Yes, i know the patient needs blood...but i can't produce blood magically...

So yea, selamat hari raya to everyone...while everyone was happily eating their lemang and rendang yesterday, i was on call...and it was one heck of a call...as if my pre-call bad day was a prelude to an even worse one during my call...Yap and i were in the OT the whole day clearing up the leftover cases from the day before...a laparotomy with bowel resection, an open cholecystectomy, an I & D, 2 perforated appendix...don't ask me why we took so long, but we just did...and halfway through had to go ICU coz one patient died..what did i tell you eh? at least one death per call...

And as if that wasn't enough, i had to settle the uro patients....and there was a liver abscess patient in sepsis who was unstable...and the nephro ppl totally set my nerves off...they sent 2 patients from their ward to our side for Tenchkoff catheter insertion the following day...and the HO on call informed me that one of the patient's femoral CVC was removed in the morning because there was pus discharge from the insertion site...which was fine...it should be removed...but the least the nephro ppl could do was to bloody reinsert one and bloody dialyse the patient before they sent the patient over...patient's potassium was 6.1 and he was supposed to be for operation the next day...really, what were they thinking? expecting the surgery MO on call to settle their crap? well, they chose a bloody wrong day and person to mess with...so i asked the HO to call the nephro MO to settle their own crap...seriously, i should write a complain letter to the Head of Nephrology Unit and Medical Department to tell them how irresponsible their bloody MOs are...since my big boss has been telling me that the medical MOs have been writing him a lot of 'love letters' regarding our surgical MOs...

We finally took a break at about 10pm plus for the first meal of the day...by then i was just so hungry and grumpy and ready to faint...thank God the OT call HO belanja us at Upper Star (coz i taught her how to do appendicectomy)...i had lamb chop...felt like the best lamb chop ever coz i was raving mad hungry...then we had to rush back to OT coz there was still another appendicectomy...which i asked Yap to teach the OT call HO coz i didn't think i was in the right state of mind to teach...and we were expecting a 25 year-old guy from Hospital Kota Marudu who had an MVA and his Hb dropped from 11.9 to 2...we thought it would be a miracle for him to survive the 2 hours plus journey to KK...

But arrived he did...the casualty MO in SMC called me about 2am to inform me that the patient has arrived...when i saw him, his BP was 84/47 mmHg with pulse rate of 130...pale as sheet...abdomen was distended and tense...they scanned him in Kota Marudu and saw free fluid in abdomen...so i called boss on call and informed him...he asked to post the patient immediately for exploratory laparotomy and proceed...the patient had 3 pints of packed cell from Kota Marudu, one of which was transfused on the way...2 of which we started transfusing while he was in the casualty enroute to OT...we crossmatched more blood but could only get 3 pints from SMC...but we couldn't wait longer...so we started surgery at 245am...the 3 pints blood we had were quickly consumed...

Big boss was called in...patient's right liver lobe, right kidney and adrenal were totally smashed and bleeding profusely...they removed the right lobe of his liver, his right kidney and adrenal...surgery took about 3 hours plus...i was scrubbed in initially but as the blood seem to be taking forever to materialize, so i had to unscrub...and produce blood magically...although it was post-fasting month and the blood banks are low on blood stock...so i had to ask the runner HO to go to Queen to get blood...they could only give us 6 more pints...and a DIVC cycle...they took about an hour to get the blood back to OT...and while then i was helping the GA side to put up the IV drips, give medications...and i was getting scolded from the GA specialist on call for not getting the blood fast enough...and i didn't like the way she was implying that the surgical team wasn't controlling the bleeding fast enough...

The thing was, i agree that the blood wasn't coming fast enough...and that we weren't fast enough in controlling the bleeding...but in case that specialist didn't notice, i'm not God...i can't just snap my fingers and 20 pints of blood would appear instantaneously....big boss is not God...he can't just lay his hands on the patient and heal the patient...considering that he did a right liver lobectomy, right nephrectomy and adrenalectomy in about 2 hours plus, that's quite amazing already...though i must commend that the GA specialist did well on her side to keep the patient alive...anyway, i guess it's God's will that this patient survived the operation...he had a total of 12-13 pints of packed cell transfusion, 1 DIVC cycle and another 6 units of fresh frozen plasma...

Patient was sent to ICU post-op...and until 8am this morning, no one called to inform me that the patient has died...so i assume he would live...big boss asked me in the OT during the operation if i still want to do surgery after this...i told him, if i were the GA MO, i would still be awake while the operation is being done...what i didn't say was the only difference is that as a surgical MO, i can be ordered around by the GA MO/specialist to produce blood magically, whereas as a GA MO, i can order the surgical MO/HO to do the impossible...sigh, i'm just so tired...and tomorrow i'm on call again...and ppl still watch Grey's Anatomy/House/ER and think being a doctor is so cool...hahahaha...

Today is the first time i ever felt like quitting...for real...

I got transferred to a new rotation after i got back from a great holiday...i've always hated that unit even as a HO...you know how when you come back from a real high to a real low? that's like a great height to fall from...and today is the first time i ever felt like quitting..for real..one of our patient, a 15 year-old girl with history of cancer was admitted for ascites...we drained out about 1.5L from her abdomen 2 days ago...she felt better....this afternoon, when i was about to do my pm round, the nurse informed my HO that the patient's blood pressure dropped drastically...so the HO told me and we went to check on the patient...

So i gave her fluids...and do the necessary investigations...she looked quite drowsy and ill...i told my colleague who in turn told my consultant (who happened to come for pm round)...i thought he'd come to see the patient...but he didn't...my colleague came to help but as she was on call, she had to go to OT for a case...so i was resuscitating the patient with the help of the nurses and 2 HOs...we put in a central venous line...put in a urinary catheter to monitor her urine...tapped her abdomen coz it was so grossly distended and tense...by the time we did all these, it was after 6pm...

I was about to go home and wanted to have a last look at the patient to make sure she was ok...that was when i noticed she suddenly became unresponsive and looked like she was having a tonic fit... had to intubate her immediately...but of course, since this was in the ward, immediately took like forever...and the on call HO in-charge of my patient was an ultra-imbecile...thank God the other 2 on call HOs who were helping me were capable...i think Murphy's law was at work today...whatever that could go wrong, did...

I was in the ward till 830pm plus...we did CPR 3 times for the patient...shocked her twice...overloaded her...she went into acute renal failure...i just couldn't save her...she couldn't even live to celebrate Hari Raya tomorrow...i didn't watch her die...i left the hospital after ICU called to transfer her...i thought she would make it...or at least i prayed she would...but one of the on call HO msged me after i got home that she passed away...

I'm just so angry at the whole thing...at myself, at the bloody imbecile HO, at my boss, at my colleague...i shouldn't have to stay to settle patients after office hour when there're on call MOs...and i shouldn't have to be angry at stupid HOs even though they are stupid...i shouldn't have to be angry at my boss for not caring for his own patients...and i shouldn't have to be angry at my colleague because she left me alone to resuscitate this patient...but i'm angry at myself for feeling all these... i shouldn't even care...patients die anyway...in 2 days, none of the ppl involved in the situation would remember the patient...but it will haunt me...for a while...

I need to get a new job...where i won't have to see patients die...cause patients' death...maybe i really should go to NZ and become a seasonal fruit-picker/packer...or maybe i should become a wedding planner...at least i'll make ppl happy...instead of killing ppl...

NZ trip - day 1 (and the day before)

I was post call on Friday and had quite the sleepless call...apparently this always happens before i go on holidays...did some last minute packing after i got home...bathed and finished up my laundry...my flight to KL was supposed to depart at 1530H...Jasmine sent me to the airport...was flying MAS...met one of my specialist, his wife and baby at the boarding gate (little did i know he would be my boss when i get back from my holiday)...as usual, the flight was delayed, thankfully only for 1/2 hour coz i only had an allowance of 1 hour delayed if i were to make it in time to check-in for my Auckland flight...couldn't really sleep in my KK-KL flight...so ended up playing with my specialist's baby... she's so cute...and miraculously, she likes me :)...

Checked-in on time for my Auckland flight, considering that Cam actually came later than i did...had a late lunch on the flight earlier...so just walked around the international departure area till our flight was called to board...we were flying MH131 to Auckland which was scheduled to depart at 2120H...which eventually departed at 2130H...i supposed that wasn't too bad...watched Little Big Soldier (starring Jackie Chan and Wang LeeHom) and had chicken briyani for late dinner...then slept fitfully...one of the trip to the lavatory, my specs actually dropped into the toilet bowl...it was flushed previously but i still felt yucks!!! totally washed it with soap multiple times...they served breakfast about an hour before we landed...hardly slept at all...

Finally we landed in Auckland airport at 1130H (minus 4 hours for Malaysian time)...thank God i didn't develop DVT...we got our luggage...thank God they didn't get lost...then we took the airport shuttle to Britomart station downtown...backpackers rate for return trip was NZD21...Jeanne (Cam's friend) was waiting for us there...so we lugged our luggage back to her place (about 15 mins walk) at 53 Cook Street...her apartment was a 2-room...a bit small but i liked the interior...very clean and sterile...after we put our luggage, off we went for lunch (together with Jeanne's housemate Neo) coz Jeanne was hungry...we walked pass the place where they had bungy...not the real free fall with you attached to a rope..this one is a ball-cage which sits 3 persons and it gets catapulted up for God knows how high and it bounces a few times before it gets back to the ground...pretty cool but we were all too chicken to try...

We had Thai food for lunch...actually it was just Jeanne and Neo eating...Cam was sick of Thai food and i wasn't hungry yet...then we walked to the ferry pier and bought ice-cream...did i mention it was like maybe 15 degrees celsius or less? and we were happily slurping our ice-cream in the friggin' cold...i had a hokey-pokey honey crumb which was seriously yummy :)...we walked as we slurped...saw lots of nice sailboats...then we went to Victoria Park and checked out cute guys playing soccer...wanted to go to Victoria Park Market but it was already after 5pm...in winter, everything close at 5pm...so we walked to NewWorld hypermarket instead...thank God that closes later...bought some groceries for breakfast...kiwifruits were so damn cheap...NZD 1.69 per kg..so we bought a few for our travels...

Went back to the apartment to put our stuffs...then we went to the Sky City to check out the casino..of course we didn't bother to play...too much at stake...then we went for Korean dinner which cost about NZD10 per meal...dollar to dollar, this is actually very cheap...but of course if you convert it to RM then it's not that cheap lah...since we'd walked quite the whole day, we decided to go back and rest...but as expected when girls get together, especially after having not met for a long time, there would be a lot to chat and catch up...4 of us ended up sleeping in the living room and had girls talk till past midnight...suffice to say everyone was sharing their experiences... hehe...finally fatigue set in and we all fell asleep...a long day awaited us tomorrow...

Having the post-vacation blues again...

I'm back in KK...got back from Middle Earth on Merdeka day...then been depressed coz i found out that i'm going to uro...kinda expected that...but when it did happen, it still felt depressing...oh well, life goes on....adaptation is most vital for evolution...next to mutation, that is...

Will write more on my trip to Middle Earth when i have time...need to get some rest now...

I'm leaving...on a jetplane...and still having bad call...

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....

A good call, a good book and a good song...

I was call again yesterday...yea 3 eod calls in a row, remember? Did 2 appendicectomies during the day...well, taught the HO how to do one but i did most of the crucial knot-tying coz she couldn't hand-tie properly...then was hanging out with Grace and Kean Khang in ICU..Grace was on call too and we had Burger King for dinner...ahh...it's good to have friends with devoted husband...even if you don't have one yourself...

Grace was about to finish a thrashy romantic novel titled "Brighter than the sun"...you know it's thrashy romance with titles like that...i haven't read one in quite some time...so i thought why the heck not...so i borrowed it, not expecting to actually get to read it...but after the last appendix i did that night, it was pretty quiet...oh, the last appendix was quite an amazing one...the lady was morbidly obese...and so was her appendix...and it had perforated at a few sites...and it was faeces-laden...and there was quite some localized pus collection...but never mind about that...

So i thought since it was quiet, i'd start reading the book a little...i guess when you're really engrossed in a book you don't realize that time flies...by the time i felt quite sleepy, i saw that it was already 6am plus...and i was almost finishing the book...really, if i read surgical textbooks with half the zeal i had, big boss would be so proud of me...hehe...so i thought i'd get some sleep and slept till 9am plus...came home, finished the book and slept some more...woke up about 115pm to get ready for locum...

Went online and checked out a friend's blog...she posted LeeHom's new song from his new movie "Lian Ai Tong Gao"...it's called "NI Bu Zhi Dao De Shi"...i love this song...the music is so touching that i couldn't stop my tears from flowing...so i put up the link on FB and few minutes later i received a mail from Kenny...he sent me the mp3 version of the song...now i can download it to my phone and use it as my sms tone...hehe...and Vince sent me the lyrics to the song...so i'll be learning it when i get home from locum tonight...here's the link to the song...

http://www.youtube.com/watch?v=n8v9xr8lqhQ

Malaysian efficiency...

Thursday wasn't too good a call...had to do op till 4am...at least Friday would be less hectic...since it's the fasting month and we did not have our regular Friday lunch, i thought it best to go to JPJ and get my licence translated to English so i could drive while we were in NZ...of course i forgot that true to Malaysian efficiency, all government offices and counters are closed for a long Friday lunch break...it doesn't matter that most of them would not be eating...crap! so i had to sleep in the car while i waited till 2pm...

Cam told me it only took her 15 mins to get her licence translated...what she didn't tell me was that i had to photocopy my IC and driver's licence...so i went to get my number and waited...i also asked the guy at the enquiry counter as to what i needed to get my licence translated...he said i only needed a photocopy of my IC...so i had to walk a good 2 mins to another place to get my IC copied...for rm1!!! and when it was my turn, the girl at the counter told me that i needed a copy of my driver's licence too...really, post call doctors should carry a sign that says "kindly do not piss off a post-call doctor, or else..."...

I thought of a lot of nasty comments i wanted to make but i'm an implosive customer...so i had to waste another 2 mins and a total of rm2 plus i had to pay rm10 for a bloody translation which i could probably do better...but at least they did only take 15 mins to do the translation...which i could have done in 2 mins...that my friends, is Malaysian efficiency...indeed, Malaysia Boleh!!!