Soul-searching

Have you ever found yourself too consumed by the moment that you no longer feel like you're part of this world? It was absolutely silent and the only sound I could hear was my own breathing.

I was utterly mesmerised by the perfect loneliness which I deemed to be an effective remedy for any wounded spirit. For just about 15 hours ago, I had to deal with 3 ill-patients in the Resus room, with one of them tried to hit me in the face with his literally bloody hand while cursing my ancestors with every breath that he could mustered.

None of the remarks was taken 'cos he was sick and probably would be the nicest 90 kg 15 year old around if he wasn't poisoned by his own rising acidosis in his bloodstream, a typical picture for a diabetic ketoacidosis (DKA) in Type 1 diabetes.

Having said that, still my mind was frantically searching for other perfect ways to spend one's Friday night.

Anyhow, let those be bygones and all I wanted to do right now there and then was to indulge myself in the quietness of the moment while feeling for my radial pulse so to be certain that I'm still a regular cast in this troubled world.

1, 2.... 4!!

2am somewhere in Klang Valley...

St John: ER, coming over.

ER: This is ER, go ahead St John.

SJ: We have a 22 year-old male with SOB, over.

ER: What's your ETA? over

SJ: ETA 10mins, do you copy?

ER: Roger that, we'll be ready for you, over and out.

By the time the ambulance pulled over at the main door, the whole resus crew had already scrambled to the trauma room with the drugs syringed up, locked and loaded.

A senior emergency physician who acts as the team leader will be doing the bird-eye view on the whole resuscitation procedure and coordinate the team members to act as a unit. The rest of the team will be busy securing the airway, providing ventilation and inserting IV lines.

Phew! With that huge sudden amount of adrenaline rush who needs coffee anyway.

But what interest me though is this is the only hospital in Malaysia that address its Accident & Emergency unit as ER.

Which make me feel like I'm working in Chicago ho ho ho!

"Hey where's the GSW victim?!!"

**

SOB = shortness of breath

GSW = gun shot wound

Hidup bebas atau...

YEHAA!

Dunno what to put here anymore to be honest. Lately I've been running amok around the wards with empty thought and loaded balls. Hey it could be vice versa and that would be briliant.

Btw it took me the whole weekend to move my stuff into the new apartment. Dang! I love the place, the smell of fresh paint, the fantastic view I laid my eyes on moments before I kiss the night goodbye -- Oh the whole enchilada!

At least this new place could rejuvenate my dying moral and would be something I look forward to at the end of any given post-on call day.

Psstt! I heard a story, a doctor got a heart attack and complicated by a rhythm abnormality (arrhythmia). However, seconds before his impending collapse, he reverted the arrhythmia himself by coughed-up forcefully.

Thought that may come in handy - when you are all alone and miles away from SJMC :)

Oh btw.... MAMPUH KERAHH is bloody awesome. Willis maybe bald but he still got some nasty moves left in him.... more sequel puhlessss!

What was that again?

It had been quite busy days and weeks for yours truly. The amount of cases need to be seen just keep climbing up by the days. Most often than not, I find myself lost somewhere between the huge amount of patients and this ever-busy hospital. Huh! The situation can be even more baffling than comprehending who's who in LOST season 3.

Not to mention, the need to open up books and read around cases is a must if one need to survive in a post-grad world.

Everyone else appears to keep their composure quite allright. For some reasons that I'm yet to found out, the other docs seem to be able to breeze through their daily routine without any problems. They seem so cool and have it all suss out well within their cerebral capacity.

Am i missing something?

Is this whole thing happening because I skipped that late afternoon lecture given by that boring lecturer 6 years ago?

Sometimes I wonder if that lecture was entitled "How to look damn cool like Travolta even when you know diddly-squat about this patient in front of you"

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.