Fever

He's 26. year old.

Professional.

Single.

The fever was abrupt in onset, accompanied by headache, muscle ache & joint pains. he went to a GP and got treated for flu instead, no blood was taken and all he got was a pain-relief injection for his headache.

At day 3 of fever he checked himself into the ER with a blood pressure of 60/40. He was already in septic-shock.

Approximately 3.5 litre of fluid in ER was infused rapidly into his veins and managed to bring his BP back up.

However the blood-vessel leakage was so great that he lost most of his circulating fluids into his abdominal cavity and lungs causing him to deteriorate rapidly in the wee hour of the morning.

He was intubated and put on rapid fluids along with inotropic drug to sustain his dying vital organ's perfusion.

Less than 24 hour after he came to the ER, his body laid lifelessly in the ICU.

One of many blood investigations that were sent to the lab came back positive that morning.

It's dengue.

typical

0500 wake-up

0530 books (sometimes channel 40)

0630 head for hospital to grab limited staff carpark

0700 ward round

0800 grand round / teaching

0900 ward round with specialist

1000 referral from ER "Hey new guy, whadayathink of this ECG, can we thrombolysed him?"

1030 call up respiratory for consult (give up after 3rd unsuccessful unanswered pager)

1100 Bed 8 chest pain --> "Lungs clear - ECG no ischeamic changes, order cardiac enzyme and repeat chest x-ray"

1200 another referral from ER -- "okay - okay bring him up to the ward"

1300 clerk the new admission

1400 quick bite in pantry

1500 Bed 3 drop her blood pressure ---- JVP reduced, looks dehydrated, low urine output fluid challenge with 1 pint gelafundin

1600 meeting with cardiothoracic surgeons

1730 pass-over ward cases to on-call docs

1800 library

2100 home

2300 bed

0200 nightmare --- 'in ward resuscitating collapsed patients'

0345 morning pee

0500 "watttt where am I?"

Killing me softly

"From now on you have to cut down on your social obligation... do tell your families and friends that they will see less of you this year...."

Hafiz the 4th year spoke with a tinge of British accent acquired during his undegrad years in UK. Mat kelate lagi tuh.

"....You're expected to do rounds on weekends too unless if you're based in coronary unit, high-dependency or emergency room...."

(insert silent pause for dramatic moment)

".. which means you will have to come to hospital everyday including weekends for the next 9 months".

He finished off his 'not so-welcoming' welcoming speech with a dry smile.

I could imagined myself stangulate him like what J.D would do to Cox in 'scrubs'.

Each team or ward is headed by one specialist, followed by his right wing man @ a registrar (4th year/final year) and the very least a first year MO aka 'freshie' aka 'newbie' aka 'bambi' aka me.

The specialist enjoy having the newbies for breakfast by giving quick quiz during morning ward rounds.

"You!... Yeah you in black tie... What are 10 common causes for atrial fibrillation??"

"Errrrr.... hmmmm..... stage fright.. hehe".

Someone quick pass me the cyanide.

Day 1

The registration day!

The new place is ain't bad. In a nutshell, fresh faces with well... fresh body odour. It's like taking a trip down the memory lane back to standard 1.

Lotsa things to do e.g security pass, name tag, new hospital car parking sticker for collection.

The new bosses are super nice, that's good to start with.

The bad news is I have to start learning about all 16 patients whom are all new to me, in 15 minutes passing-over session. Hoho it's just too early too stress out...

..arrgh where's my java chip venti???!

Silent departure

30.5.2007 Wednesday 9 am

To my surprise, my last day and on call in the ICU was uneventful. It was a good 4 hour-sleep. All patients were as stable as a sunday morning shift in Kuala Kerteh outpatient clinic. I was both delighted and sad.

I was lucky to have the opportunity to work there and to be among the few good doctors/teachers whom had taught me the importance of work ethics.

For example it was the only time in my life have I came across a consultant AKA the Head of Department who came as early as 7.15am sharp every morning beating everyone else when it comes to attendance and ward round. And this is a government hospital we're talking about here.

As the old tradition goes, it is usually the Houseman who do the 1st morning round, followed later by medical officers, specialists and then consultants.

As I close the main door behind me, a quick final glance of the place reminds me the faces of those people I had helped and also those who I could not.

"The unbroken morning! The sweet surrender of the past shall cast away the pitiful soul of regrets and

bring tears to the devil himself" - drfrapp

Goodbye my friends!

Trash talk!

You wouldn't believe weird things people would do late at night when they think other people don't see them. The thrill of doing crazy thing and being caught red handed or get away with it.

EXHIBIT A: During my heydey in down under, me and my buddies didn't mind taking a leak next to a side walk at 1 am -- hey u gotta go when you gotta go rite?

On another note people become a bunch of 'clown' when they consciously disinhibit their cingulate areas, cerebellum and the medial frontal regions of the brain bla bla!.

Oh yea! Those areas are the 'ground zero' hit by the A-bomb (alcohol... cute eh!) when one's dead drunk.

EXHIBIT B: The countless fights that happen between drunken Maori and pakeha gang at your friendly 24-hour Burger king joint where I used to work part time.

Not to mention the countless time I had to clean the toilet sink by scooping out their vomit using the burger king (TM) extra large cup.

----IS DAT YOU JACK SPARROW ??---

Question: Would a person shows her true colour (in public) when she is drunk?

Perhaps most hidden-racist would only display their charm' out-loud in public when they lost control of their action.

EXHIBIT C: I only got shouted "Go home asian boy!!' While being thrown at with Steinlager bottles at 6am after my graveyeard shift by some local kids in their speeding cars, when they're totally piss drunk.

Shocker! They could tell that I'm asian even though my uniform was XXL size with a cap on at the wee hour in the morning.

Huh maybe it's the same mat salleh kid who worked at Harvey Norman where I bought my stereo from. Dang I gave him the bloody commission for that transaction too.





AAH! THE REAL CAPTAIN JACK!! FORTUNATELY IT WASN'T YOU WHO SAID

"WELCOME TO SINGAPORE!!"

HOHO IT'S TEMASEK BACK THEN YOU HOLLYWOOD PRICK!




OOHH AAH! McCLANE SEE YA SOON 'OLD' BUDDY!

seriously mate...

Last night was my last 'on call' ever in this hospital operating theatre, soon I'll be moving out to a new place.

However, my sentimental kodak-moment during the last operation at 2am was interupted when the surgeon decided to play his favourite collection on Window media player.

To my horror it was none other than the dreadful The best of Hanson, starting with its gayish 'Mmbopp'.

Has the world gone schizophrenic... a male orthopaedic surgeon listening to that crap!

If it was me I'd play this piece... a nice powerful ballad from My Chemical Romance.!

(oh BTW, for those of you who haven't seen the clip can click on the Youtube --> right side panel).

When you go
So never think I'll make you try to stay
And maybe when you get back
I'll be off to find another way

When after all this time that you still owe
You're still, the good-for-nothing I don't know
So take your gloves and get out

Better get out, While you can

When you go
Would you even turn to say
"I don't love you Like I did Yesterday"

Sometimes I cry so hard from pleading
So sick and tired of all the needless beating
But baby when they knock you
Down and out
It's where you oughta stay

And after all the blood that you still owe
Another dollar's just another blow
So fix your eyes and get up
Better get up, While you can

When you go
Would you even turn to say
"I don't love you Like I did Yesterday"

Well come on, come on

When you go
Would you have the guts to say
"I don't love you Like I loved you Yesterday"

******
Next tuesday will be my last 'ICU on-call'.

Which will also mark my last official duty at this hospital which I've grown fond of these past 2 years.

Two years eh! Time flies.

Anyhow according to the old tradition, usually it's 'all hell break loose' on your last day . I think that's what the TV folks refer to as 'Season finale suspense ending'... Hahaha!

** Sigh**