Monday, February 02, 2004

A rude wake-up call

WHO update on the bird flu epidemic

Key sentence: "...the World Health Organisation (WHO) warned that the deaths of two sisters in Vietnam could have been caused by the disease being passed from human to human."

I brought this up indirectly via email to fellow colleagues in the ER recently, but was confidently told by a senior ( not our chief ) that there was no proof of the possibility of human-to-human transmission. My concerns stemmed from the fact that, despite an implemented policy for suspected bird flu patients to be transferred to TTSH for further evaluation and admission, those of us at other peripheral hospitals are still obliged to see them even if, upon screening at the entrance, they are found to have the relevant positive travel and contact history ( ie. risk factors for the disease ). I suggested sending these cases directly to TTSH, without having them enter the ER proper, which entails visits to the registration counter, triage, parking in the waiting area ( where other patients are in close proximity ) and last but not least, coming into our consultation rooms and sitting inches away from the doctors who see them.

Paranoia, you say? Not if my life depends on it. And not if other people's lives are at stake too. The spread of SARS throughout Singapore was partly due to the lack of adequate isolation measures in the initial period, such that patients were seen at ALL hospitals, with some being admitted at these institutions. My suggestion is: if someone has all the risk factors for exposure, and is obviously stable, transfer them to TTSH stat instead of letting them cook elsewhere. No-one will fault you for it, right?

Nice start to a new month. :) It's a public holiday-in-lieu today, but being the tail end of a long weekend, and a Monday at that, we're pretty busy fielding everything from NS men asking for MC for a mosquito bite ( yes, believe it! ) to coughs and colds and perhaps a bit of a hangover. I hate to say this, but my patience has been wearing thin recently. Yesterday, a couple in their 20s showed up after a minor bicycle mishap. The girl sustained a small chin laceration and some abrasions, but was otherwise comfortable. Her boyfriend wasn't injured, but his incessant coddling drove me crazy. "Are you okay? Is she okay, doctor? Is it serious? Are you in pain, darling? Oh no, she needs stitches?!? ( looks as if he's going to burst into tears )" Ugh. Luckily, the girl was a model patient, quietly sitting in the wheelchair, looking irritated herself at the idiotic behaviour of her companion. I could almost hear her saying, "What a moron." to herself. If I had a boyfriend like that, I'd slap him. Honestly. :)

Then, just before my afternoon shift ended last night, I attended to a 14-year-old boy who also sustained multiple abrasions when he fell off his bike. Nothing major, so I ordered some simple dressing to the wounds. For the next hour, the entire ER reverberated ( I'm not kidding ) with his cries and screams as the nurses cleaned him up. They weren't being rough at all -- I went over myself to check on him in between patients, as did another MO who asked me, "Who's being slaughtered?" :D Just think, this quivering mess will be entering National Service to defend our country in 4 years' time. Yay.

Looks like there's a "celebrity" in our midst. :) A fellow medical officer in my department was mentioned in the Straits Times on Saturday for his research on SARS cases here, as part of a team headed by Dr. Pierce Chow, a surgeon from SGH. Teased him a bit about it, but as always, his unfailing humility is admirable. He also has a PhD for work done on the Epstein-Barr virus. A great accomplishment indeed!

Feeling a bit fatigued from the busy shift yesterday. Will post again if time and energy level permit.

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