together... no chance that we would miss a karaoke session...hehe...

Jasmine and i went to meet Elaine and Siang Lin at Warisan Square's Secret Recipe for dinner...ate till about 9.30pm...and thus started our karaoke session...only Elaine and i...and we still managed to sing till 1am...had to go coz they were closing..hehe...not bad lah hor?..3 1/2 hours...and i'm happy to say that my repertoire is expanding...i've learned more of leehom and jay chou's songs...and also some other singers whose songs i like...

Really, good music is therapy to the soul...hehe, Khalil's songs will always be the soothing balm for my ailing soul...i think if you've read my past few posts...you can sense that i'm edging nearer and nearer to a breaking point...but work is something i can't escape from...i chose this life...and i don't regret it...but when things get a bit too overwhelming, i can always find solace in music...i wonder if that's how it is with musicians....i always think that they're in their own world when they're playing music...like they are sharing something among themselves that the audience can never really appreciate...

I should get some sleep...going to church later...haven't been to church in a long time...though i actually don't think my heart will be in it though my physical body may be there...sigh...how did that happen? when i was in uni, i made a vow to myself...i'll always go to church at every opportunity i get...no matter how tired i feel...i guess i'm not really a person for keeping vows huh? once again, a disappointment....

Just another bad call...

I'm still on call actually...it's now 4.40am...and i can't wait till my passover round is over....i just want to crawl into my bed and crash...it's not like i've been busy till now...i just can't sleep coz i was awakened by my colleague's snores..i'm just too light a sleeper..

But until 9.30pm last night, i've been busy....and after yesterday, i really feel that i'm just not meant to work in ICU...it just stressed me out too much...perhaps my premature greying isn't just due to my genes...coz i'm definitely getting more white hairs over the last year...since i started as a GA MO...

Anyway, the morning started out ok..boss wasn't in a foul mood...we finished our rounds in ICU about 10am something...then we went to do peripheral round in the male and female wards...there was some problem with an uncle who was on epidural infusion...turned out that uncle was quite an important person in the health department so big boss was involved and there was quite an uproar over that matter...so big boss had to persuade the uncle to be admitted into ICU for observation...he refused initially...but eventually agreed after a few rounds of persuasion...

About after lunch, there was an admission...the lady had intra-abdominal sepsis...ventilated for respiratory distress..there was another whole story behind this one..but i think i shall skip...after settling her, had to prepare another patient for re-exploration of tracheostomy site coz he was bleeding from his tracheostomy site...the poor man had a thoracotomy and tracheostomy done the day before...

Just about before 5pm, i got a call from an HO who escorted a CCU patient for MRI brain and cervical...patient was ventilated and on inotrope (a fact which i wasn't informed earlier)...i was supposed to just help them set the MRI-compatible ventilator but when i went down, it still wasn't the patient's turn...i'm telling you, if bad things were to happen, they won't just come in 3 ok? they come in a whole bloody long stretch!!! that patient came with a bloody leaking tube...and the nurse insisted it was fine before they transferred the patient to SMC...i didn't want to change the ETT coz he could still be ventilated and i did not want to look for trouble by changing an ETT just outside the MRI room...and they didn't even bring a laryngoscope...so i went to do a pre-med while waiting for the patient's turn...

The HO finally called me again at about 7pm (imagine that..the SMC staff made a ventilated patient on inotrope wait for 2 hours)...the HO said the patient desaturated and they were bagging him...big boss was in ICU to attend to the epidural uncle who was just admitted into ICU around that time...so big boss and i went down with all the drugs and laryngoscope and bougie (patient was a burly Chinese man..so difficult intubation until proven otherwise)...when we reached the MRI room, the patient was back on his portable ventilator and the HO said his saturation improved..but then i noted that his saturation was actually 20% and he looked kind of blue..so big boss said we needed to bag him again...and guess what? the HO had been bagging with room air earlier coz they didn't bring the suitable oxygen connector for the ambubag..and to make things worse, the portable monitor's battery died...marvelous!!!

We had no choice but to bag with room air and rushed the patient to ICU for resuscitation...thank God he didn't go asystole...so big boss successfully re-intubated him and his saturation went back to 100%...his blood pressure was also quite stable...so we sent the patient back down to the MRI room for his MRI...and then i found out that the infusion pump in the MRI room can't deliver the inotrope at the rate we wanted...for whatever reason...hey i'm not a techie...so i had to ask the HO to manually infuse the inotrope throughout the procedure...and then patient was a bit restless despite us giving him sedation..so i wanted to paralyse him so he wouldn't move during the procedure...but they only brought 1 ampoule of tracium...which wouldn't have last him 1/2 an hour...i was quite pissed off by then coz it was taking too much of my time out of ICU and i was expecting another admission from OT...so i had to go up to ICU and bring an ampoule of esmeron for the patient...i was practically cussing all the way...

Finally i kind of settle the patient and went back to ICU just in time to collect the patient from OT...20 year-old lady...was involved in an accident..she was the passenger...post-partum 2 months...sustained intra-abdominal injury...liver laceration...splenic rupture...it was bad...she lost about 5-6 liters of blood intra-op...and she was in DIVC..her blood pressure was so low despite on maximum double inotropes...i couldn't feel her femoral pulses..when she came into ICU, there was no blood left..only platelets and cryo...so we were transfusing whatever we had...but she was probably still bleeding...she was in ICU for only 50 minutes when she became bradycardic and then asystole...we CPRed for 30 minutes..but she never came back...

I cried...while i was having my dinner...i couldn't save her...perhaps she was beyond saving..but perhaps i could have push in fluids and blood products faster...perhaps i should have started that 3rd inotrope earlier...but it's too late now...a 2 month-old baby just lost its mother...all these deaths are really making me doubt...i can't remember a single patient whose life i had saved...i can only recall those who died while i was on call...

Sigh...i really need a break from all this...or else i'm really gonna sink into depression...i'm so sleep-deprived...so emotionally drained...and i'm not even sure if all this is worth it anymore...

Khalil's Birthday...

It's Khalil's 26th birthday today...happy birthday to you, happy birthday to you, happy birthday to Khalil...happy birthday to you!!!...i hope he had a great celebration...though i was reading an online entertainment news site mentioning that he was actually busy doing a photoshoot for his upcoming Timeless concert's poster...i saw his poster on his FB fan page...very very cool!!! it's a photo of him playing the guitar...underwater...

Apparently, he can't really swim...hmmm, what is it with guys who can't swim? i seem to meet more and more guys who can't really swim....hehe, i actually have a thing for guys who swim...run..and play basketball...hehe...so anyhow, i thought it was very courageous of Khalil to agree to post underwater despite the fact he can't really swim...and all the effort is so worth it...check out the pic...

Anyway, Khalil's really working too hard..i noticed that in his latest MV "red bean"..a cover version of Faye Wong's song, which will be released in his new album called Timeless, his chin is getting sharper and sharper...his face is beginning to assume an almost ET-like face...i sure hope he'll pack on those vege burgers and all...if not then somebody will really sing a line from his song 夠不夠(is it enough?)...你的朋友　說我太瘦...(your friends said, i'm too thin)....hehe...

Alright...time to call it a night..tomorrow on call again...at least i'm back in ICU SMC...happy birthday again Khalil!!!

Transformers 2: Revenge of the Fallen

Yea, i've finally just watch Transformers 2 for the 1st time...i was getting comments from people..like, which part of the world you're in lah? still haven't watch Transformers 2?....i know people who've watched it at least twice...and i've also been given advice to save my 10 bucks and just give the show a miss...well, i finally got a free Saturday today...so why not Transformers 2? it was either that...or ice age 3, or obsessed...i think some people actually think i should have gone for ice age 3 instead, hehe...

I know what you're thinking...you're thinking, finally, she's posting about something besides work...she does have a life outside work after all, hahahaha...so how did i like Transformers 2?...i think i'm having mixed feelings about this one...and there's a strange sense of deja vu hovering over me as i walked out of the cinema...i mean, it was just like the previous one...same cast (except for an additional annoying human, a hot crazy bitch of a decepticon, and a few new robots)...same plot..same place of showdown (the poor egyptians always have to bear the brunt)..and didn't Optimus died and was resurrected in the 1st instalment as well?..and i guess the transformation becomes a bit less impressive the second time round...and as usual when the autobots and decepticons are in a chaos of fight amidst all the missile attacks, i can never tell who's who...so much for my power of observation....

Anyhow, i was wondering why Jetfire (the oldie decepticon turned good robot) had so many metal chains down his face....then i realized those were his beard...haha, good one...and why is Optimus Prime the Primes' descendents when he looks nothing like them? the Primes have an uncanny resemblance to the Fallen...and did anyone notice that in the scene after the Fallen was defeated and Megatron and Starscream have fled like the chicken they were, where there was a footage of the Sphinx (i think), there was a bird (or maybe a chicken) on the Sphinx's nose? it was pretty distracting...coz i think there was something else going on in that scene but i can't seem to remember what...

So yea, no more second helpings for me for this one... i think if they are coming up with Transformers 3, maybe they should think of more substantial plots and subplots...and a new place to fight in...i mean, leave the Arabs in peace already....

She asked for it...

I was on call in Queen again yesterday...there were 3 admissions into ICU throughout the day...one was a 42 year-old man who had very bad pneumonia (was intubated) and was in septic shock...requiring maximum double inotropic support...his kidney shut down and he had very severe metabolic acidosis...we gave him bicarbonate correction and even managed to dialysed him...and he seemed to be improving after the dialysis...but eventually by 2am, i guess his whole body was so overwhelmed by the sepsis that he just deteriorated...adding another inotrope didn't seem to help...he finally died at 4.25am today...but at least i think this man had wanted to live..so did his mother and family...

But not so with my other admission...this idiot of a 29 year-old lady (let's call her S for stupid), was a mother of 9 children...had only recently delivered her 9th child less than 2 months ago..S came with symptoms of fever, dehydration and her blood investigations were suggestive of dengue...her ABG showed very severe metabolic acidosis and she was very tachypnoiec (she couldn't even complete a full sentence) by the time i saw her in the ICU...S would have eventually required intubation when she finally got tired from breathing too fast...and she would have needed urgent dialysis to correct her metabolic acidosis as she wasn't really responding to bicarbonate correction...and she was passing very little urine despite us giving her fluid...

Since S was still awake and able to comprehend what was happening to her, we told her that she'd need to be intubated her to prevent her from going into respiratory failure...and she'd need several invasive procedures i.e. central venous line and catheter insertion...but she refused...and so did her husband....and S actually insisted on at own risk (AOR) discharge...she said she cannot bear to be put out of consciousness and be intubated and had all the invasive procedures done to her..although we tried very hard to convince her that was the only way to safe her from dying...S replied that she'd rather go home and die in the presence of her 9 children....i called my boss and asked him what i could do...he said we can't force treatment onto a person who's still in his/her sound mind...somehow we managed to make her stay in the hospital in the hopes that eventually she would allow her to treat her...

So we transferred her to the general female ward...knowing that she'd collapsed in another few hours...though i was hoping that perhaps i'd be proven wrong...that perhaps she didn't need all the 'torture' we planned to subject her to after all...this is one time i'd hate to be proven right...she was transferred out of ICU at 6pm....by 10.30pm, the houseman on call from female acute ward (i supposed the specialist on call transfered her there) called me to say that S' husband finally agreed for intubation...i went down to see her...she was so tachypnoiec, dyspnoiec, restless and drowsy that i guess my question was pointless...but i just had to rub it in...so i asked her and the husband, so you want intubation now?...so we prepared for intubation...but before we managed to give her the medications for induction, she developed hypoxic fit (her saturation by then was only 88% on high flow mask 10L/min)...so we quickly gave the medications and i intubated her....saturation picked up...but her pupils were fixed and dilated...not a good sign...

The husband had the cheek to ask me to do whatever i can to save her...when earlier on he so arrogantly told me that if his wife didn't want any of our treatment, then he won't force her..there you have it..a couple of idiot...so i told him, i am and will do whatever i can....but it's probably too late already...and he broke into tears...anyway, i continued rescuscitating S...gave her more bicarbonate...asked the houseman to refer to the nephro MO on call for urgent dialysis...after about 15 minutes, S actually regained consciousness...i was actually shocked...i thought that maybe there was hope for her after all...she actually looked at me and responded to what i told her...so i asked her husband to see her...so i turned to help the houseman to refer that patient for dialysis...coz the nephro MO on call yesterday was a bitch...she gave the houseman such a hard time...grilling him for like 20 minutes and yet won't agree to the urgent dialysis...so by the time i went to check on S again, she was not responsive again...hmmm...something wasn't right....so i checked her pulse and shit...there was no pulse..no heart sound...

We started CPR....but i wasn't too sure how long it has lapsed since her heart actually stop....there was no proper ECG monitoring in the female acute ward...so an unconscious person might have been dead for like a long time before someone actually bothered to check the pulse and noticed that there wasn't any...so anyway, she wasn't revived after 30 minutes of CPR....and that was the end of the story for S...there was no pity...because she asked for it...and so she only got the fruits of her labour....as for her husband...he was a murderer...because he allowed his wife to die...i only pity the 9 children...few of whom might end up with a short life just like their mother....the husband cried when i told him we were doing CPR on his wife...all the tears in the world would not bring his wife back to life...and he didn't deserve the miracle of resurrection...not him..not a murderer....

Oh well, at least my last admission didn't die..and he was the oldest of them all...69 year-old uncle with chronic kidney disease...was probably uraemic...had Steven-Johnson syndrome...developed a few bouts of supraventricular tachycardia...but managed to stabilized his heart rate and rhythm...hopefully he won't deteriorate after my call...and i don't know if W (of Scenario A) is still alive...by the time i left the hospital, her blood pressure was already very low...well, at least then her husband didn't need to choose...

Scenario A & B

Guys, imagine scenario A (ok, girls also can imagine lah):

W is a 35 year-old lady who was diagnosed with Systemic Lupus Erythematosus (SLE) since the age of 17...SLE is an autoimmune disease which ravages through the patient's body, particularly attacking the connective tissues causing complications to the kidneys, joints, lungs, brain, haematological system, basically the whole body...W's disease can only be controlled by long term high dose steroids which left her chubby, with a moon-like face i.e. round...about a few years back, she was also found to have uterine adenomyosis and she ended up with her uterus being removed...but somehow, throughout her sufferings, she found a man who has learned to love her for who she was, inspite of her disease and inability to ever have children...in fact, W and her future husband were going to be married...they just took their wedding photos last month...and their wedding ceremony would have been in another month or two...but last week, she was admitted to the hospital as the doctors found that her kidney function was worsening, thanks to her lupus nephritis...few days into her hospital stay, she developed hypertensive crisis and seizures...which resulted in her being intubated and admitted to ICU...but she seemed to have recovered from her seizures after 2 days in ICU...and she was as conscious as she could be...but last night, W suddenly became unconscious after a sudden increase in her blood pressure...her pupils became fixed and dilated...this morning, an urgent CT brain was done, which showed a massive right subdural and intracerebral haemorrhage...after much discussion among the consultants, it was decided that there will be no surgical intervention as the prognosis was very poor...and brain death testing will be done to confirm brain death...W's husband and family has been explained of her poor prognosis and possibility of brain death...

Now girls, imagine scenario B (ok ok, guys also can imagine):

H is a 35 year-old man who was born with haemophilia, an X-linked inherited blood disease which can cause minor problems like unstoppable bleeding from a small cut...to major problems like spontaneous bleed into the joints and brain...depending on the severity of the disease... unfortunately for H, his was the severe kind...causing him to require frequent blood product transfusion...and he also suffered frequent spontaneous bleed into the knee joints leaving him with deformed arthritic knees...inspite of all his problems, he too, found a woman who loved him unconditionally...and they were planning to get married...but a few days before their wedding, H suddenly collapsed at home after suffering a bout of seizure....he was rushed to the hospital, intubated and resuscitated...an urgent CT brain was done...it showed a massive left intracerebral bleed...the consultants decided that surgical intervention would not improve any outcome...and brain death testing was carried out....

Now Questions:
1. If you were W or H's partner, after being informed that your beloved is now brain dead, which would you choose?
a. Continue to hold on and believe that there might still be a chance/hope that your beloved will someday wake up, and therefore request for continuous ventilatory support until his/her heart fails?
or
b. Accept the fact that your beloved is gone and allow withdrawal of ventilatory support, and slowly pick up your life again and move on without your beloved?

2. If your answer for 1 is a, how long will you wait?
a. 1 year?
b. 10 year?
or
c. forever and ever?

3. If you were W or H, would you want your partner to choose:
a. 1a?
or
b. 1b?

I do not even dare to imagine myself being in W or H's partner's shoes...it is just too painful a situation to go through...given my nature, i might initially choose 1a...i'd play the faithful and hopeful partner because i can't bear to lose my beloved...despite the fact that given my knowledge, i know that the chance of recovery is next to nil...but i can always have faith for a miracle to happen yea?...which brings me to question 2...again, given my personality traits, one day i'd wake up and realize that my beloved is never going to wake up again (that might be only 1 year down the road), and even if he did, i might be tired of waiting...it is not easy caring for a bed-ridden person who cannot return the love you magnanimously give...

So perhaps it would be easier if i chose 1b after all...coz i don't think i can be that magnanimous to live a life of 1a...by choosing 1b, i can play the poor broken hearted soul who lost her one and only love to life's natural selection...and i can isolate myself and listen to 徐佳瑩's 失落沙洲 every day and cry my heart out till there's no more tears to cry...and then perhaps one day, i'll be able to pick myself up again and try to love again....and move on to a life without my beloved...

I'm a selfish soul...so if i were W, i'd want my partner to choose 1a...hoping that a miracle would happen..that he'd stay by my side and speak to me words of love and encouragement...my mind may not hear it, but my soul might...at least then i'll know how much he really loved me...but then again, perhaps 1b is still the more appropriate choice...my mind's gone, he should let my body go as well...so that i can go in peace and be with the Lord and no longer suffer in this world...

Just my two cents...what would your answers be?

Another escort session....

I had to escort another patient to SMC ICU again today...it was a planned transfer and the patient wasn't as unstable as the one yesterday...and as expected, boss happily dictated that i would be the one escorting this patient, despite the fact that there was a peripheral MO who should be doing all the escorts....in fact, there was a peripheral MO yesterday but boss didn't make her escort the patient.. and when i was doing periphery in Queen, boss made me escort all the patients who needed escorting....i should change my job description...it should no longer be medical officer...instead it should be 'high-class escort'!!!! no wonder i don't get any job satisfaction lately...

So i escorted another patient to SMC ICU yet again...and the boss there commented...you again??!! yea, that's right...me again....and he said i kept escorting bloody patients...like in the literal sense...coz this patient today also has some bleeding problem...anyway, the transfer took 1 1/2 hours...not too bad compared to yesterday...and i got back to the hospital about 5pm something...then left for home...yay!!!

On another note, there was a patient who was admitted yesterday...a 50 something year-old Chinese man who had severe community acquired pneumonia....he had been having some respiratory symptoms for 10 days prior to admission...he went to casualty on Sunday but he was sent home and referred to a government clinic for TB workout despite the chest x-ray showing very bad lungs...so yesterday, when he went to the clinic, he was referred again to Queen for admission...by the time the GA MO on call saw him in the ward (and he was just passing by the ward), the uncle was so hypoxic that his oxygen saturation on nasal prong 2L/min was about 50% and on high flow mask 15L/min was only 70-80%...

So the GA MO on call decided to intubate the patient and bring him into ICU...unfortunately his wife wasn't too prepared for his unexpected deterioration...and she told the MO that if she knew he was going to go downhill so suddenly and needed intubation, she would have asked for some time to have some 'last' words with her husband...anyway, the uncle died this morning while we were doing rounds...his lungs were so bad that he couldn't be oxygenated...and then his blood pressure dropped probably due to a combination of sepsis and hypoxia, requiring maximal inotropic support...when i told the wife that his heart has stopped, i think it took quite a while for her to register the fact...and she kept asking, why so sudden? is he really dead?...and she cried and cried...the uncle's daughter (who was studying in Singapore) didn't manage to come back in time to see her father before he died...by the time she reached the hospital, her father had moved on...

It's so sad...his death was quite preventable, if treated earlier....in this era, in this country, and in a city, i just don't think it's acceptable for someone to die of pneumonia...or post-partum haemorrhage, TB, malaria, dengue and many other treatable diseases for that matter...it would be a different matter if he was in the middle of the Amazon jungle with no immediate access to medical care...i messaged the post call MO and told him that the uncle died...and his reply was, guess God doesn't heal anymore huh?...sigh...it's so hard to keep the faith when day in and day out, your work life keeps throwing 'shit' at you....somehow you can't help but start doubting...it's not that i don't believe in miracle...i do.. the fact that my patient J is still alive till now (and he probably survived his op) is a miracle...but somehow it doesn't seem to happen often enough huh?

Oh well, tomorrow i'm doing periphery...and there's no ICU MO in-charge...guess i'll be the escort again, if an escort is needed...which usually is the case...uughh!!!

Bad Day....:(

Ok, i'm still in Queen this week...and today, i hate my boss...not for the person he is...but for the things he put me through today...grrr!!! i know i may end up sounding petty but i don't really care...at the moment, i'm tired and i feel like being a 小人 and bitch about people...and i don't care if someone actually tells my boss about this..in fact i hope he'd actually get to read this...uughh!!!

Anyway, i woke up late this morning..well, only 15 minutes later than usual...i was too tired from yesterday's locum which was from 2-11pm...and i was post call...and the bloody locum was so busy that i was cursing Pang for making me take that locum...i vowed to myself never to do locum there again...i wasn't too late to work...well, about 20 minutes late...the morning wasn't too bad in ICU...boss made me put in a femoral catheter for an uncle which i finished in about 15 minutes while they were still doing rounds...even put in an art line for that uncle...

Somewhere towards the end of our rounds, while we got a surprised visit from one of our ex-patient, we encountered a jerk of a consultant who works in Singapore (he is a relative of one of our ICU patient)...who marched in and exclaimed to our visitors that they shouldn't bring camera into the ICU and take pictures...the bloody jerk didn't even know what was happening...and he passed comments as if he owned the ICU...and he was actually telling boss how to treat his relative and telling us lowly MOs about how unethical it was to ask family members to donate blood to replace blood that was used on patients...so Pang and I were having a good time bitching about the jerk...and as if encountering a jerk wasn't bad enough, there's more to come...

There was a patient (let's call him J) who was supposed to go for CT mesenteric angiogram today...but the appointment was initially at 5pm...and boss said i had to escort the patient..and i'm supposed to go off work at 5pm..and i don't get to claim overtime for the extra hours i put in..and despite my being single, i don't like staying in the hospital any longer than i'm supposed to...just a little background on J...he's 35...somehow managed to acquire haemophilia which caused his coagulation profile to be deranged...was having per rectal bleed for the past 1 week...and we're talking about massive bleed that requires massive blood and blood product transfusion...like about 12-16 pints of packed cells and 2-3 cycles of DIVC regime per day...so i would say that transfering him to SMC for CT was actually not the most brilliant idea...though J did seem to have stopped bleeding when we saw him this morning during rounds..

Anyhow, somehow, the HO managed to bring forward the appointment to 3pm...so i thought well, at least i won't have to stay till after 5pm...hah, no such luck...by 2.30pm, we still couldn't get an ambulance to take us to SMC...reason being, the only available ambulance at that time had non-functioning wipers..and the driver claimed it was raining (at the said moment) when i looked out the window and saw clear blue skies and not a drop of rain....lovely!!!...then the stupid attendant was missing in action and the HO had already escorted another patient to SMC for CT scan earlier...so great!! no one to go get J's blood from the blood bank...and we definitely needed lots of blood for him if he were to survive the trip to SMC....so guess who had to become an attendant and go collect the blood? of course Pang doesn't get sent because boss loves Pang...so that left me!!! and boss sarcastically thank me for going to get the blood...and i replied...oh boss, don't thank me..it's my job!!! in the sweetest and most sickening voice possible...(grit teeth)...

By the time we finally left Queen it was almost 4pm...and as expected...J re-bled again by the time we were halfway to SMC....all the transfering and bumpy ride would have dislodged whatever clot that was tamponading the bleed and so by the time we reached SMC, we could have been escorting a patient with post-partum haemorrhage and the scene wouldn't have been so bloody...i was worried J might not be able to withstand the procedure (thank God it's CT and not MRI)...but we persevered and went ahead...we transfused blood while waiting for the CT...and thank God the whole thing probably took only 10 minutes...but transfering the patient and settling him down probably took us an hour...and the portable monitor went hay-wire and we couldn't get the arterial blood pressure...it was quite chaotic...

I called Sharon (who's on call in SMC ICU today) to ask if she had available bed for this patient.. thank God she did...and so after many phone calls (between me and boss, boss and the radiologist, me and sharon, boss and on call specialist..etc..), it was decided that J would be transfered to SMC ICU...in the hope that since he was there, the surgical team would decide to go in for op...the CT scan showed that there was extravasation of contrast into the small bowels at the proximal to mid-ileum region i.e. he was bleeding there...so after we brought him up to SMC ICU in one piece, we finally left SMC...we only reached back at Queen almost 7pm...

And as if that wasn't bad enough...i went to my car and found Karen's car parked behind my car (i parked at Karen's place) and she was out for dinner...i think i was just too tired and numbed or else i would have just broke down in tears...thank God Karen's housemate was around so i took her car keys, drove her car out of the way...and finally, i got to go home....well, after i went to refill my car at the gas station....

What a long, long, long day....and i still need to do my laundry...it's been piling up the whole week...sigh...on days like these, i really wish this wasn't the life i lead...i can't wait for my next holiday....

A good night swim...

The ACA and NCIC started today...i had to go early to do my peripheral rounds before i could go for the sessions..i felt like Cinderella trying to finish up her chores before going for the ball..except that, there was no ball for me to attend...only sessions on how not to let your brain fall out..which thankfully, mine didn't..knowing how i would start 'fishing' 15 minutes into a lecture/talk...

So i guess i should be proud of myself today...i managed to last through the whole day with minimal sleep during all the sessions..and i realized i wasn't the only one dozing off..hehe..even some of the professors were 'fishing'...and it was a good thing...this conference...got to meet up with old friends and seniors from uni...

Went for a good night swim this evening...with Flora...at the Marina...she's having swimming lessons there every Friday...so this evening i went with her....i think i'm becoming an NYHA class II....swam one lap and i was out of breath already...so unfit....but still managed to swim 11 laps in total lah..hehe..just got back from dinner and bathed...hope to get a good night's sleep...coz tomorrow on call again...so gonna miss tomorrow's conference sessions...oh well..life goes on...