Monday, October 27, 2008

In Retrospect

I hate these moments, when I get crabby about work.

Blame it on the endless parade of drunks brought in by ambulance, thanks to the "kind" souls who stumble upon these fellows and decide to dial 995.

Interestingly, many of tonight's patients belong to the older age group ( including the alcoholics ). But the sober ones actually have legitimate complaints, requiring admission and urgent intervention. Being often stoic, I can't blame them for swamping our ER in the middle of the night, after trying to endure their symptoms for as long as possible.

Of course, a significant proportion of the crowd hails from ambulance diversions, which are becoming a daily routine in recent months. I don't know what the heck is going on over there, and I'm obviously not at liberty to whack my colleagues, but there's clearly a problem, and I can't help wondering what's being done to solve it. Is this going to continue for all eternity? Have some mercy on us, for pete's sake.

Night shifts these days involve handling social ills rather than real medical / surgical emergencies. It's as if Singapore's become a festering cesspool of alcoholics, manjas and thugs. On any given early morning ( 12 midnight to 6am ), we see people so drunk out of their minds it's positively shameful. They strip, they spew vulgarities, they piss on the floor, spit at medical staff and police officers, come in bloody from fights, usually accompanied by friends who are equally wasted and kick up a major ruckus in the ER.

And they're supposed to be doing this all in the name of fun?!

I'm sorry, man. The only time I got anywhere near the definition of "drunk" was back in my GS MO days, when I had too much Long Island Iced Tea for my own good and had trouble driving home. Since then, I've made it a point to moderate my alcohol intake. That's the sensible thing to do, right? Why is it so difficult for these twerps to understand this? Where's the thrill in puking your guts out or feeling like crap? Yeesh.

There's also a rising trend in PSY cases among young adults. Depression, panic attacks, stress reactions, you name it. It's okay if they need someone to talk to or an early referral, but I can't stand it when they try to be funny. For example, I recently saw a young man who repeatedly presents with chest pain, for which numerous tests ( including TMX and echo ) have been performed, with normal results. When he returned one evening with the exact same symptoms and a completely pristine ECG, I reassured him that he was okay and could be discharged. He then became angry and accused me of trying to get rid of him. It took me 20 minutes just to pacify the guy, while the patient queue got progressively longer.

At times like these, I wonder if I'll still be doing this %^&$ work 10 or 20 years down the road. Emergency medicine is one of those rare specialties where even the most senior consultants still do night shfits. I'm starting to feel ancient, not sure if I can take any more of this.

But then I think about ward rounds and clinics, and the ER begins to look good again. :)

Anyway, I recently attended to a young lady with severe epigastric pain who failed to respond to multiple medications, despite a soft abdomen, normal vitals, bloods and x-ray findings. When I wanted to admit her, I called her husband to update him ( he was at work ), but was told to wait for him to come to the ER 2 hours later so he could talk to his wife and see if she could be discharged. She was in so much pain she shed tears, and I relayed this information to him, to no avail. I gave him the 2 hours he requested, but when he failed to turn up on time, I marched back to the lady, told her I would admit her as long as SHE granted permission, and she begged me to send her to the ward.
Turns out she was incubating an acute surgical condition and subsequently went for emergency laparotomy. I could've admitted her sooner if I hadn't decided to wait for her spouse. Won't make that stupid mistake again.

Got an earful of attitude from a ward MO the other day, when I called to ask a simple question about whether to admit to one department or the other. Granted, I only identified myself by first name, not by rank ( I do that only when calling doctors who are known to cause trouble ), but this guy spoke to me in a sarcastic tone, even though I didn't even ask him to come down to the ER or accept an admission. I later consulted my friend, who's this MO's registrar, and was told that the MO gets compliments from patients. Hah! Why am I not surprised? There're lots of doctors like that, who treat patients like royalty and know which senior arses to kiss, but trample all over those who don't directly impact their career prospects. I've met enough of such hypocrites to develop a thick skin ( and ample amounts of bitterness ), But I have a very good memory where such encounters are concerned, so you've been marked, pal.

This warpath mode has been building up for a while, though unleashed only now. I suppose last week's Sun Festival helped lighten my mood significantly. Too bad the effects have worn off so quickly, heh.

It's times like these that make me miss the carefree days of my youth. As I write this, I'm playing the soundtrack to Beyond The Sea on my PC, with Kevin Spacey singing a verse from Once Upon A Time:

"Once upon a time
The world was sweeter than we knew
Everything was ours
How happy we were then
But somehow once upon a time
Never comes again...."

It's extremely sad, yet also comforting in a weird way. But I've long realized that happiness entails an active search which, in my case, extends far beyond work. How can I possibly define my existence through patients, when there's travel, music, film and exquisite prose to occupy my thoughts?

Maybe someday, I'll hit the jackpot with a personal project, and bid medicine farewell. Till then, I shall rant periodically, for your reading pleasure. :)

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