Tag Archives: Medicine

Soccer

I didn’t turn up for my soccer training today. Was too tired. I could only feel disappointment and resignation. There was nothing i could do about it. I was already dozing off on the drive home from work. It was a struggle. This need for sleep. I had to take a nap or risk a crash tomorrow.

Also I need to break the news – I got a new puppy. She’s a miniature Pinscher. Got her last Saturday as company for my dog. The puppy turns exactly 10 weeks tomorrow. I named her Fleur. More updates soon!

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Death

I came in the morning and did my usual routine of retrieving my ward list and scanning the list for any new patients. There was one, a terminally ill patient. Someone who understood her situation and opted to go peacefully. I walked past her room quietly, throwing a glance in. The patient i saw had a face so gray, i thought she was already dead.

We visited her on our rounds. I introduced myself. She gave me a smile so warm, i was disoriented. People who are about to die should not look so…happy? She reached out with her hand; i did not offer mine. I did not want to touch her, but then i was appalled at my manners. I could not even hold her gaze. The usual questions i normally ask my patients remained frozen in my throat. Do you ask a dying patient how they feel, are they feeling better or what plans they have for the day?

Just as we were about to exit the room, i reached out and held her hand. She clasped my hand in a surprising grip and smiled at me again with an encouraging look. I could only muster a weak smile and could not wait to exit the room. My head was churning with emotions. A dying stranger was comforting me because of her impending death instead of the other way around. What logic was that?

Throughout the day, i would not enter her room. I usually smile, greet or stop for a small chat with my patients, but for some reason i could not muster the courage to talk to this lady. I do not know how to converse with a lady who has no more hopes and only a final destination to arrive at. What do we talk about? What can we talk about? Everything else would be so mundane and pale compared to where she is heading to.

The next morning, i glanced in her room. I thought a face could not get any grayer, and that expression must be a mask of impending death. I have never seen that look before. 15 minutes later, i was paged. My patient had moved on. I felt a jolt of shock hit me. That was not a mask i witnessed; that was death itself. I just did not recognize it when i saw it.

I was asked to pronounce her death.

I hesitated. The senior doctor saw the look on my face.

“This is your first dead patient?” she asked incredulously.

I nodded mutely.

Instantly her expression softened.

“I will accompany you into the room,” she said and i was very grateful for that.

I knew what had to be done, but i never had to go through the motions before. Hell, i only did one week of palliative care in my 5 years of medical school. Now i wonder how we managed not to learn more about palliative care when it actually dominates every aspect of medicine.

I was afraid. This lady was dead but she was not a corpse to me. A corpse did not look like that. A corpse is one i associate at crime scenes and funeral parlors, not one that still retained some sort of human resemblance. I was frightened that she would rouse at any minute and yell at me to get my frigging fingers off her.

I did the sternal rub, determined to elicit a response. The senior doctor had to gently tell me to move onto the next stage. I auscultated the chest – it was silent, yet i held my breath and my stethoscope, waiting to hear a sound, any sound. It was weird. Then i palpated for the carotid pulses, and i knew i will not find one, yet i held my fingers to her throat, waiting for one. It was all so surreal.

Then i lifted her eyelids to look at her pupils and that was when i knew she was dead. Not because her pupils were dilated but because the eyelids did not slid back in place. I gaped in shock.

“Close her eyes Spud,” the senior doctor said.

I did as i was told. I have never known the eyelids do not move automatically back in dead people. Clearly i know they will but somehow the dots did not connect.

Then i wrote the death report. I carelessly looked at my watch and recorded the time of entry. The ward clerk ambled over, peered over my shoulder, noted the time and said, “That shall be her time of death.”

I stared wordlessly at her. How can such an insignificant action to one be of so much value to another, especially when it is not accurate?

I hope i never have to do that again.

 

What the hell??

I saw this whilst browsing Book Depository.

 

I cannot believe this.

Do we need a clinical atlas focusing solely on Chinese infants?! This borders almost on the line of bizarre and discrimination. I have yet to see another book focusing on just one race (except for Natives). Unbelievable.

Click on the image above and it will lead you to Book Depository where there is a free Google preview. You will soon realize that there is no special (less than extraordinary) condition that affects this race than any other race.

MATCHED!

Top news of the day – i got the hospital of my first choice! I am really thrilled, happy, relieved and grateful. I can breathe a little easier now. All i have to do is pass the exams of the next and final semester, which starts in less than a week.

I spent the most part of the day looking at rental properties. It’s exciting; we are going to move, but probably remain in the same area since this neighbourhood is really safe. Hopefully we are able to rent a townhouse with a courtyard for the dog.

I mentioned before that i was probably going to move inter-state; but towards the end, i decided that staying would be the best decision. I have most of my social networks established here – sports (although i am not sure what’s going to happen to soccer now), volunteer work, language and music teachers. Hell, i can even continue with the dog’s intermediate obedience classes if i wanted to (i have not decided yet. So far the past month has seen us skipping our lessons mostly because i have been too lazy to wake up early. It is too difficult to pass up the temptation to remain in bed when most days i have to be up by 6am).

The Housemate and i are thinking of housing together for at least the next year because i would like to save up to get my own place soon, and she wants to get a boat. She’s matched to a different hospital but our current location is situated comfortably between both our hospitals so it is a good arrangement for both of us. We are thinking of finding a third housemate (from a different hospital) just so it would make things interesting? Imagine the kind of case studies we can pool and discuss. Haha, how nerdy.

Anyway, i was frantically reading up on BJJ techniques. I was appalled at the regression of the skills i have learnt. Need to regain them back as soon as possible. I have also resumed my Japanese and flute lessons. I must say that my rate of learning is so much faster when i do not have to study Medicine at the same time.

My Japanese teacher was rather shocked when she realized that i did not forget most of my Japanese and i was learning at a rate much quicker than the one i usually present with during my semester days. I felt less pressured during the lesson too. I could grasp the new grammatical structures better unlike the blank space i get when i draw up on my brain reserves after a long day during semesters. My flute teacher was as delighted. We were absolutely whizzing through the new pieces and i am hitting the high notes more consistently. So much so, i realized i can actually start trying out the movie music scores that i bought – most notably Titanic (i know, i can be quite cheesy). My teacher was momentarily puzzled before it dawned upon him.

“You have been practicing, haven’t you?” he declared.

I grinned sheepishly.

“I can tell when you practice!” he stated in mock sternness.

The sad part? It will all come crashing down when i start the busiest semester yet, next week.

Anyway, gotta run. BJJ started five minutes ago! Pizza celebration after! Yay!

Walking through the masses

I was walking through the hospital today, in civilian clothes, blending in with the visitors. I took my time strolling through the lobby, gazing at the patients, their families and friends, glancing at the professionally dressed healthcare staff. And it suddenly occurred to me that whatever bad decisions i have made in my life, some i don’t remember, others i can’t forget, this decision to work in the hospital is not one of them.

I like the ever-changing landscape of the hospital. I meet different people all the time, and do various life-changing interventions that make a real difference, no matter how insignificant it looks. Even the simple act of inserting an IV cannula to provide pain relief to a lady in severe pain from gallstones, or antibiotics to a guy with appendicitis, means a lot. As much i do not want to admit this to my egoistical nature, i like medicine because my skills are needed, i feel wanted. I am not just some useless sidekick or some dispensable minion on the payroll.

I have done my fair share of office jobs and cafe jobs. Although the office jobs pay more and i physically expend less energy; i actually enjoy myself better as a barista. I like doing manual jobs with my hands, pulling the shots, steaming the milk, wiping the counters, heaving heavy cartons of milk. I like meeting new customers, chatting with my team-mates and just exchanging smiles and grins with random strangers. Just being part of the lives of so many people i will probably never meet or recognize in this infinite universe – the mere few seconds of interaction in this cosmic web of time; i am just completely awed by it.

Sometimes, i imagine to myself, when i am dead and alive in the next dimension, i will be talking to a stranger and peering at a huge diagram of my life in seconds and find out that when i was 8 or 16 or 24, our lives actually cross in the briefest of moments. We just never knew it. How incredible would that be? Whereas in an office, i went to work in the same bland environment, sat on my desk and faced the same papers and computer and the same sour-faced colleagues. I did not even have new clients to break up the routine. It was bad.

And being a doctor just fits the bill. I may whinge at times, but it is all good-natured and good fun. The odd patient may cause me to shriek or tear my hair out, but in the end, i have a giggle over it with my pals. The patients who do well and who are grateful and who really appreciate your work – the feeling that you can proudly acknowledge to yourself that you have accomplished something in life – it’s intoxicating. The constant challenges you get that keeps you on the ball and your mind engaged.

Yes, Medicine ticks all the boxes. And this morning as i strolled through the hospital, a passerby in that frame of time, i knew i made the right decision despite my misgivings.

It really is funny how little facts of life can strike you at the oddest moments. And i was actually going to the hospital to chase after one of my referee reports for an application that is starting to reveal the odds may be against me. Who knows, maybe all the comical bad luck i have been encountering in my lifetime is to compensate for this void in time where a miracle can happen. Who knows right? Right. I need to shut this optimism up now.

Pediatricians Want Redesign of Hot Dogs

My attention was brought to this news article by T-Post.

Pediatricians Want Redesign of Hot Dogs, Candy to Curb Kids’ Choking

“We know what shape, sizes and consistencies pose the greatest risk for choking in children and whenever possible food manufacturers should design foods to avoid those characteristics, or redesign existing foods when possible, to change those characteristics to reduce the choking risk,” said Dr. Gary Smith, immediate-past chairman of the American Academy of Pediatrics’ Committee on Injury, Violence and Poison Prevention and lead author of the organization’s new policy statement on preventing choking.

“Any food that has a cylindrical or round shape poses a risk,” he pointed out. Smith said that hot dogs were high on the list of foods that could be redesigned — perhaps the shape, although he said it would be up to the manufacturers to figure out the specifics.

The AAP policy statement appears in the March issue of Pediatrics and is the first such guidance on the subject from that group.

Read more here (Healthfinder).

Hot dogs have an iconic shape that should not be changed. They are no longer hot dogs if the shape was changed, say to a rectangle or a square or what not. I reckon it is up to the onus of caregivers to pay more attention to the children under their charge. Anything that is too big, regardless if it is triangular or hexagonal or spherical, will still kill. You don’t stop eating fish just because it has too many bones, do you?

Pregnant women

Today i attended my first antenatal clinic. It was good. I got to perform Leopold maneuvers.

Leopold Maneuvers

I have never touched a pregnant abdomen before and i was glad i was not too nervous about it. (I think i was more freaked out about taking blood pressures, because i have not taken blood pressures in 6 months and i was confusing myself over which way i should place the damn cuff. It got sorted out eventually. I need to stop psyching myself out. Confidence is what i need.) Anyway, back to pregnant bellies. I had to palpate for the top part of the uterus, something which i need to work on more. I can’t tell the difference, but i have got a couple more weeks to figure that out. I just need to palpate more pregnant abdomens to get a “feel” of what normal is like. Then i had to palpate for the fetus’s head near the pubic symphysis to see if the fetus was in the correct position for delivery (head down would be preferable, sometimes the fetus ends up wanting to come out buttocks first – known also as a breech delivery). That was even more challenging. So far in all my palpation of abdomens, all i ever needed to do was to feel for lumps and characterize it. Now i am supposed to take it one step further, to try to delineate whether the lump i was feeling is a head, and whether it has engaged into the pelvis (descend far enough into the pelvis to know that delivery is imminent).

Then i got to seek to out the baby’s heartbeat using a handheld device (what is it called? I was told by friends it was a Doppler, but how can it be a Doppler if there are no sonograms, let alone coloured sonograms for us to see directions of bloodflow??). And i thought heart murmurs were challenging. This was even worse. I had to differentiate between the mother’s heart sounds, the placenta noises and finally the fetal’s heartbeat. It was all a bit mad. I could not get any fetal sounds in the first two patients but after observing and hurriedly picking up the subtle tricks and techniques the consultant was using; i got the hang of it. Now i just want to feel more comfortable doing the whole process.

Really love the outpatient clinic. Actually it really brought the point home today as to how much i love physical signs. I really love being able to palpate for masses, and looking for hard clinical signs on physical examinations. This is why i like surgery so much – it is a specialty built on physical signs. I mean, if you don’t have convincing physical signs, you would not be sending the patient into the operating theatre to be cut open in a jiffy right? That’s why surgeons are so good at picking up such subtle signs. It is an Art, an Art that i would really like to learn.