I'm on call today...in Queen...my last call before i leave for NZ tomorrow...and so far i've been picking up messes...while creating mess myself...i think my boss on call must be cursing me now...in the morning, medical referred an 80 year-old man to rule out intra-abdominal injury...so i asked why did they think he was having that...the MO told me he had a fall...i thought, hmmm..did he fall from like 10 feet or something? and if he did, why would he end up in medical ward in the first place?
They got an ultrasound abdomen for the uncle, and the radiology MO informed me that the uncle had free fluid in the abdomen most likely due to splenic laceration...so ok, i went to see and was quite appalled by the course of events that ended the uncle in medical ward...he was actually referred for anaemia for investigation...they missed the crucial information that he was actually hit with a plank on his abdomen...right...so called boss on call...she asked to transfer patient over to surgical...for splenectomy..so yea, 1st mess picked up...
Then medical referred another 20 year-old guy for acute abdomen...they think he was having typhoid...his abdomen was very distended...ultrasound showed free fluid with sediments..so possible perforated bowel...called boss again...she asked to tap to see what fluid comes out...but i couldn't see anything when i scanned the guy's abdomen with the kuno scan in the medical ward...so i just poked at the right iliac fossa...aspirated a lot of air...then got some small intestinal fluid came out...looked like liquid faeces...so i thought ok...so it's bowel contents...so sent patient to surgical for laparotomy...then i told boss and he said that i poked through the bowels...shit!!!! so 2nd mess picked up...and er..created as well...now i hope his wasn't a negative laparotomy...
Medical also referred another 77 year-old aunty for rectal mass...the specific referral was for surgery to do proctoscopy...excuse me, but since when only surgical MOs are capable of doing proctoscopy? and the medical gastro team is capable of doing a colonoscopy, taking biopsy and getting the HPE result all by themselves all this while...since when are they no longer able to do so... forcing them to turn to the surgical team for proctoscopy? my my...how things have changes...oh, but i didn't pick this patient up yet...waiting for the HPE after the gastro team performs the colonoscopy and obtains the biopsy...
Then i saw another patient in the casualty (i actually saw a lot more but this one is the most interesting by far)...49 year-old aunty who presented with 5 days history of progressive abdominal distension and absolute constipation...no history to suggest colorectal or gynae malignancy...the only signs of malignancy was that she was quite wasted and pale...per rectal revealed an anterior mass externally compressing the rectum...so we did a per speculum and vaginal examination... we found a cervical mass...so called boss on call again...and she asked to refer gynae to take over first and surgery team will review the patient in their ward...poor aunty...
Oh well...come tomorrow, i'll be leaving on a jetplane...for a break i so badly needed...NZ, here i come..."i'm leaving, on a jetplane, wish i don't have to be back again, oh babe, i love to go" (sang to the tune of 'leaving on a jetplane')....my life is in a mess and it's time for some time off for personal reflection and soul-searching...hahaha...i always think that a trip would do that for me... but after i come back from every trip, i still feel lost and "un-searched"...sigh...may this restless wanderer finds rest some day....
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