Good Sunday morning! Got home late last night after the wedding, so I'm fighting to keep awake at the moment. Shall cheer myself up with some humour, thanks to eucalyptus's hilarious post. :D

"If you really want it published in the Forum Page, you need these...

1. Dramatic events that will have everyone gasping in horror. eg "I suffered a severe paper cut..."

2. Big name target. "...I went SGH..."

3. Perceived shabby treatment. "... only got a handyplast..."

4. Bombastic words. "i am appalled at the appalling treatment..."

5. Throw in some gory details. "...there was blood all over my thumb, I almost fainted..."

6. Fantastic leap of logic to arrive at deadly outcome. "...I could have bled to death!!!!"

7. Extrapolate it to the whole hospital or doctors in general. "Attitude problem" is a favourite phrase.

8. Make yourself sound noble. "I only want to warn future patients..."

9. Quoting some obscure "expert" opinions. "...according to the International Society of Paper-Cut Sufferers..."

10. Be sure to use the all-time pet phrase "I wanna complain..." somewhere in the letter. Preferably, but not confined to, the first sentence.

Tada! Instant publishing in the Forum. "SGH Almost Causes Death in Bleeding Patient."

By the way, I've read re-minisce's letter. Of course it wouldn't have been published! It contained two fatal, taboo ingredients...

1. Argument based on facts. Argh! Horror! He left out the sensationalisation and mandatory finger-pointing.

2. Disagreement with "official" opinion. Blasphemy! Heretic! Burn him at the stake!"

Thank you, eucalyptus, for putting things in such wonderful perspective. ;)

Ah yes, the wedding dinner. The food wasn't the best, but it's the ambience people pay for, and that was terrific. Granted, the ballroom was huge, so the coziness factor was lost. Luckily for my table, we're all ex-JC mates, so we had lots of catching up to do, and the conversation never stopped flowing, as did the wine, haha. :) Topics were as diverse as dropping birth rates, cost of living, emigration, a certain minister's work schedule, another minister's ability at his new job, kids, hospitals, patients, investing... the list just kept going. My JC class has always been close, and we've all stayed in touch these past 10 years, mostly via email and the occasional meetup for dinner ( matrimonial or otherwise ). It's nice that although everyone's carved out successful careers in different areas, deep down we're still the same fun-loving, eccentric bunch. Put us together in a group and the laughs just keep on comin'!

My friend was the lovely bride, and her husband, a super-nice Malaysian fellow with a famous law firm. They did away with the usual video presentations featuring baby photos, etc, opting instead for a fantastic live band that played jazz favourites and oldies ( in both English and Mandarin ). The highlights of the evening would have to be the couple's waltz after their second entrance, and the groom's poignant speech. One of the reasons I love weddings is because I get to witness true bliss firsthand, temporarily overshadowing my constant disillusion with the subject of relationships. :P All the very best to the happy couple! Next wedding dinner: 21st March!

Secret Garden is giving a concert at the Esplanade on 18th March. It consists of a duo that plays Celtic music, and they may or may not be accompanied by an orchestra when they perform here. Their more famous pieces include "Nocturne", and "You Raise Me Up" ( the latter recently covered by Josh Groban on his Closer album ). Mostly violin and piano, but the melodies are hauntingly beautiful ( or beautifully haunting, haha :)). Promises to be a treat.

And let's not forget the Academy Awards show, which will be telecast live on Singapore TV ( Channel 5 ) tomorrow 9am. I'll be at work, but keeping track via the Internet. Good luck to Peter Jackson! I have no doubts at all that 2004 will be LOTR's year. Finally .

The ER crowd is starting to swell. Don't Singaporeans have anything better to do on a nice Sunday morning? :/

ClayMania Resurgence

:D

Ah, I'm picking my way through the Charlotte concert bootleg videos right now ( I'm talkin' about Clay Aiken, for the benefit of those who aren't fans :)). You can view them ( plus the newest ones from Duluth ) at this link:

Airplay Central

Just watched his renditions of Kyrie Eleison and When I Need You. Waiting for Carolina On My Mind, and the whole list of others following that! I gotta tell ya, Clay is in his element! Kyrie was the opening song, and he walked all the way from the back of the auditorium to the stage, causing mass hysteria along the way. Really funny. :) His voice has never been better, soaring high above all the chaos and deafening screams and cheers from the appreciative crowd. Then there's the acoustic set, of which WINY is a part. Clay has always demonstrated such finesse when doing covers, sounding ten times as good as the original ( e.g. Somewhere Out There, To Love Somebody, Unchained Melody, and the now world-famous improvement of Bridge Over Troubled Water ). Hearing him belt out WINY gave me goosebumps big-time! Absolutely beautiful. :)
He's learnt to work the audience since his shy American Idol days, so it's lots of fun seeing him shake his stuff on this tour. He's loosened up nicely, and enjoys himself immensely while performing. Love his dress sense too, haha!
A bunch of fellow Singaporean Clay fans will be flying to LA to watch the concert in April. How I wish I could go with them! Used up all my annual leave for the NZ trip, but "I have no regrets" ( a la William Hung, heh :P ). I just hope Clay'll drop by our shores in the near future, before I get a nervous breakdown from seeing all these video clips and hearing about the tour from my friends. :D

Now I shall gush about something inanimate. :)
Went to the condo estate at the developer's invitation today, and I'm officially in love with the swimming pool area. No, I'm not kidding. I was practically draping myself over these gorgeous ?oak round tables located next to spanking new BBQ pits just adjacent to the water. There's even an amazing al fresco type dining enclosure, which can be used for sitting around, reading, brainstorming, studying, thinking up plots for novels *wink*. Super-windy everywhere we went, and the overall decor is breath-taking. Extremely well done, I must say, exceeding all my expectations. Did I mention the outdoor jacuzzi? How about the playground that's partially submerged? And the clubhouse, with 2 function rooms, games room, card room, gym, and another open gusty area with a great view? Ooh, and there's a well-known, huge park nearby for jogging and cycling. Not to mention a direct bus to a bustling mall, interchange and MRT station that's 10 minutes away from the CBD area ( at most ). I'm gonna enjoy living here. :D

Will be attending a very old friend's wedding tomorrow. Promises to be a lively affair, complete with band and a lovely atmosphere. Will of course be meeting the usual people -- old classmates, medical friends, maybe our civics tutor. I just want to gorge on the good food. :P Nah, I wish the happy couple the greatest happiness that life can offer. Just hope I get some rest during this night shift so I won't look half-dead at the dinner.

Right then, on to more Clay videos. :)

I couldn't resist. :)

This is just TOO FUNNY! HAHAHAHAHAHAHA!!!

Best With Sound

Or how about this? *Warning: potentially addictive*

Dodge

Just a short post before I hit the books. Am on 4-12 shift today, and still recovering from a major errand-running marathon yesterday, so I'm not too upbeat. :(
Although, I have to say the Ikea store makes me feel like a kid in a candy store all over again. That place is huge! And I love their furniture and assorted knick-knacks!

Quick check with the Forum Page -- all quiet. :)

Predictions for American Idol 3 finalists #4 and #5: Latoya London is a definite shoo-in ( love her voice! ), but Amy Adams and Jon Peter Lewis may have to jostle for the remaining place. However, if one of them fails to get through this time, it's pretty obvious whoever's ousted will be brought back for the wild card. My bet is on Jon Peter, even though Amy has the better voice. Is it just me, or is there "something" about the guy that makes him so inexplicably appealing? I think it's his spark-plug personality, especially when he performs. Can't believe Simon compared Eric Yoder to Clay Aiken -- except for some high-powered notes, I fail to see any other similarities.

And speaking of Clay, I've read through descriptions of the opening night for his Independent Tour with Kelly Clarkson, and guess what? Clay does covers of Kyrie ( Mr. Mister ), When Doves Cry ( Prince ), When I Need You ( Leo Sayer ) and Fields of Gold ( Sting )! I wish I could listen to them, but the website keeps crashing due to overload ( no surprise there :)). Sounds absolutely amazing, and I can only imagine how excited a few of my fellow local Clay fans are, since they've already booked tickets to shows in LA come April. If only I had some annual leave left! :(

Before I sign off ( yes, I did say SHORT post :P ), just want to say thanks to Mark Richmond at Class 95 for actually trying to get his hands on the Peter Cincotti CD ( I emailed the station to recommend it for their Dinner Jazz segments ). Was told that the store he went to had no more stock, so I suggested That CD Shop. Hope he'll find a copy soon so we can all hear "Sway" on the airwaves. :)
Also, another thank-you to Mark for playing The Way after a couple of Clay fans sms-ed to vote for our favourite guy in the station's Top Ten Of The Week countdown, which will be aired this Friday evening. He even read out our messages, haha! Really nice gesture, especially the bit where he played the song without us even requesting for it.

Right then, time to study yet again. Have a good day, everyone.

3:45am, and the worst is over. :) The worst meaning the period where I'm running consult all alone, that is. Now it's just a 2-hour watch in resus, followed by some rest, then consult with backup from 7-8. Seen 28 cases so far, which I guess is pretty decent by CGH standards. Though I do miss the less than 20 tally of SGH now and then. :P

Cheered myself up a bit by watching Peter Cincotti's "artist profile" on the Internet. The link is provided in recent blog entries, so check those out if you haven't already ( and WHY NOT!? ;)). My laptop couldn't seem to configure the video, but I finally got it to work on one of the consult room terminals, and wow, it's worth the wait! First of all, I learnt how to pronounce his name, heh heh -- it's "Sin-COT-ti". Then, I got to hear him talk -- mature, softspoken, nice voice. Best of all, I got to see and hear him perform -- these are mostly short snippets, some in pubs, some on a concert stage ( Peter looks terrific in a tuxedo ). The longest one is of him banging "Ain't Misbehavin'" in a small, nondescript bar, dressed casually in shirt and pants, with beer-drinking patrons seated nearby. If only I were one of them! :P Peter sounds phenomenal even on that old shaky piano with zero acoustics. Imagine him in the Esplanade concert hall!

It's interesting to hear about his great love for jazz, even as a child. Brings back memories of my growing up with oldies but goodies, thanks to my mom. Connie Francis, the Everly Brothers, Brothers Four, Beach Boys, the Carpenters, Cliff Richard, Barry Manilow, Engelbert Humperdink, Elvis Presley... I memorized so many of their songs just by listening to them in the car during our long drives to and from school. Then there was the classical genre -- I developed an early taste for Tchaikovsky and Johann Strauss as a primary school student. Really weird. :)
Well, it seems I'm a late bloomer where jazz is concerned. But hey, it's never too late to learn how to appreciate a good thing. Just hope Peter Cincotti will indeed drop by our little island someday, or I'll just have to fly to the US in order to watch him.

And speaking of concerts, Clay Aiken's tour with Kelly Clarkson will kick off come Feb 24 ( we're 12 hours ahead of America, so that makes it Feb 25 Singapore time ). First stop is Charlotte, North Carolina, where Diane Bubel resides. Diane has mentioned that she will get to meet him to say hi, and we're all eagerly awaiting news of the opening night. The tour will last till late April, so it's going to be pretty exhausting. Hope Clay will remain in good health and high spirits throughout this gruelling schedule.

Nothing much to report from the medical side. It was nice to see no letters of complaint in the Forum Page these past few days. But of course, they have a tendency to accumulate letters before splashing them all out on one full page for added dramatic effect, as mentioned by re-minisce, so don't get your hopes up. I, for one, wonder if I'll ever see a complaint lodged against Raffles Hospital, 'cos we all know a certain "someone" holds a position there. Enough said.

Going furniture-hunting at Ikea on Wednesday. You may be shocked to learn that I've NEVER been to the store to shop before -- walked through once in 3rd year med school, but that was on a whim after lunch with my clinical group, so I don't remember any of it. I've heard good things about their stuff -- reasonable prices, excellent quality. Heck, I even heard it mentioned multiple times on "The Oprah Winfrey Show" today, by renowned American decorators Nate Berkus and Vern Ho. They like to call it "Ai-Keeah" rather than "Ee-kea" like we do. I'm just toying with the idea of colour-coordinating the rooms ( my bedroom MUST be turqoise or navy blue ). Also suggested getting our cat declawed, 'cos he's developed this terrible habit of scratching everything in sight, including my pajamas. He's a sweet little feline, and it's another one of his kitty habits, but we can't have him demolishing our new furniture now, can we?

Right then, now I've got a drunk woman with an unexplained abdominal laceration, which looks suspiciously like a stab wound. No witnesses, just found lying on the kitchen floor in a small pool of blood. She's completely out of it, her family refused to come to the hospital with her, and her friend reeks of alcohol too. BP 95 systolic, but could be due to the vasodilatory effects of alcohol. Abdomen's really soft, though the wound has breached the subcutaneous layer and she's got adipose tissue bulging out of the laceration. Social issues plus-plus-plus-plus. Awaiting X-rays now. General surgical reg-on-call is a friend of mine. Looks like I'll be depriving him of some sleep tonight. Sorry. :)

Guess what? Seems another Forum Page complaint is erroneous -- again! No I'm not transcribing it ( you can read it in today's edition though ). In a nutshell, the COO of SNEC's rebuttal was polite yet potent. :)

And in other more important news *wink*, Rob Cesternino was booted off "Survivor: All-Stars"! NOOOOOOOOOOO! But in truth, I think we all saw it coming. He's too good a player to begin with, and it's only natural for the other tribe members to feel threatened. Now we're only left with Rupert, but if all the capable ones are kicked out, the eventual victor may very well be someone really dull and unworthy. Sigh.

Beer-drinking game, anyone? Chug a pint each time any of these things happen ( guaranteed to give you liver cirrhosis in no time ):

1. Richard Hatch flaunts his jewels
2. Boston Rob and Amber get touchy-feely
3. It rains
4. Someone gets overwhelmed by all the suffering and sinks into depression
5. A good player gets kicked off

I'm standby today, but technically off since no-one's on medical leave. A Saturday, yeah! Not that I'm going anywhere, of course. Just hanging out at home, reading, studying, clearing bills ( sob ), tahan-ing some major drilling from my neighbour's house, ugh. Seems the keys to our new place will be handed over in about a fortnight, after which we can quickly plan "the big move". But with my crazy work schedule, this'll most likely be completed in May. I'm dreaming about the Olympic-sized swimming pool just below my block, woohoo! No more long drives to the club to get my weekly dose of endorphins. :)

Dave Barry gems Part Deux!

Excerpts:

Don't let your boss see you playing this:

The Crimson Room
-- It's kinda like a low-tech version of Myst, but a lot more frustrating. I suspect there isn't a way out. What do you think?

Unbelievable, but true -- 'unsportsmanlike interference' indeed, har har!

Triple har!

Superstar Virgo - American style ( well, actually they're pretty similar, come to think of it )

45 minutes to go. Tomorrow's my first Saturday off since November ( not counting my NZ trip, of course ). YES!

Please read ( re-minisce: thanks for the link ):

Yet another letter from a doctor that wasn't published -- what's new ( Nov 12 2003 entry )

Key sentences:

"It is also time that the Press in Singapore realises that anybody can write. Anybody can string the words together. What distinguishes a journalist from a layperson is not his ease or proficiency with the language - but his sense of responsibility, and professionalism."

It's 5:30am, so forgive me if I lay off the heavy thinking for now, and talk about fluff for a bit. :)

American Idol 3

I can't be bothered to tune in to the results segment at this point in the competition. But I did check the website, and the next 2 through to the finals are Camile ( pretty Hawaiian with a voice but needs to get over a major case of stage fright ) and Matt Rogers ( footballer dude whom I've been rooting for since Day 1, woohoo! ). Granted, Matt picked the wrong song, and for some strange reason sounded super-wobbly during his semi-final performance, but the public clearly likes him, and decided he deserves another chance. Good for him. :D

And now, my review of Peter Cincotti's CD.

You can sample tracks here: CD song list

I hope you visited the link I provided a couple of days back. Make sure your computer's sound is turned on, 'cos "Sway" starts to play once the site loads -- a real treat!

Cincotti, as described in the bio, is only 20 years old, yet his resume already reads like that of a seasoned veteran, with tour dates scheduled till 2005.
High praise spews forth from numerous reputable publications, but the one that rings most true is one reporter's admiration at Cincotti's "quadruple whammy" of talent -- singer, pianist, composer and arranger. He confesses that he penned his first composition before hitting age 10, and the self-titled debut album features 3 original songs which show off his maturity and wonderful feel for the jazz genre ( ie. the upbeat "I Changed The Rules", the sweet "Are You The One?" -- written when Peter was only 13 years old! -- and the brooding "Lovers, Secrets, Lies" ).

Cincotti has a voice, no doubt about it. Young yet layered with a smoky texture, it adds just enough pizazz to his song deliveries without sounding overdone. And the fact that every single piece on the CD was specially arranged by this young man is again testament to his immense talent. The best example of this ability would definitely have to be his cover of "Sway", also a favourite with Michael Buble fans. But while the latter is backed by a big band and belts out a fast-tempo version that gets the heart thumping, Cincotti winds down and does a slow, sizzling, intoxicating about-face. His moody piano-playing on this particular piece sets the tone beautifully, making it a slow-burner that's sure to make you hot under the collar.

Yes, his skills at the ivories are indeed amazing. Sufficiently demonstrative of his many years at the keyboards ( 17 to be exact ), yet mostly steering clear of the overly dramatic ( and occasionally jarring ) antics of some other jazz musicians ( Harry Connick Jr once gave me a headache, but I can't exactly call myself a jazz expert either, so I guess it's a question of personal taste ). I love Cincotti's style. He gleefully experiments with chords and arpeggios, varying his touch between feather-light and forceful. Just listen to "Spinning Wheel", a purely instrumental solo that showcases his finger agility, and you'll be blown away.

What's additionally interesting about this album is how it sounds so fabulous despite the presence of only 3 players ( or 4 on certain tracks ), namely pianist Cincotti, David Finck on bass, Kenny Washington on drums, +/- Scott Kreitzer on saxophone. Contrast this to Buble's full orchestral accompaniment and you'll wonder if Buble would sound as good with this little.

I first came across Cincotti in a recent issue of People magazine. I bought it because of Johnny Depp and Clay Aiken, but saw a picture of Peter, perched on a piano with the description "20-year-old jazz phenom". I finally found his album at That CD Shop ( where else? :P ), and played it over the store's PA system to get a taste. Funnily enough, it didn't sound that fantastic, but I purchased the disc anyway. And guess what? It sounded terrific in the car, and even better on my Discman. This is an album that begs for intimate settings, whether you're relaxing at home alone with a glass of wine, driving to and from work, or enjoying an evening with a date or spouse. I'm more partial to plugging him in while tapping on the computer keyboard, studying my medical texts, or battling insomnia when my sleep cycle gets disrupted.

It sure doesn't hurt that he photographs like a dream -- he looks more like a boyband member than a jazz musician! With a tall, lanky frame, auburn locks and a boyishly handsome face, Cincotti is the perfect poster boy for a genre that is often favoured by an older age group -- the same way violinist Joshua Bell reeled in millions of teenage girls when his dark looks graced the cover of his CD many years earlier. Here's a guy who can hopefully draw the youngsters and introduce them to music that's classy, romantic and intelligent. The current generation of youths is constantly exposed to the likes of 50 Cent and Puff Daddy, whose songs ( such as P.I.M.P. and Shake Your Tailfeather, yeesh ) are nominated for Grammy Awards, blech. Whatever happened to good taste? Can't love -- even foreplay -- be subtle anymore?

More mainstream than Harry Connick Jr, less sedate than Norah Jones and Diana Krall, tonnes more versatile than Michael Buble, Peter Cincotti is definitely a force to be reckoned with, and clearly destined for much greater things ahead. I'm 8 years his senior, so swooning isn't appropriate :P. But there's no denying his talent. Let's hope he drops by for a concert real soon.

Verdict: Inspired and incredible. Buy it, buy it, buy it!

P.S. I'm still a loyal Clay Aiken groupie, in case you're wondering. :D

In continuation with the earlier discussion of Forum Page complaint letters against hospitals:


Case #2: Miss Peh Lay Har's father

"My father's recent death highlights a problem that has been overlooked: Patients should be diagnosed correctly and taken to the appropriate hospital.
He was a victim of subarachnoid haemorrhage -- a serious kind of stroke -- who urgently needed to undergo a CT scan for broken blood vessels.
An ambulance took him to the nearest hospital -- Alexandra -- on Jan 19, where specific treatments and surgical operations were not available.
The doctor who examined my father told me that he was suffering from a minor stroke, when it was a major one. Upon realizing the severity of his condition, the doctor had him transferred to NUH.
When the paramedics arrived at my house that fateful day, they said they did not know what caused my father's fainting and headache, so they took him to AH.
The paramedics failed to recognize that the patient had had a stroke and did not act quickly to reduce his blood pressure so that his life would not be endangered.
It is a known fact that stroke patients need to be attended to as soon as possible and the first one to two hours are the most crucial. The patient's recovery -- and life-- depend on it.
In my father's case, the informal examination at AH took more than 1 1/2 hours before he was transferred to NUH.
By the time he was operated on at NUH, 5 hours had elapsed and his condition had deteriorated to the point where the treatment was difficult and dangerous. He did 5 days later."

-- Miss Peh Lay Har ( Feb 7 2004 )


Reply from AH and NUH:

"We refer to the letter above. Our sincere condolences and empathy are with Miss Peh on the loss of her father.
Her father arrived in an ambulance at AH at 9.55pm and was attended to immediately by the Emergency staff and doctors.
He was adequately and properly examined -- a CT scan was also done -- and all appropriate treatment rendered before he was transferred to NUH at 11:30pm.
AH has an established and reliable arrangement with NUH to speedily transfer patients who need specialist attention from a neurosurgeon.
We would like to reassure Miss Peh that, in her father's case, this was done quickly, with constant attention paid to stabilizing him. An AH Emergency Medicine doctor also accompanied the patient to NUH.
In stroke cases, due to the carying modes of presentation and evolution, accurate assessment of severity, even with help from CT scans, can be difficult. We could have done better and communicated this more effectively to Miss Peh, as well as the state of her father's condition and the risks involved. We are sorry that we did not update her well enough after the initial diagnosis.
Unfortunately, despite stabilizing him, her father succumbed to a re-bleeding in the brain and, upon arrival at NUH, his condition had deteriorated further. The clinicians did the necessary tests and treated him, knowing that the mortality rate in such cases was high.
We are of the opinion that the patient had been speedily transferred to NUH and treatment was administered without any significant delay.
We hope that this letter helps to clarify Miss Peh's concerns over the care given to her late father. Once again, we would like to convey our deepest condolences to the family on the loss of a loved one."

-- Clinical Assoc Prof Rajasoorya, Chairman Medical Board AH; Assoc Prof Luke Tan, Acting Chairman Medical Board NUH; Dr Chou Ning, Head Neurosurgery AH and NUH ( Feb 13 2004 )


I've highlighted the more important bits.
Readers who hail from the medical profession will no doubt spot the flaws in Miss Peh's complaint instantly. And Dr Wee's logical explanation ( transcribed in my entry dated Feb 17 ) addresses these mistakes directly. Even more disturbing is Miss Peh's over-confidence in her statements. It's all black and white to her, and she didn't even attend medical school!
Also note again the discrepancies between her version of events and the doctors' objective interpretation. As Linda has pointed out in her comments, complaints are often subjective and personal, so it wouldn't surprise me in the least if a few of them are embellished to some degree. And when such letters are published in a paper with a circulation of a few million subscribers, the ripple effects are widespread and yes, DANGEROUS. What do you think people will say? The uninformed will no doubt think the doctors were at fault. The fact that THE FORUM printed the complaint should confirm that, right? Our nation's most reputable newpaper knows best, no? Sadly, not anymore.

There was a letter from the son of another stroke sufferer -- a lady who was admitted to NUH in 1996. Yet an additional illustration of the influence The Straits Times Forum Page has. Of course, the editors must be ecstatic at the response. Which paper doesn't want to generate buzz? However, the question is: At what price? If you resort to printing inaccuracies without first doing your job ( ie. checking the facts and making sure the person's comment can be backed up by reliable data ), then sit back and watch the circus unfold, it's pretty obvious who the irresponsible party is here. And if you argue that the burden is on the respective hospitals / doctors to explain themselves, while your role is purely to print "newsworthy" pieces, then it's a deplorable case of "passing the buck".

And here's the "icing on the cake": a day after I emailed and directed the Forum to my blog ( to read the concerns raised by myself and a few other readers ), THIS appeared in today's edition:

"Recently, my girlfriend visited the dentist at a private dental clinic. While cleaning her teeth, the dentist caught up on the office gossip with his nurse and even began crooning songs to her!
While it is all right to seek relief from the stresses of the work day, there are limits to what is appropriate.
Policemen do not chat about the previous night's television shows while taking a statement, surgeons do not discuss politics in the middle of an operation. Likewise, the dentist in question should not be singing or gossiping while working on a patient.
Is this what one would expect from a healthcare professional?"

-- Damian Chue Wye Luen

My response to Damian:

What does your girlfriend -- aka THE PATIENT -- think of all this? Does she share your sentiments or are these purely your own grouses? Oh wait, perhaps she doesn't want to identify herself, for fear of being found out by the dentist in question? Does this mean she intends to continue consulting said dentist? He must be good at his job then. Is this how Singaporeans show their gratitude nowadays?
Yeesh, doctors get flak for not being communicative enough, and now they're being criticized for being happy, chatty and partaking in singing activities in the presence of the clientele. I certainly hope the Singapore Dentist Association isn't going to entertain this nonsense by issuing a formal reply. This is getting way out of hand.

Horrible shift! More about that another time.

Just want to post this link for any of you who are interested. Suffice to say, Michael Buble cannot compare. :)

Peter Cincotti -- The Next Jazz Sensation

Enjoy.

p.s. I'll review his CD tomorrow if I have time. It's fantastic!

Eucalyptus: Your question on the Forum Page complaints deprived me of some sleep yesterday. :) Yes, I cut the letters out. EVERY SINGLE ONE OF THEM. This is gonna be a long post, but hey, hopefully it'll be a fruitful discussion.


CASE #1 -- Mr. Lee Cheow Poon's father, August 2003


The complaint that started it all:

"On Aug 3 last year, my 79-year-old father fell at home. I didn't think much of it then as my mother called and said he was none the worse for it.
However, the next day, a staff member of The Salvation Army's Day Care Home for the Aged in Bedok where my father spent his day called to say that he might have suffered a stroke as he was not his normal self.
On hearing this, I rushed down to the Salvation Army and sent him Singapore General Hospital's A&E Department. He was very quiet and had a blank look. He also had difficulty walking.
After a rather long wait, we saw the doctor, who sent my father for X-rays of the hip area. I told the doctor about my father's unusual behaviour and also about what the staff at the home said about him possibly having suffered a stroke.
The X-rays showed no fractures and, for reasons that I still do not understand, the doctor asked me to take him back 3 days later for a scan to see if he had suffered a stroke.
I brought him home later int he afternoon, only to have him collapse in a heap at his bedside at about 4pm. He could not move at all.
I called for an ambulance, which sent him to Changi General Hospital where he was later diagnosed to have suffered a stroke.
He stayed in hospital for about a month, after which my family sent him to St. Andrew's Community Hospital for rehabilitation. His left limbs had been left immobile as a result of the stroke. Sadly, this did not improve his condition and he is now bedridden.
It hurts when I think about what mimght have been if the doctor had paid attention to what I said and ordered the scan immediately. My dad could have continued to lead a fruitful life.
Nothing can be done for him now but if highlighting this incident changes the attitude of SGH towards other likely stroke victims, I would have gained some measure of satisfaction from writing this letter."

-- Mr. Lee Cheow Poon ( 5 Feb 2004 )


The SGH Reply:

"We refer to the letter (above). We are sorry to learn that Mr. Lee's father suffered a stroke upon returning home from the hospital. We have investigated the matter and would like to clarify the medical management of the patient. Mr. Lee's father was examined promptly by the doctor at our Emergency Department last Aug 4. On presentation, he was conscious and able to give his medical history. His chief complaint was pain over the right hip as he had had a fall at home the day before and had injured his right hip.
During the consultation, the patient did not complain of any weakness and was able to walk. As there was no clinical evidence of a stroke, a CT scan was therefore not ordered at that time. He was thus treated for his fall.
However, in view of the patient's age, history of fall and Mr. Lee's concern about the possibility of stroke, the doctor scheduled a follow-up outpatient appointment for him. Mr. Lee's father was to be evaluated by a neurologist on the third day. Unfortunately, he suffered a stroke at home on the same day.
We empathize with the emotional distress experienced by Mr. Lee and his family. We will be glad to meet Mr. Lee to clarify any further concerns."

-- Assoc Prof Tay Boon Keng, Chairman Medical Board, SGH ( Feb 7 2004 )


Mr. Lee's response ( or more accurately, retort ):

"I refer to Assoc Prof Tay's reply. Some of his statements are very misleading.
Firstly, he said my father was "examined promptly" by the doctor. This leads one to think that my father was attended to immediately, or at least quickly, upon his arrival at SGH.
We waited for more than 1 1/2 hourse before being attended to. In between I had to leave Dad in a wheelchair at the A&E Department for a much-needed lunch, having skipped breakfast that day.
If I could afford to take time out to walk to a canteen, have my lunch, walk back to the A&E Department and continue to wait, I would hardly term it as "prompt".
Secondly, he wrote that my father could walk. From the time Dad alighted from my vehicle to the time he left the hospital, he was confined in a wheelchair.
At no time during the consultation with the doctor did my father rise to walk. Nor did the doctor instruct Dad to show him that he could walk. The doctor did not see my father walk, period. So how did Prof Tay conclude that my father was able to walk?
In fact, during the X-ray procedure, the attendant and I had a great deal of problem trying to get him out of the wheelchair and in position as Dad was complaining of pain.
Also, the procedure had to be repeated because the doctor, after seeing the results, said that the X-rays were not taken according to his instructions.
When the procedure was carried out a second time, I had to don a heavy lead jacket in order to go into the room and prop Dad up in an awkward position so that the X-rays could be taken.
Thirdly, Prof Tay wrote that my father was "conscious and able to give his medical history". I accompanied Dad throughout the consultation and never left him alone with the doctor at any time.
Dad never volunteered any information. I was the one who was answering most of the doctor's questions because Dad remained very quiet and had that glazed look throughout.
As I wrote in my earlier letter, I told the doctor about Dad's unusual behaviour and about what the staff at The Salvation Army said about the possibility of him suffering a stroke.l
How is it that The Salvation Army could diagnose Dad's condition so accurately and the good doctor could not?"

-- Mr. Lee Cheow Poon ( Feb 11 2004 )


SGH's 2nd reply:

"We refer to the letter above.
We apologize if there had been any lapse in communication. As the incident took place more than six months ago, we seek Mr. Lee's understanding that we could rely only on the notes documented in the patient's case file for our reply.
We appreciate Mr. Lee's valuable feedback and have given him our assurance over the phone that we have taken his feedback to heart. We have always had clinical protocols in place for the diagnosis and management of stroke patients.
However, we are reminded through Dr. Wee Lee Loong's letter that it can be extremely difficult to diagnose a stroke the minute it happens. We have stepped up efforts to be vigilant at all times, especially when screening potential stroke patients.
We have given our contact person's details to Mr. Lee. We would like to extend our invitation once again, should he wish to meet us to further discuss his concerns."

-- Assoc Prof Tay Boon Keng ( Feb 14 2004 )


And here's Dr. Wee's letter, dated Feb 11 2004

" I refer to the letters on stroke patients. The practice of medicine is a science yet, in many ways, also an art. This is because illnesses do not always present themselves in either black or white; very often, they present themselves in shades of grey, eventually progressing to black.
While it is every doctor's aim to diagnose a stroke early, the difficulty lies in the fact that early manifestations of stroke -- within the hour or so -- may not always show the classical symptoms of weakness, numbness or change in mental state.
A comment was made that the early treatment of stroke involves lowering and controlling the blood pressure [ I will transcribe these in a separate post -- Jen Jen ]. There are actually two spectrums of stroke. The haemorrhagic ones which bleed, caused by a rupture of the blood vessels in the brain, and the ischemic ones, caused by a clot in the vessels, depriving brain cells of invaluable nutrients and oxygen.
Management of the former would involve judicious control of the blood pressure, and perhaps the option of surgery, while management of the latter would entail allowing a high blood pressure kept within safe limits. A precipitous drop in the blood pressure during an ischemic stroke can starve the brain of more nutrients, resulting in more detriment than benefit.
It is therefore unwise and potentially dangerous to expect paramedics to make a judgment call prior to a brain scan.
Presentation of illnesses in the elderly population can be extremely atypical at times. It is not always prudent to subject elderly patients to a battery of brain scans, chest X-rays, liver scans, and serial blood tests.
Ultimately, a high index of slinical suspicion, couples with a suggestive history, and appropriate tests are required to clinch the right diagnosis.
Therefore, it can be extremely difficult and perhaps even impossible to diagnose a stroke the minute it happens."

-- Dr. Wee Wei Loong ( Feb 11 2004 )


And if you're still with me after all that, here're a few points for FRIENDLY debate. ( Yes, key word in capital letters, ahem. )

1. Did the SGH A&E doctor miss the diagnosis?

From Mr. Lee's accounts, his father appears to have become aphasic after the episode. To the non-medical readers, this means he had problems with verbal communication ( in this case, he couldn't even speak, aka expressive aphasia ). Some people have receptive aphasia -- they can talk fine, but are incapable of understanding what you say. Some others have global aphasia, which is a combination of both. Aphasia is one of the so-called alarm bells in stroke patients, especially the elderly. It constitutes a change in mental state, together with other signs such as apathy, drowsiness, even agitation, confusion, visual and auditory hallucinations ( though these can also occur in cases of sepsis and electrolyte disturbances ).

I'm trying to recall if I was ever taught the importance of baseline mental state in medical school. I don't recall it being covered, but if anyone can refute this, please inform me quickly so I don't end up giving the wrong impression. The importance of a person's premorbid status was only drummed into my head during my housemanship internal medicine posting at CGH. I was lucky, 'cos CGH Medicine isn't subdivided into Neurology, Renal, Gastroenterology, Haematology, Respiratory and the like. We got to care for everything from stroke to gastroenteritis to renal failure and asthma, so baseline mental state was frequently asked during initial clerking.

Perhaps the SGH doctor in question lacked this experience? We know ERs in Singapore are mostly run by medical officers, some of whom may have had only a year of housemanship and another as an MO ( doing who-knows-what posting ) under his/her belt, before being thrust into a warzone of medical, surgical, orthopaedic and paediatric emergencies, some of which require a very sharp eye and admirable clinical acumen in order to diagnose correctly. Qualified ER physicians are trained to develop the necessary skills for this vital task, but they usually cover the resus and critical care areas, not consult, where Mr. Lee's dad was examined. Not having adequate experience can result in missing a diagnosis, or inappropriate managment. The important thing is, WHEN IN DOUBT, ALWAYS CONSULT A SENIOR. This could not be stressed more in the ER setting. But of course, not every MO does this. Whether it's out of ignorance, arrogance, or an insanely busy shift in Mr. Lee's father's case, we will never know.

Bottomline: Stroke was not definite in this patient. But it sure was a possibility.

2. Why the discrepancy between Mr. Lee's account and the A&E documentation of events?

I have no insider knowledge, so I don't want to speculate. However, if we consider Prof Tay's explanation, it certainly seems as if the doctor's version is the total opposite of Mr. Lee's. Here's the deal: the A&E notes were entered at the time of consultation back in August 2003, while Mr. Lee's account is made 6 months after the fact. I don't see why Mr. Lee would give an inaccurate description, if indeed it is that. On the contrary, the memory appears to be etched in his mind forever. This is something I just can't put my finger on.

3. Why the delay in the complaint?

Incidents like this almost always have a trigger, and who can hazard any guesses here? A sudden surge of anger, a comment ( innocent or deliberate ) from someone, maybe reading an article in a magazine somewhere, or a similar experience recounted by a friend or relative -- anything is possible. Again, this is something we can't confirm, but the half-year delay, to me, makes this letter sound suspiciously incited by an outside force. If Mr. Lee was so disturbed and concerned, why didn't he lodge the complaint from the word go? Why wait 6 months? Why now? He never did say.

4. An incorrect statement

"... but if highlighting this incident changes the attitude of SGH towards other likely stroke victims, I would have gained some measure of satisfaction from writing this letter."

This is the only issue that I feel very strongly about. People who read Mr. Lee's letter may get the wrong impression that SGH A&E makes it a habit of not diagnosing strokes, whether obvious, likely or remotely possible. My reply to the non-medical readers, and especially the press, is that SGH does not have an "attitude" towards possible stroke victims, or any other type of patient.
At triage, the nurse is the first to see walk-in cases. If you're sent over via ambulance, you get pushed into critical care immediately, regardless of your condition or complaint ( ie. even minor infections or trivial trauma gets seen in there, AS LONG AS the paramedics bring you in ). Mr. Lee's dad was seen in consult because (1) he was brought by his son, (2) in stable condition, and (3) not exhibiting overt signs of a stroke. If the next thing you expect is for nurses to do the diagnosing, then you are being unreasonable. ER nurses are already among the most astute and intelligent of their cohort. I've met a few who can read ECGs and tell you when a patient "just doesn't look good" ( their way of saying s/he needs to be seen ASAP ). Most of the senior ones are well-trained in advanced resuscitation, and invaluable in assisting doctors as they handle heavy caseloads on a daily basis. If there had been a real need to up-triage Mr. Lee's dad to critical care, I'm sure the nurse would've done so.
Waiting times in consult are, of course, longer than those in resus / critical care. The queues at SGH are long, and patients often hail from the Renal, Haematology and Oncology departments, among others. These can have a long list of medical conditions with overlapping features. So a simple case of fever isn't "just the flu" anymore -- it could be neutropenic sepsis, peritonitis from the dialysis catheter, or a serious infection of unknown origin due to the patient's compromised immunity from chronic illness. Such consults require detailed history-taking and examination. In capable hands, the case can be disposed of in 10 minutes. In more junior ones, up to half an hour, +/- a senior consult. Throw your usual cough/colds, lacerations, fractures and foreign bodies in the eyes/ears into the whole mix, and you're talking an average waiting time of at least 30 to 60 minutes. Maybe 2-3 hours during very busy periods. 1 1/2 hours, to me, is already pretty decent.
Next, SGH's CT head protocols. Let me say right now that if a stroke had been suspected at all, and the senior doctor on shift made aware of it , the scan would most definitely have been done. Again, I repeat that Mr. Lee's father appears to have been seen by someone who was probably an MO, who DID NOT discuss the case with the ER physician, and thus dispensed with his own management as he saw fit. If a senior had been consulted, he may or may not have ordered the CT stat ( a change in mental state doesn't constitute a stroke, as mentioned earlier ). BUT Mr. Lee's dad would have been admitted, AT THE VERY LEAST. It all depends on the senior's discretion. I've had patients undergo CTs for much less -- a middle-aged fellow with no history of head trauma once presented with one episode of being unable to stop walking, and knocking against a wall because of it. No neurological deficit, fully alert, speech normal. I spoke to my consultant, who immediately approved the scan. The result? A subacute subdural haemorrhage.

I too empathize with Mr. Lee's predicament. My late uncle died from a haemorrhagic stroke in 2001, after being bedridden and tortured by contractures and pressure sores for more than a year. It's never easy, watching a loved one suffer. He was my favourite uncle, and my mother's favourite brother. We were extremely close, and his stroke came only days after he had just comforted me during my traumatic breakup. I thought I couldn't possibly take any more pain, and seeing him awake yet unable to speak, shedding silent tears as we stood at his side holding his hands, haunts me to this day. His diagnosis wasn't missed because he presented so dramatically -- sudden loss of consciousness then sinking into a coma -- but if it had been missed, I wouldn't have been happy either.

But let's not lose sight of the bigger picture here. Mr. Lee's putting the blame on the hospital is incorrect. Misguided, I'm sure, but still wrong. It's interesting that he chose this particular time to finally voice his concerns -- he says he gained "some measure of satisfaction", but doesn't he also realize that the delay may have put other stroke victims ( and their relatives ) at a disadvantage as well? 6 months is a long time, you know.
Non-medical people don't know how the system works. Heck, even doctors don't know how other hospitals work if they haven't rotated through them before. Making sweeping statements in a national paper is irresponsible. And not going through the proper channels ( ie. the hospital's clinical services / corporate affairs departments ) first is just plain jumping the gun.

Last but not least, The Straits Times could be more discerning with the missives it decides to publish. Considering it is an organization that prides itself on reporting the truth, the Forum Page editors are being frighteningly lenient with complaints involving medical personnel. If their aim was to get a major reaction, then bravo, they've succeeded brilliantly. But let's not forget the reactions from the doctors, nurses and paramedics as well -- people whose jobs are to save lives, sometimes putting their own at risk in the process. Public opinions of healthcare workers reached an all-time high during the SARS epidemic, but see how quickly the appreciation has dissipated less than a year later. Mr. Lee's letter even caused a sudden onslaught of similar complaints last week, which again the Forum Page editors opted to print, and which exhibited misconceptions about the diagnosis and proper management of stroke, misconceptions that the editors glaringly knew nothing about, or chose to ignore. I will transcribe and discuss these letters another day, after you've digested this lengthy entry of mine. :)

Anyhow, for your information, I will be emailing the Forum after this to direct them to my post. Thanks for reading.

One of the things I sometimes miss about medicine is being able to talk to my patients. Not talk as in take history and explain procedures, get consent, etc. No, I mean sit down and really talk , as in what's your job, how're you coping with your condition(s), why exactly aren't you taking your meds, etc. I used to do this from time to time, especially when I ran the SGH gastroenterology MO clinics way back in 2000. We had these sessions maybe once a week, seeing simple referrals for Hepatitis B or non-specific abdominal pain. I loved the old fogies the most. And in the wards, SGH haematology offered many opportunities to know our patients well, due to the chronic nature of their illnesses ( e.g. leukemia, lymphoma, aplastic anemia ), which necessitated repeat admissions and long hospital stays. We got to know their families, favourite foods, assorted idiosyncracies. On a more medical aspect, we were even able to memorize their drug allergies, blood groups and chemo regimens.

Such leisurely communication isn't possible in the A&E setting, but this evening, I saw a Malay man in his late 50s who was diagnosed with stomach cancer a year ago, but is now undergoing chemotherapy for recurrence. Before discharging him, I asked if he needed an MC, but his wife told me he was retrenched. Usually, I don't ask for details, but I liked this couple -- soft-spoken, very pleasant -- and queried if he lost his job before or after the CA was diagnosed.
"After," she replied. "They sacked him because he couldn't work anymore."
"But he couldn't work because of the cancer, right?" I commented. This wasn't new to me, having come across quite a few similar cases these past few years. In 2002, I met a guy in his 40s with an acute myocardial infarct ( ie. medical jargon for heart attack )over at NUH, who was promptly relieved of his duties soon after he was admitted for treatment. I could never fully understand how employers can do such things without getting into any trouble. But then, I'm not a lawyer, so I can't say if this constitutes some kind of "wrongful termination" situation. Seems rather unfair to the patient if s/he has medical benefits to begin with, then gets the sack when diagnosed with something moderately serious yet treatable, at least in the short term. Shouldn't there be a "probation period" in the interim, while the patient is in the convalescent phase, with a proper review later on when s/he returns to work? Sure, cancer can be severely debilitating, hence the inability to perform at one's job. But many people with heart attacks recover well and continue to lead normal lives. And yet, this man wasn't even given a chance. :(

Will be staying in consult for the night this time round, as one of my fellow MOs-on-call has sinusitis and requested to run resus for the entire shift. Let's hope this is the night we have minimal attendances -- at least in consult!

The MTVAsia Awards show wasn't too bad this year in terms of star turnout, I suppose. Performances-wise, however, I think last year's was a lot better. Granted, the Black-Eyed Peas were the closing act and caused a lot of excitement. But they've never sounded good live, and last night was no exception. Pity that. Stacie Orrico was a little shaky, the Sugababes too, and Michelle Branch, t.A.T.u, surprise guest Mariah Carey and Blue didn't sing! What a travesty! Carey, for your info, appeared for a total duration of maybe 3 minutes, smiling her little plastic smile, decked out in a bright pink slinky gown, accepting her MTVAsia Lifetime Achievement Award ( Lifetime achievement? What is she, in her 30s? ). And speaking of pink and slinky, get a load of Michelle's eye-popping top, which threatened to turn into another Janet Jackson Nipplegate all on its own. Interesting how the show's producers let that get by.
My pick for most enjoyable performance of the night? Unexpectedly, it's Gareth Gates' duet with Siti Nurhaliza on "Say It Isn't So". I'm not a Gates fan, but was sufficiently impressed with his rendition of an Elvis song during a recent telecast of the Royal Variety Performance on local TV. He's always been too toothy and shrill-voiced for my liking, but I found myself humming along and nodding appreciatively during the power-notes. Nurhaliza, in particular, has an admirably strong voice, and the collaboration was quite the show-stealer.

Another show I'd like to talk about -- before I sneak off for my nap :) -- is "Survivor All-Stars". The latest loss is Jenna Morasca, who won on "Survivor: Amazon" through unbelievably, dumbfoundingly good luck ( Rob Cesternino deserved the trophy in that one, but Matt the machete-obsessed psycho couldn't risk losing, so in the end, he picked Jenna to join him in the final two and lost to her, har har ). Anyhow, Jenna's mother's battle with cancer was already a well-known issue in the Amazon, and the story ended quite happily when she received news that her mom was responding to treatment. This time, though, Jenna left her side yet again, then started to brood and cry 10 days into the competition, saying she "had a feeling" her mom was getting worse. She subsequently bowed out, saving the rest from having to go to tribal council, but my question is: if she's such a loving daughter ( and an only child to boot ), why THE HECK did she bother returning for a second chance at being marooned on an island, cut off from all contact with her sick mother? Yes yes, her mom wanted her to do it, but c'mon, even she should've known better.
Anyway, 8 days after she rushed home, her mom passed away. But all I can think about is how Jenna wasted 10 perfectly good days with her during her last moments on Earth. Even another million isn't worth this .

My morning in resus started in the usual manner, with a slow patter of stable patients ( gastroenteritis, superficial forehead laceration, minor road mishap ). At 9:30am, however, the situation changed dramatically, beginning with our first standby case for the day -- a 46-year-old lady with diabetes, hypertension and schizophrenia, found collapsed at home. Asystolic at scene, blue and flat on arrival at the ER. Intubated stat, CPR, near impossible IV access that took 4 people and 15 minutes to obtain, finally getting a subclavian line using a green plug. 6 Adrenalines and the full vagolytic dose of Atropine later, we called it. I met the deceased's siblings and in-laws, who grieved yet managed to thank us for trying to save her. In the midst of all this, another standby called in, apparently an 80-year-old collapse.

A number of ambulance cases got downtriaged, but an additional MO was diverted from consult when a 78-year-old man was pushed in, sporting a 15cm gash across his anterior lower neck. Self-inflicted with a chopper, the paramedic shouted, as we transferred him to the trauma trolley. Bubbling was seen from an opening in the middle of the whole bloody mess. Likely the trachea, my consultant said. An ETT was inserted via this route with success, though he subsequently poured out blood through the tubing. I was sent off to speak to his distraught family -- a son, daughter-in-law and grand-daughter. He looked depressed recently, but gave no indication of suicidal intent. He'd mauled himself when everyone was out, only to be found when his daughter-in-law returned from the market.
Systolic BP 90 despite aggressive fluid resus. Dropping into the 80s with each repeat BP check every few minutes. The general and ENT surgeons were paged and rushed down immediately. "E" blood was infused. A quick update from the ER physician and surgeon, and the patient was pushed up to OT, doctors and nurses running by his side. As I walked by the trauma room in the wake of this exciting ( albeit gory ) episode, a health attendant was picking up bloodied pieces of gauze, mopping up the scattered pools of red, the sudden silence and lack of activity feeling oddly abnormal.

The rest of the shift passed by in a blur. Fractured pelvis, PV bleed in an elderly bedbound woman, viral gastritis, non-specific exertional dyspnoea... if only they were as straightforward as they sound! Most patients presented atypically -- pain out of proportion to the actual injury, only confirmed when the x-rays came back normal; a lady claiming a history of coronary artery stenosis, but old notes documented a completely normal dobutamine stress echo; the bleeder found to have blood on her diapers, initially thought to be per-rectal in origin, but is actually per-vaginal in nature. I reviewed so many old notes my head began to spin, and getting a history out of each person was absolutely exhausting. Now that it's finally 4pm, I'm overwhelmingly relieved. I can't wait to go home. :)

And by the way, that 80-year-old standby collapse never did come to the hospital. S/he may have perished at home, or as one nurse suggested, woken up. Oh well, you never know. :D

Pick Of The Crop

Mr. Dave Barry, my deepest gratitude to you and your blog for keeping me awake as I sit in the resus area waiting for my turn to nap ( ie. 5am ). I'm also trying hard not to think about the fact that my core body temperature is now so low cellular respiration has probably halted, and my breath is coming out in little clouds of frost that subsequently fall to the ground and shatter into pretty little crystal smithereens. ( You think I'm joking? Patients here have CRIED because of the cold, okay?! )

Anyhow, I'm catching up with Dave's latest blog entries ( Yahoo Games are now BANNED, darn it ):

One Word -- YUCK

I was wrong - DOUBLE YUCK

Someone obviously doesn't like penguins very much

Not if the clamper is a female DOCTOR

Cool game - highly recommended!

Brrr...

G'day - or more accurately, g'evening. :)
Night shift, waiting for the inevitable tsunami of cases once midnight hits and we're officially down to 3 MOs and one senior manning the whole ER. I'm telling you, there's a conspiracy going on ( picture Mel Gibson looking crazed in "Conspiracy Theory" ). The ?Hokkien / ?Malay term for this is "pakat", as in people in the eastern part of Singapore communicating with one another and telling each other to storm the department at 12:01am. "You know ah, when the doctor is harrassed and tired, s/he is less resistant to issuing MCs." Is it? I tend to become more resistant, actually. "What?! You waited till 3am to come to the hospital?! You want MC for how many days?!" Long pause. Laser stare. I'm kidding. :P

I finally got my hands on the book I mentioned yesterday. It's actually quite well-done, and the Children's Cancer Foundation was very sweet to give me a certificate for my contribution, aww. I met one of the publishing company's staff members this afternoon, a very nice fellow who has his heart in the right place * thumbs up*. He said the company is contemplating a Volume 2 in the near future, and I asked him about a similar effort from the medical aspect. He seemed quite interested in that, but everyone's busy with various things at the moment, so the idea will have to wait.

What do you readers think? Is there a big enough market in Singapore for a collection of stories from local doctors, especially if it's for a good cause and not a profit-making venture? There're already quite a few prominent doctors who are very good writers. I personally think it'll do well, but only if marketed sufficiently, especially in terms of media exposure. Hey, Helmi Yusof is back. Maybe he can help when the time comes. :)

I can't find the results for the American Idol semi-finals as yet, but I must say Fantasia Barrino is by far the best in this set. Coming in a distant second is Katie Webber, the striking blonde who did a sexy rendition of the jazz-flavoured "Orange-Coloured Sky". Katie's good, but Fantasia is so much better. Strutting her stuff on stage, never missing a note, putting everything she had into a classic R&B song, she is one superstar of a 19-year-old! Matthew Metzger, the guy who resembles Michael Vartan from "Alias", is great to look at, but doesn't have that strong a voice. And Erskine, sadly, didn't do very well with "Open Arms" -- he sounded a little too controlled, if you know what I mean. Same thing with Ashley Thomas, who sang "Crazy" in a very constipated manner ( pity, her voice is actually quite nice if you can get past the clenched teeth ).

Did you see the SMSs pouring in during the AI3 telecast though? Lots of mentions of William Hung -- "Where's Hung? We want Hung! Bring Hung back!" And get this, a radio station in San Francisco is doing a story on "The Hung", and Singapore is featured! This is told to me by a lady I got to know through a previous collaboration, and who works at this station. It's hilarious, but also really cute. :D I like Hung a lot! Glad he's now got his own legions of fans!

Also caught "CSI: Season 3", which now screens on cable every Wednesday night at 9 pm. The premiere has the CSI team tracking a serial killer who targets young married couples, luring them with the promise of kinky bedroom activities. Another rehash, you say? Hardly. The first half of this two-parter offers a major twist that is guaranteed to make you tune in to the next episode. And if you don't mind a spoiler, the twist is: the prime suspects became the victims. Major hmmmm...

Right, a fellow Clay fan just told me the results from AI3: Fantasia ( YES! ), Diana ( a 16-year-old who isn't too bad but I still prefer Katie ), and Matthew the good-looker were in the top 3, but Matt didn't make it to the finals in the end ( they like to show you the top 3 then kick one off ). No Katie?? Let's hope she returns for the wild card show then. Clay won that segment last year, and look where he is today. :)

As predicted, the patients are flocking to the ER. Let's see, another 7 hours to go. SOB.

Rest assured that there will be no more heated exchanges with you-know-who from this point on. :) My apologies to the readers for getting caught in the crossfire, but also many thanks to everyone who emailed to share your thoughts, offer words of encouragement / support, and provide valuable feedback.

It's a slow-ish day in consult this afternoon, something I greatly welcome after the exhausting night call on Sunday -- I saw 50 cases in total, and didn't get any sleep. The queue currently sits at... ZERO, hah! Famous last words. :P

The Sugababes Showcase pass is in my baju pocket, but there aren't any takers! How can this be? 3 pretty girls who like to wear slinky outfits and shake their booty and no-one's interested? Something's terribly wrong here. ;) Anyhow, I also got a free copy of their CD, "Three", which I have to admit is actually quite good. Lots of pop / R&B tracks, with above-average vocals. Some of the songs, such as "Hole In The Head", "Caught In A Moment" and "Too Lost In You", are extremely catchy. Would I buy their subsequent albums though? Probably not. I don't enjoy listening to female voices much, except for Barbra Streisand and Celine Dion. My Charlotte Church, Norah Jones and Mariah Carey CDs are sort-of flukes, and they're just sitting there collecting dust. Give me a male singer anyday! :D

Speaking of singing, check out the first semi-final group of 8 on "American Idol". I have my eye on Erskine and Fantasia, but who's that white fellow who looks like Michael Vartan? I can't watch the TV telecast till tomorrow 'cos I'm working, but I'll live. The latest season of "CSI" is starting tonight as well. Mark your calendar!

Just a belated mention of this year's Grammy Awards ceremony, since I didn't log on for 2 days. This was definitely the year of collaborations -- Beyonce & Prince, Earth Wind And Fire & Outkast ( plus an assortment of other people I don't recognize ), Celine Dion & Richard Marx, Justin Timberlake & Arturro Sandoval. My favs would have to be Beyonce and Justin, who gave unbelievably rousing renditions of Dangerously In Love and Senorita. Country star Martina McBride also did a great job -- she's got such a fantastic voice. But the surprise of the evening ( for me anyhow ) was The White Stripes' bring-down-the-house electric-guitar-twanging, drum-whacking extravaganza that got the audience on their feet. What a powerhouse duo! I'm almost tempted to run out and buy their album! Almost. :)

Saw Helmi Yusof's article in the paper yesterday, together with Shzr Ee's take on AI3. Nice to see him back!

One of the registrars in my department asked me about the possibility of a novel written by a local doctor taking off in Singapore or, perhaps, elsewhere in the world. Well, I said, it really depends on the novel itself, 'cos not many people are interested in Singapore, much less a book written by an obscure physician here. Even Prof. Chao Tze Cheng's collection of true stories, based on his long career in forensic pathology, failed to hit bestseller proportions. Michael Crichton's name came up, but if I may speak frankly ( lest "someone" claims I'm being "arrogant" again ), I tried reading some of his stuff, and didn't like his writing style, which is kinda slipshod and, well, mediocre. I think what he does have going for him is very original ideas, and the ability to visualize scenes in "movie mode", so film-makers favour his novels when adapting screenplays and churning out blockbusters. Besides the very profitable "Jurassic Park", Crichton also helped create the TV series "ER". Not bad for a Harvard grad who doesn't even touch patients anymore. :)

Sorry, I digressed. So is there a solution to the problem above? Maybe a joint effort of sorts, with a number of doctors coming together to contribute their own stories, then compiling this into a compact yet substantial collection which addresses a topic or topics that even non-medical people find quite fascinating. "But how will the profits ( if any ) be distributed?" I guess one good way is to make it a zero-profit project, meaning no-one gets paid, and all proceeds go to charitable organizations, which can be determined by the contributing authors. This is my ideal scenario. I actually know of one publishing company in Singapore that has already done something like this, but with writers from non-medical professions, except for myself ( I wrote a story about a child with cerebral palsy, whom I know personally, including her amazing parents ). It was, however, a low-profile event, and a $10,000 cheque from book sales was later presented to the Children's Cancer Foundation without much fanfare. Doing a medical version might be feasible, but who's going to helm it? I have an exam to prepare for, so I can't do anything for at least another 6 months. Maybe after that. There're lots of good writers in the local medical community after all. :)

Right then, I'm off to grab some dinner. I've seen about 5-6 patients so far, over a 3-hour period, woohoo! All but one was an army guy, hmm. But quite warranted, so I was quite lenient. Plus, I'm in a good mood. :P

The Plot Thickens

Urgh has replied! :)

"I'm not avoiding you but rather it hasn't been my practice to allocate time to read your blog frequently, hence the late reply.

I'm indeed a medic who incidentally have talked to people you've worked with, including your seniors, registrars and the like.
If you want to keep a blog and a comment section, then it is the liberty and prerogative of any reader to write in his or her comments and still remain anonymous. Treat me seriously or as a "troll" if you like, but hey, that's the nature of things.

Looking at the comments, not everyone agrees that the AXR is of utmost importance. And you haven't explained how you've come about to say your cousin was "this close to perforation", a statement I think hinges dangerously on sensationalism. Was it based on you talking to the surgeon or the fact that the MO apologised for not having done the AXR earlier?

Finally I doubt I'm the only one around here who uses multisyllabic flowery adjectives. And I'm amazed that you fail to recognise just how arrogant you sound on your blog. You're always right in your interpersonal and professional skills; it's someone else who's giving you a hard time or screwing up. Have you never erred?"

Let me address each issue in turn:

1. I'm glad you've spoken to people I've worked with. Please tell me what they said. Again, bad comments should be backed up by a mention of the name of the department(s) they originated from, reasons, and the identity of the person(s) who uttered them ( or at least the person's rank ). Since I have no idea who you are, I wouldn't put it past you to conjure up adverse assessments or twist someone's words to suit your own purposes. If you do not wish to put these details down on my blog, then by all means ask whoever it is to contact me via email. As long as I can verify your claims.

2. One of the features of my blog is the fact that I use my real identity, something not every blogger is comfortable with. This started out as a hobby, but attracted a lot of attention when I began to cover the SARS epidemic. Many readers came to know about my site via word of mouth, not blatant advertising on my part. And as the owner of this blog, is it too much to ask that those with critical comments at least tell me who they are? Not doing so, to me, constitutes a lack of confidence in your own opinions, or worse, fear of ( in your own words ) "repercussions".

3. Ah, the "arrogance" argument rears its head yet again. Another indication that this is a personal attack. I'm just curious: have I ever met you before? It's obvious from what you've written that we've never been direct colleagues, yet this deep animosity suggests otherwise. I've never said I'm without flaws. But am I going to reveal them on a public website? You wish! On your planet, having strong views on issues important to me and speaking the truth automatically translates into cockiness. This has evidently been frustrating you for a while, because your outburst ( under the pretext of discussing my cousin's case ) illustrates some form of grudge against me.

However, as a medical professional, I do indeed pride myself on caring for my patients and doing my best for them, even when I'm tired, hungry or just plain feeling fed up about my fatigue and hunger. Please find me a doctor in Singapore who has worked with me before and thinks I'm horrible at my job, and I'll eat my words.

It's sad that you choose not to reveal your identity. The "prerogative" to remain anonymous is a gutless way out. And I'll keep saying this until you tell me your name, thank you very much.

Something quite interesting happened to me last night. I was in the middle of dinner at home when my handphone rang -- it's seldom on, but was active at that very moment because I was waiting for an update from a relative ( which I'll explain below ). When I answered the call, I actually saw the number but failed to recognize it ( even though I know it well, duh! :)).

"Hello?" I said, munching away.
"Hi there! Is that Jen?" a chirpy male voice asked.
"Yes, speaking."
"Hi, this is Mark Richmond from Class 95."
Silence as I stopped chewing.
"Err, hello..." I managed to sputter.
"Congratulations! You're our lucky winner for the Sugababes exclusive showcase next week!"
My jaw dropped. "How did THAT happen?!" I stammered.
"You took part in the Car Tunes contest! You voted for Celine Dion, remember?"
Aaaahhhhh. The light dawns. I'd completely forgotten about it! I voted on Wednesday evening while listening to my Walkman.
"You're the last winner for the Sugababes contest. Can you hang on the line so we can put you on the air in a short while?"
"Sure," I replied. Before long, I was live on Class 95. Mark went on about my winning the tickets to the performance, then asked me to announce the next singer.
Huh? Did he mention it earlier? My mind went blank after he asked me to wait!
"Who is it?" I asked, feeling stupid. But he was really nice about it.
"Madonna," he said.
"Which song are you playing?"
"Borderline."
"Okay," I began. "Here's the #1 female singer as voted by the Class 95 listeners. This is Madonna with Borderline."
"Wow! You did a great job!" Mark responded enthusiastically.
"Thanks!" I felt so relieved. :)
"You want to work here?" he asked, actually sounding serious, heh heh.
"Oh, I already have a job." That made him laugh quite hard. I'm just glad it didn't offend anyone. :P
Anyway, he took down my details and said someone will contact me later about collecting the passes as well as a free Sugababes CD. I kinda like the gals 'cos their songs are pretty good. But sadly, I can't attend the showcase 'cos I'm on night shift! Aaaaaagh!

Anyway, I'm going to email my department first to see if there are any takers. If not, then it's a free for all for local blog readers. :D

The issue about my relative concerns another cousin of mine, a 34-year-old guy who is currently admitted at SGH for some neurological symptoms. An MRI brain is being arranged for -- get this -- tomorrow. When did the hospital start doing MRIs on Sundays? Impressive! Compare this to a certain hospital ( which I shall not name ), where certain radiologists refuse to do scans even if clearly warranted. A friend of mine personally experienced this problem during a medical posting a couple of years back, when a patient with suspected deep vein thrombosis needed an urgent Doppler prior to commencement of anticoagulation therapy. The radiologist-on-call said no to his request, and no again despite my friend's repeated persuasion. In the end, my friend was so concerned he called ANOTHER hospital's on-call radiologist, who immediately agreed to do the scan.
So the patient was transferred -- via ambulance -- to the other hospital, where the scan CONFIRMED a DVT, then transferred back to his original hospital, where IV heparin was begun.
Sigh.
Anyway, I hope my cousin's MRI will be normal.

The afternoon shift in resus today was quite busy, but it's now coming to an end. Lots of admissions, which isn't going to be fun for the ward teams. But I have to commend the medical house officer who came down multiple times to accompany our patients to the CT scan room. He's extremely obliging and shows up stat whenever we call him, unlike some other HOs I've encountered. Wish more people could be like him. Keep it up! :)

This post addresses one particular issue which may not interest anyone very much, so please feel free to skip ahead. My main reason for writing these next few paragraphs stems from a recent ( ?vicious ?malicious ?vengeful ) attack on an entry I made, dated Jan 30, about my poor cousin, as well as my character. The author only signs off as "Urgh", and since a request by myself for him/her to email me with his/her identity, for the purpose of further mutual clarification of details pertaining to this incident, went unanswered, I'd like to now bring this out into the open.

Here're Urgh's comments. [ You can view them directly at the end of the Jan 30 post. ]

"As you said,you didn't see your cousin until after his operation, having not read his case notes,all the pre-op symptoms you described-"sunken eyes" and looking "like a skeleton" were probably told to you by your non-medical relatives.Why are you so hasty to criticise what the medics did (or didn't do, as you asserted), and isn't it so lavishly proud of you to say,"?f I'd seen him, the first thing I would do is..."? Ah, the luxury of retrospection! Did he complain of abdominal pain? What in your mind would be the most likely cause of a 15-year-old with vomiting? Obviously even his parents didn't suspect it was so severe initially since they brought him to KL for a holiday..

How did you know he was "this close to a perforation" without talking to the surgeon, reading the case notes or being in OT yourself? E-laparotomies are done all the time, sometimes due to a lack of response with conservative management, not necessarily because of impending perforation.
You have clearly expressed expansive repugnance to journalists, but perhaps you should exercise more objectivity in your own reporting, as there are obvious repercussions. Will your readers go, oh no, avoid NUH? Quick find out who's the surgeon? Why don't you try a little more fact-finding before you lash out? I gather from your blog that you must be the quintessential good doctor.."


And here's my reply:

With regard to my cousin's illness:

He started vomiting on Jan 21, and was seen at the NUH A&E, where he was diagnosed with food poisoning -- something I do not find fault with. Discharged with the necessary medications, he went to KL with his parents and siblings the next day. He was still vomiting, but as mentioned earlier, had been seen the day before and was already on treatment. He remained in KL for another 2 days, before the trip was cut short due to his protracted illness. Upon their return to Singapore, my aunt and uncle took him straight back to the NUH A&E on Jan 24, where the paediatrician-on-call told them my cousin was "severely dehydrated", and required admission for intravenous fluids. In the ward, he continued vomiting bilious contents for another 24 hours, with no X-rays done, but a trial of feeds was instituted. My aunt and uncle then requested that an X-ray be ordered, but was told by ??the medical officer that it wasn't needed. After repeated requests, the investigation was eventually done, and a mere hour later, the surgical team arrived, and an immediate decision for an emergency laparotomy was made. The operation was carried out on Jan 25. The doctor who initially refused to order the X-ray, for your information, later expressed some degree of contrition to my uncle.

Urgh was extremely upset by my blog entry, as you can see from his/her reply. My initial post didn't include that many details, but since Urgh has made some incorrect assumptions regarding my opinions, I hope the above description gives him/her a clearer perspective.

Can I just ask those of you with medical backgrounds one question?
If you saw a 15-year-old boy with abdominal pain and recurrent bilious vomiting for 4 days, would you

(1) do an abdominal X-ray stat,
(2) keep him nil by mouth, or
(3) feed him?

And for the record, I trust my uncle's account of events completely. Unlike some patients / their relatives, he is far from suspicious or demanding, and only makes special requests if he feels strongly about them. He doesn't fabricate stories to make himself look good, or to make others look bad. He is also well-educated, and makes it a point to remember information correctly.

Anyway, so much for those aspects. Now I'd like to ask Urgh what precipitated this onslaught of insult-hurling. "Lavishly proud"? "Lash out"? "The quintessential good doctor" - a remark that is dripping with contempt? Have I ever come across as being so full of myself I think I'm God's gift to the medical profession? I suppose all my accounts of being verbally abused and second-guessed by patients, my frequent complaints about work, or my constant expressions of fear while being at the frontlines during the SARS and bird flu epidemics, have only enhanced this image of arrogance, eh?

In my reply in the "comments" box, I said that I had 3 theories regarding Urgh's identity: an NUH doctor ( perhaps with a friend / relative who's a reporter ), someone I'm acquainted with ( who obviously greatly dislikes me ), or a reporter ( who may or may not have a friend / relative who's a doctor in NUH ). I tend to favour the last possibility, as I can't think of any medical professional who would be this nasty to his/her own colleagues, even if a difference in opinions exists. As for the second option, only one person comes to mind, and only because he also favours multisyllabic words, flowery adjectives, and NUH. But then, I believe his sense of overwhelming guilt prevents him from hurting me further, so that goes out the window too. :)

The reason I think Urgh is a reporter is because of his/her telling comment about my "expansive repugnance" of the press. Okay, I admit I am responsible for giving the wrong impression here. My feelings are actually directed at certain reporters, rather than the general journalistic population. However, my opinions are also shared by many in the medical profession. One senior professor even voiced them out loud to me once, after a scathing article in the newspaper criticized a certain hospital's handling of SARS cases, plus a few other boo-boos ( remember Ms. Mok? ). This is further compounded by the newspaper's propensity for putting doctors in a bad light, either in the form of a column by a reporter stricken by breast cancer, or multiple complaint letters published in the Forum Page. Is my distaste directed against everyone at The Straits Times? Of course not. I can name 3 journalists who have my deepest respect -- Sumiko Tan, Helmi Yusof ( he might be on hiatus right now ), and Tan Shzr Ee ( my classmate from RGS ). The first two have emailed me before, even after some sarcastic feedback I gave, to share their own views and thank me for reading their articles. Imagine that! Such graciousness and maturity earned my admiration instantly, as opposed to, for example, Tommy Wee's nasty reply when I pointed out his obsession with leggy blondes ( am I wrong? ). Shzr Ee, on the other hand, has always been an extremely nice person, and an exceptional writer. I have high hopes for her as a future Chief Editor. :D

Last but not least, I hope Urgh doesn't think I'm sabotaging NUH. I am only relating my cousin's case, nothing more. I never extrapolated that NUH is crawling with incompetent doctors, nor did I ever tell people to avoid going there at all costs. I worked in NUH Cardiology in 2002, and greatly enjoyed my time there. I also got to meet and work with a number of excellent colleagues from the various medical and surgical departments. But I still feel that a simple X-ray would've helped my cousin, and if anyone violently objects to this remark, feel free to explain why so we can discuss. If I wanted to have a monologue that's immune to any form of criticism, I wouldn't have installed a comments box now, would I?

Before I end, I'd like Urgh to try asking anyone who's worked with me before about my skills as a doctor. This isn't a challenge, by the way. I just think Urgh would benefit from some objectivity with regards to his/her opinion that I'm not good at my job. I take what I do very seriously, and having someone question my ability ( someone who conveniently hides beneath the cloak of anonymity ) sickens me.


Okay, now on to something a little less annoying. :)

I take my hat off to Simon Cowell, Paula Abdul and Randy Jackson, for kicking Michael "Unchained Melody" Keown out of the competition in the latest episode of "American Idol". I can only describe this guy as being profoundly "full of it", which is a great pity, 'cos he has a good voice, and would've gone far with his talent and looks, IF ONLY he hadn't come across as cocky and complacent. Eat your words, Mikey! The hunky beefcakey blonde (I can't be bothered to remember his name ) also didn't make it, har har. :D

Spotted many of my favs among the final 32 -- Matt "Rose Bowl footballer" Rogers, Jon "pen salesman" Peter, John "Dean Martin" the redhead, and Fantasia "Macy Gray's little sister". Can't wait for next week!

Second, I'd like to recommend "High Crimes", starring Ashley Judd, Morgan Freeman and Jim Caviezel. Based on a novel, it may seem dry and boring based on content alone ( wife defends husband accused of a military crime he claims he didn't commit ), but I found it to be a terrific film, almost on par with "A Few Good Men". Caviezel outshines his two bigger co-stars easily, but I can't describe it for you for fear of giving the whole plot away. It screens on cable TV, so go check the catalogue.

"Survivor: All Stars" airs again tonight. Wonder who's going next?

Anyway, I just realized that readers' comments on my blog up till Jan 22 have all disappeared after my recent "renovation" of the website, something I didn't expect, but which I obviously can't rectify. My sincerest apologies to everyone affected, especially those who posted about the SARS entries.

Some reading material:

Cover story for Time Asia Feb 9 issue: Bird Flu - Is Asia hatching the next human pandemic?

Excerpts:

"As early as mid-October, says Ah Tong ( an Indonesian chicken farmer ), his chickens began to die in tens every day. At first, officials insisted that the birds were merely suffering from Newcastle disase, a viral infection that's deadly to chickens but which poses no threat to humans. By late November, about 100 chickens were dying each day. The vet then sent a blood sample from a dead chicken to the veterinary research bureau of the Bogor Institute of Agriculture, near Jakarta. "They found it was not Newcastle disease that killed my chickens, but AI - avian influenza," says Ah Tong. "But the government still insisted it was Newcastle disease.""

"In Thailand, it wasn't just the bureaucrats who were reluctant to face reality. Politicians also publicly vilified would-be whistle-blowers. Senator Malinee Sukavejworakit, a medical doctor who represents one of the worst-affected provinces, convened a meeting of the Senate Committee on Public Health, for which she is chief adviser, and revealed her findings. The same day she held a press conference, asking the government to release the results of tests on the hospitalized butcher and to explain what was killing chickens in such terrifying numbers, Deputy Agriculture Minister Newin Chidchob accused her of being "irresponsible to the motherland" and endangering is economy. Thie attitude of aggressive denial went right to the top: a few days earlier, Prime Minister Thaksin Shinawatra dismissed the idea of a bird-flu epidemic as "fantasy and imagination"."

"This time round, China has shown alarming signs that it has somehow failed to learn the lessons of SARS. For weeks, while avian flu rampaged through much of Asia, Chinese officials insisted - to the disbelief of many experts - that the disease had not struck their country. During that time, they made little effort to tell farmers what to do if their flocks began dying, and failed to offer timely information to UN organizations in Beijing that had requested briefings."

Last night's "American Idol 3" picked up the pace a little, after faltering a week ago ( William Hung was the only highlight in the previous episode -- he's now famous on local radio, with a few stations playing a special "remix" of him singing "She Bangs", together with the judges' comments, haha! :D ). Yesterday, the 120 shortlisted contestants went through two extra rounds of singing, with quite a few nervous wrecks messing up their lines and annoying the judges. What's funny about this is how some of them attempted to cover up with lame excuses -- "The lights are blinding me and I can't concentrate," offered one blonde. "Can we switch them off please?" Simon Cowell countered. The spotlights went dark, and the hapless girl still failed to remember the lyrics. "Guess that theory was wrong," Simon snapped. Heh heh. :)

As for shocking moments, get a load of one African-American gal with a major attitude problem, bashing Simon repeatedly with rude insults, even incurring the usually tolerant Paula Abdul's wrath in the process. Abdul's "I'm shocked by your disrespect" comment subdued the girl sufficiently, and believe it or not, she wasn't eliminated when it came down to the crunch. She even went up to Simon and gave him a hug. Well, if this teaches her a thing or two about manners and class, then good for everyone.

I managed to catch the names of 3 out of 4 of my favourites. The one I still can't remember is the Macy Gray soundalike, who by the way, has a lovely personality and is a likely shoo-in for the semi-finals. The 3 guys are: Matt Rogers ( the beefy fellow with a short beard ) and the two "Jon's" -- Jon Peter who resembles Brian Littrell from Backstreet Boys and practically crackles on-stage, and "the other Jon", a 16-year-old redhead who sounds 30 years older and loves to do jazz classics. The hunky blonde with the washboard abs doesn't appeal to me, though lots of people I know think he's hot. :) As for Michael Keown, who did "Unchained Melody" for his first AI audition, he's starting to come across as a little bland, especially with a boring song he composed during the last round. Sure, he can sing, but you won't last in Hollywood if you put people to sleep after the first 5 minutes.

My reading of "LIFE: Our Century In Pictures" continues. I've gone through WWII, the Holocaust, the Vietnam War, JFK's assassination and the Civil Rights movement, and the photos are absolutely riveting. Images of Pearl Harbour in flames, a little boy walking past a mass of dead Jews, a corpse burnt beyond recognition by napalm, JFK's head exploding in a fountain of blood and brains, and multiple shots of riots fuelled by racism are just some of the amazing photos featured in this book, aided by informative captions that vividly describe the history, mood and ripple effects of each event. Highly recommended!

Nothing much going on in the ER today, so I'm just catching up with some reading. Guess I should mention a complaint letter in The Forum Page today, from someone whose father's stroke was missed at the SGH A&E Department in August 2003. I'm still wondering why s/he decided to bring this up 6 months after the actual incident, but at least the language used isn't as strong as some other complaints published previously. From my standpoint, if the facts given by the writer are correct, then not admitting the patient was a little inappropriate. From the looks of it, it might have been a medical officer attending to this particular patient, rather than a senior doctor. But that's the way it is in ERs. The ideal situation would be if all ERs were run purely by trained emergency physicians, but manpower issues don't allow for this -- not currently, anyway. When I did my first MO posting at SGH in 2001, I was very inexperienced where surgery and orthopaedics were concerned, but I always made it a point to consult a registrar or consultant if I wasn't sure. Most A&E MOs are either medically or surgically trained -- they do an ER rotation because it's part of the requirement for their post-grad exam -- so deficiencies in certain areas is expected. Thus, those of us who have already done countless postings in various specialties are understandably more well-equipped for making the right diagnoses.

If the author of this complaint thinks s/he is doing a great service, then s/he is sadly very wrong. Unless it can miraculously change the A&E system overnight, the same problem will still crop up from time to time. You need experienced ER physicians running the departments, not MOs with limited training. Ministry of Health, take note!

3:30am Wednesday morning. After seeing patients non-stop since midnight, I've hit a tally of 32 cases with 4 1/2 more hours to go. The good news is, I'm now stationed in resus, which is completely empty, woohoo! The nurses tell me it's been quiet so far, so I hope I'll get a breather before my rest-time's due at five.

I went to the pantry a few minutes ago to get a snack, but found that our usual supply had been snapped up by other people -- likely non -night shift staff. What gives!? This has been happening a lot lately, and although we have a short list of suspects, nothing's been proven as yet. I like to call this "The Curious Incident Of The ER Doctors' Snacks In The Night-Time" ( a play on the title of this year's Whitbread Award winner ). Haha. Some dry humour for you there. :)
Anyhow, I had to resort to buying some Milo ( ie. hot chocolate ) from the nearby vending machine. To my distress, the machine selling biscuits and assorted crackers / peanuts was out of order! Now I'm tired and hungry, which doesn't bode well for my mood. And it seems I'm attracting patients like moths to a flame. I spoke too soon AGAIN! The ambulances are now driving up one after another, argh! :(

So the pilot episode of "Survivor: All-Stars" was really interesting. ( I think changing the subject will do me some good here. :))
Tina Wesson, winner of Survivor: Australian Outback, was the first to get booted off. The obvious strategy is: Vote off anyone who's already won the $1 million prize, which makes perfect sense to me. I mean, who's going to let you bag another million when s/he hasn't even tasted the dough yet? So it didn't surprise me in the least when Rupert ( an overall good guy ) formed an alliance with the underdogs ( including renowned bitch Jerri ) to oust Tina despite an overture from another winner ( Ethan from Survivor: Africa ). The way I see it, the show will be a lot more watchable without any of the winners, some of whom aren't crafty enough to hold viewers' attention. I still have my eye on Rob Cesternino, who's laying low at the moment. Go, Rob!

One other person I'd like to mention is Richard Hatch, the original Survivor from the first series located in Borneo. Openly homosexual and famous for baring it all on television, he does it again in the current season, regularly stripping for dips in the ocean, or worse, immunity challenges. His fellow tribe members weren't amused when he removed his shorts then proceeded to haul a heavy raft during a rough obstacle course. But heck, the team won, so no-one's going to fault him for it. Still, Hatch is basically a motor-mouth with a major attitude problem. He struts around like a peacock, refuses to help with any chores, and keeps saying he's superior to everyone else. I'm just waiting for that moment when he has to eat his words, or even better, gets voted off, hah!

There's a recruitment exercise going on in the department, as one of the locums gathers doctor-musicians for a band. This came about after a fellow MO emailed to tell us about his piano recital at The Esplanade last Sunday. I replied to say that I also play the instrument, then an ER registrar mentioned he's a drummer, and so forth. We're considering a jam session, with maybe an attempt at Evanescence's "Bring Me To Life" ( I was asked if I could play the opening chords just by listening to the music -- the answer is yes, but I don't have perfect pitch, so if it isn't in C major, I have to think a little harder :P ). Anyhow, it's something fun to do, and I'm asking some guitarist friends if they'd like to join in as well. A band comprising doctors - sounds pretty cool eh? :)