Happy Lunar New Year!
Hope you had a great weekend. Mine was immensely enjoyable. :)
Updates
1. My back hurts. All that spring cleaning, swimming, playing with friends' and relatives' kids, and aging ( haha ).
2. Based on what I saw during my shift on CNY Day 1, I have a theory that all those calorie-loaded reunion dinners have a direct causal effect on coronary arterial plaques. Meaning: tuan2 yuan2 fan4 => AMI.
Although someone disagrees. :)
One guy with an evolving anterior STEMI decided to AOR discharge.
"Uncle, you MUST understand that you've had a heart attack, need urgent angioplasty, and may DIE if you discharge yourself against medical advice!"
"Yes, doc! I understand! Never mind lah!"
Yeesh.
3. Almost got run off the road by this sociopath driving an SUV. CNY Eve, he swerves into my lane and I horn at him. He rolls down his window, screams at me for being "noisy", then when I remind him that it's my right of way, he shouts, "Right of way, right of way LAH! So WHAT?! Don't want to let me in, we BANG LAH!!!" before proceeding to ignore me. We're at a red light, and when it turns green, he jerks forward - attempting to scare me, no doubt. But he's got my hackles raised, and I don't take the bait. So I zoom past him, which drives him off the deep end. He races past me on the left, cuts into my lane, missing me by a mere couple of inches, then brakes so hard I almost got a heart attack. He speeds up again, but when I accelerate so as not to block traffic behind me, he jams on the brakes again. I get fed up, switch to the left lane, then he slows down and swerves towards me AGAIN! At this point, I've practically given up playing psycho games with him, so I stay behind at a safe distance and later filter off at a slip road while he glares daggers at my rear bumper.
And get this, there was a little boy in the back seat of that SUV.
Fact one: Road rage isn't quite so bad if it's just adults involved. But when a child's in the vehicle, well that's just plain irresponsible and reprehensible.
Fact two: the kid's most likely going to grow up to be another sociopath like his good ol' dad.
Is this incident reportable? Please advise.
In Hibernation
The day has come, but it couldn't be helped -- we're all just too busy.
However, further plans may materialize, so stay tuned.
American Idol 5 - Week 2
Spotted a few other stars-in-the-making.
Baldie #1: The cop who sang Marvin Gaye's Let's Get It On, then did a slow dance with Paula Abdul, before revealing that he's in fact MARRIED, which really pissed Paula off. But you gotta admit -- the fellow's got a fantastic set of pipes. Those high notes were pure gold!
Baldie #2: Hispanic dude whose name escapes me ( as does the title of the song he did ), but he's reaaaally good.
Blondie #1: Hunky chunk of beefcake called Jeffrey something-or-other. Voice is so-so. Obvious that he got through only because of his bod. Sad.
Blondie #2: Beautiful young lady named Kelly Pickler, who hails from a small town, was abandoned by her mother, has a dad in prison, stays with her grand-pappy, and hit a Kelly Clarkson number right out of the ballpark.
Paris Bennett: So far the BEST I've seen EVER. 16-year-old with vocals to die for ( did you hear her cover of that Billie Holiday song? ). Endearingly humble despite her relation to quite a few musical celebrities. Lovely girl.
Weekend Fix
Jay Leno's Tonight Show airs on local cable's CNBC Channel 15 every Saturday and Sunday at 10pm, and I've been having a ball watching all the fun. Recent guests include Jake Gyllenhaal and Heath Ledger from "Brokeback Mountain", Colin Firth ( "Bridget Jones' Diary" ), ex-supermodel Heidi Klum ( "Project Runway" ) and ice-skating Olympic gold medalist Sasha Cohen. Klum, in particular, was an absolute delight. She demonstrated quick wit, loads of bubbly personality, and had everyone in stitches when she repeatedly shot stern questions at fellow guest Ledger ( who played along by looking befuddled and terrified, heh ) and did a hilarious impression of her snowboarding instructor's surfer-dude slang.
A great way to spend one's weekend nights. There's also Jon Stewart's show on CNN Channel 14 at 11:30pm. Political satire with lots of Bush-bashing. I love it. :)
Feast Your Eyes
I don't really want to see movies in cinemas anymore ( high cost and microbiological loads ), but I'll make the exception for "Brokeback Mountain" and "Zoolander". If I find the time, that is. And the energy.
The latter's definitely worth catching. Don't recall much from the time I first saw it in the Fox Glacier region in New Zealand back in 2003, but I do remember laughing my socks off while my parents snored in the next bed ( we'd just completed a full day of major hiking ).
ER Discussion Part 2
In reply to milo's comments about the merits of direct admissions vs A&E referrals: since I've worked in different departments and experienced both systems, I think admitting rights should be allowed for the following:
- all medical disciplines
- most surgical specialties ( GS, ortho, neurosurg, uro )
Screening in the ER before admission is warranted for:
- cardiology ( don't play-play with chest pains, ok )
- ENT
- eye
- O&G ( all those PV bleeds can be tremendously scary )
In addition, ENT and eye cases should preferably be reviewed by those on-call ( e.g. FBs, traumas, other complicated conditions ), rather than deferred to the A&E doc ( junior OR senior ) to handle. I once worked at an ER where the ENT MO refused to come down unless we'd CONFIRMED an FB ( either through x-rays or direct visualization ) and/or at least attempted to remove the darn thing on our own.
Although I tried to empathize ( maybe the MO is busy or very stressed for whatever reason ), it later dawned on me that it made no sense to subject the patient to prolonged / repeated examinations which is often VERY uncomfortable and, if done by inexperienced hands, extremely unpleasant, perhaps even dangerous.
Plus, this same ER had the horrible habit of allocating patients to consult rooms, so while you're digging around the guy's throat, you have this nagging worry in the back of your mind about your queue getting jammed. Of course, the patient is completely oblivious, but it does little for the poor doctor's psyche and every case that comes after the FB throat.
As for eye, sigh... the worst encounter I had was with an MO(S) who die-die refused at all cost to set foot in the A&E. He'd ask a million questions in a sarcastic tone. He even asked my senior whether she had "any understanding of basic eye anatomy"! Nasty bugger.
Anyway, I personally feel that ophthalmological diseases presenting at the ER deserve an urgent eye consult, even if it looks and smells like simple conjunctivitis. This is because -- and this stems from a short stint at the SNEC a year ago -- nothing is absolute where eyes are concerned, and even the simplest condition can deteriorate within just a few hours. A slit-lamp exam is almost always warranted, and this is a skill which requires adequate experience and sufficient time -- something not many A&E MOs possess and which the busy ER seldom accomodates.
My hospital provides excellent eye backup, for which I am extremely grateful. It also helps that the SNEC director knows my mother and me personally. Very nice man. :)
V-Day
In response to Vagus' query, NO I HAVE NO PLANS FOR FEB 14. Haven't had any for the past 5 years, don't think that will change any time soon.
I'm not a chocolate-and-roses type of gal. What REALLY gets me going? That's for me to know, and for the guy to find out. :)
Okay, enough information for one day! Enjoy the rest of the New Year.
Tuesday, January 24, 2006
Follow-Up
What happens when I've got free time on my hands, am too tired post-full-day-AST-session to do anything else, and there's no "House" on cable?
Why, I blog, of course. :)
See This Dude
But bear in mind - he's more of a personal taste than a mainstream artiste.
March 17th. Mark your calendars.
I will say this: His 2002 album, Waiting For My Rocket To Come, is a real gem, thanks to the beautiful, upbeat You And I Both, and the ingenious The Remedy ( I Won't Worry ). ( Also love that rooster featured in his CD photos. )
Mraz has an impressive vocal range and displays seasoned versatility in pop, rock, folk and jazz styles. He also delivers pitch-perfect 'live' performances, as evidenced by samples from concert recordings played on the radio now and then.
An "intimate, acoustic" evening -- sounds like heaven to me. :)
Don't know why I never saw his latest release in the stores I usually haunt. Time to go hunting for it the next time I'm in town.
By the way, is anyone going to the Kings Of Convenience show? Have heard some of their music via videos on MTV previously - really enjoyed it - but alas, I have to watch my spending this year, in preparation for some good stuff in New York City, New Orleans, Las Vegas and perhaps even Los Angeles.
It's gonna be a rather long wait ( by my standard at least ), but definitely worth it. :)
The Bubble Burst
Ah, one mystery solved.
A male colleague described me as "not a bad deal" the other day ( he isn't comfortable with direct compliments, so I appreciate the effort, heh ), but what's the point really, if certain people consider my ex so overwhelming a factor that they won't even dare make an approach?
I kid you not.
It's one thing to be avoided because of my own flaws.
It's entirely another when the ex still manages to exert such ( negative ) influence on my social circle.
Quite frankly, I find it insulting.
Funny
It came up during a conversation while strolling in the park this evening: how Italian television is almost extra-terrestrial in nature, with 99% of the programmes broadcast in the native language, whether they're locally produced or Hollywood fare.
I still recall how, when I first arrived in Rome, I spent a couple of days flipping channels like crazy and watching the likes of "The Firm" and "Grease" in Italian. If it weren't for CNN, I would've lost my mind.
But it also helped that they've got lax censorship. "The Lover" ( that Jane March vehicle ) was screened in all its uncut glory, though everyone spoke - you guessed it - Italian. Not that I cared, heh heh.
3 more days of leave left. Need to make the most of it.
Ciao.
What happens when I've got free time on my hands, am too tired post-full-day-AST-session to do anything else, and there's no "House" on cable?
Why, I blog, of course. :)
See This Dude
But bear in mind - he's more of a personal taste than a mainstream artiste.
March 17th. Mark your calendars.
I will say this: His 2002 album, Waiting For My Rocket To Come, is a real gem, thanks to the beautiful, upbeat You And I Both, and the ingenious The Remedy ( I Won't Worry ). ( Also love that rooster featured in his CD photos. )
Mraz has an impressive vocal range and displays seasoned versatility in pop, rock, folk and jazz styles. He also delivers pitch-perfect 'live' performances, as evidenced by samples from concert recordings played on the radio now and then.
An "intimate, acoustic" evening -- sounds like heaven to me. :)
Don't know why I never saw his latest release in the stores I usually haunt. Time to go hunting for it the next time I'm in town.
By the way, is anyone going to the Kings Of Convenience show? Have heard some of their music via videos on MTV previously - really enjoyed it - but alas, I have to watch my spending this year, in preparation for some good stuff in New York City, New Orleans, Las Vegas and perhaps even Los Angeles.
It's gonna be a rather long wait ( by my standard at least ), but definitely worth it. :)
The Bubble Burst
Ah, one mystery solved.
A male colleague described me as "not a bad deal" the other day ( he isn't comfortable with direct compliments, so I appreciate the effort, heh ), but what's the point really, if certain people consider my ex so overwhelming a factor that they won't even dare make an approach?
I kid you not.
It's one thing to be avoided because of my own flaws.
It's entirely another when the ex still manages to exert such ( negative ) influence on my social circle.
Quite frankly, I find it insulting.
Funny
It came up during a conversation while strolling in the park this evening: how Italian television is almost extra-terrestrial in nature, with 99% of the programmes broadcast in the native language, whether they're locally produced or Hollywood fare.
I still recall how, when I first arrived in Rome, I spent a couple of days flipping channels like crazy and watching the likes of "The Firm" and "Grease" in Italian. If it weren't for CNN, I would've lost my mind.
But it also helped that they've got lax censorship. "The Lover" ( that Jane March vehicle ) was screened in all its uncut glory, though everyone spoke - you guessed it - Italian. Not that I cared, heh heh.
3 more days of leave left. Need to make the most of it.
Ciao.
Saturday, January 21, 2006
Reprieve!
Just started a week of annual leave. S-weet. :)
Congratulations In Order
For a good friend and A&E colleague, who just welcomed his baby boy into the world. Poor wife had a tough time though, but thank goodness everyone pulled through okay. Now if only he'd find the courage to pick the little neonate up! :)
Good wishes also go out to Hugh Laurie, who won his first Golden Globe for Best Actor ( TV Drama "House" ) 4 days ago. Did you catch his hilarious acceptance speech, where he stuffed a fistful of more than a hundred names on little strips of paper into his left pants pocket then randomly drew 3 out like a lotto? Think he thanked his hairstylist and a caterer, before moving on to his agent ( "Hmm, this isn't my handwriting." ). One of the best I've heard since Emma Thompson's Oscar speech for "Sense & Sensibility", Cuba Gooding Jr's for "Jerry Maguire", Matt Damon and Ben Affleck's for "Good Will Hunting" and Adrien Brody's for "The Pianist" ( although the kiss took up >50% of that one, heh ).
Surprise of the evening? Sandra Oh's win for her supporting role on "Grey's Anatomy" ( which, incidentally, also got nominated for Best Actor - Patrick Dempsey - and Best TV Drama ( no "House"! horrors! )). She looked equally stunned too. Not sure if she really deserved it, but heck, something for me to write about in my review.
American Idol 5
More of the same, but amazingly, still as entertaining as ever.
Loads of deluded tone-deaf Idol wannabes, with the occasional manic / effeminate ( bordering on transvestite ) / foul-mouthed character.
Can you guess who I've picked out?
2 fellows.
Both 17.
Both cute.
Both fans of the jazz genre.
One - Zachary Smits, who did a beautiful version of "I'm In The Mood For Love". Lush tenor vibrato, bedroom eyes, winsome smile, dark brown curls. No wonder Paula Abdul was drooling.
Two - David Radford, who sang "Summer Wind" ( one of my favourites, and Simon Cowell's too ). Sounded a little forced and bland, but he was trying to imitate his idol, Frank Sinatra, so it's hard to tell at this point. Definitely shows promise, especially when he crooned Dream A Little Dream in his car ( his friends listen to jazz as well, which is great ). He just needs to loosen up a bit.
Patrizio Show
It's confirmed! 22 February at the Esplanade Concert Hall. Tickets go on sale next week ( direct info from the record company ). Well worth the time and money. Don't miss!
ER Issues
Here's where I may shoot myself in the foot. :)
First, the less controversial stuff.
I saw a few "live cadavers" recently. Not exactly the Chinese New Year Dumping Syndrome as yet, but they're starting to trickle in, and it may really pour this coming week.
The lady I saw was in her 80s. Paramedics called in just before 8am at the tail end of my night shift as a standby for "drowsiness and low BP".
She was in one of THE worst states I've ever witnessed ( and I've seen my fair share of gross neglect in the elderly ). Absolutely parched, sandpaper tongue, skin that remained tented after a gentle pinch, sunken eyes and temples.
BP on arrival 60/40. Patient was gasping at a rate of maybe 10 breaths a minute. Man, she didn't look like she was going to last very long.
Good thing resus was empty at the time, so my 2 MOs and I ( plus a whole army of nurses ) went straight to work. Quick IV access, oxygen 100%, concurrent ECG and hypocount.
"Sugar's LOW," the nurse hollered.
"How low?" I asked.
"LOW, as in 'LO' on the hypocount machine. Unrecordable."
Aha! At least there was something we could treat! IV Dextrose 50% 40 ml stat, a pint of normal saline fast, and before we knew it, she turned pink, opened her eyes and nodded her head when we called her name. Respiratory rate 18 per minute. BP 100/65. She was even starting to move her upper limbs.
"Remember the old lady we saw the other day?" one of the MOs involved with the case asked me last night. "She's been discharged back to her family. But I can bet we'll see her again soon."
Or maybe her family won't call the ambulance next time.
Second, a pseudo-controversial issue.
Seems a patient got VERY worked up over some public comment made by a certain government official in the local paper, and shot in a lengthy essay detailing why s/he thinks this official's opinions are WRONG, WRONG, WRONG.
Something about a botched admission. Psychological distress caused by anticipation / anxiety / venepuncture. S/he even brought up an incident which occurred ONE YEAR AGO to further illustrate the point.
That's where I kena.
So I checked up this person's records on the computer. S/he made some sweeping statements about things I said, and turns out I remember this person quite well ( s/he has a rather unusual condition ). And besides, I'm quite paranoid where case-notes documentation is concerned, so I practically transcribed every conversation word for word.
In a word, I'm APPALLED.
The complaint pertaining to the ER experience makes up only a tiny part of the overall complaint ( which mainly pinpoints the ward ), but I managed to pick out a huge number of lies within a single paragraph.
Apparently, 20 minutes qualifies as a "long waiting time". An "urgent referral" from a GP warrants quick attention, I agree, but what s/he left out is that fact that s/he opted to wait FOUR ENTIRE DAYS before coming to the ER. S/he was so "sick" s/he managed to celebrate the Chinese New Year! ( By the way, this was the reason given when I asked why s/he didn't come to see us sooner. And yes, I typed it all in. Whew. )
Wait, there's more.
This is an educated young adult. Works in the civil service. Respected job.
But get this: I fully explained the management plan to him/her, after personally speaking to the specialist-on-call, who didn't think anything further needed to be done and requested an early outpatient review, which I thought was completely reasonable given the situation.
I ALWAYS inform the patient, or at least the patient's relatives, of the plan on discharge. I documented this in my notes ( "patient informed and agreeable" ), but s/he turns around and says I told him/her to consult the specialist on his/her own instead! Making it sound like I was totally bo-chap and negligent in some way!
Argh, my blood boiled for a full 5 minutes.
Anyhow, I submitted my reply ( no choice, since the official got a direct email and needed our answers ). But thanks to my obsessive-compulsive scribing, my ass is covered. Yay me.
Moving on...
Alex, this bit's for you. :)
So I had an interesting email exchange about the merits of direct admissions from ER to the ward versus reviews by the ward teams in the A&E prior to accepting cases.
Bottomline: There's no perfect, win-win scenario. Rather, it depends on how we adapt to whichever system we're working under.
After all, what's the use of having referrals from the ER prior to admission, if the ward teams either can't or won't review patients, or worse, refuse to accept clear-cut cases into their care, thus causing major problems for the ER and the patients themselves.
Admitting directly to the ward also has its drawbacks. I once did an Internal Med call as a house officer where I got swamped with 5 extremely sick patients at one go. There was an allergic reaction which progressed to anaphylactic shock, a severe asthmatic attack, one pulmonary oedema, another haemorrhagic stroke ( no scan in the ER, yeesh ), and a septic shock.
My MO and registrar were already mobilized, but we were hanging by a thread, and still had a whole string of other cases waiting to be seen. Details are blurry ( it happened 7 years ago ), but I probably saw the last patient of the night maybe 4 hours after s/he was sent up to the ward. Thank goodness everyone else after that nightmare bunch was stable and remained so till morning.
The ideal situation, of course, is to have all patients either reviewed by the ward teams in the ER itself, OR have them admitted directly upstairs and seen within the hour, BEFORE anything untoward happens.
What I suggest: document ER notes METICULOUSLY, call the ward teams if you're worried, maintain good relations with the various specialties, and put your foot down once in a while if it's warranted.
Here's the kicker:
True stories related by a consultant and a senior medical officer respectively.
Incident #1:
Patient has condition A. Scan done, awaiting bed in observation.
Unexpectedly, patient develops condition B. Wheeled back to resus and intubated.
Specialist A called because patient originally presented with A, so by right should go to ICU A.
But specialist A says "the nurses in ICU A cannot handle condition B", and wants the ER to call specialist B.
Specialist B, however, agrees that condition A should be treated by specialty A. Doesn't accept case to ICU B.
Specialist A called again, this time requested by the ER to come down to see patient personally ( original consult conducted via phone ). So s/he comes down, still doesn't take the case, then suggests admitting to specialty X, which has no real jurisdiction where conditions A and B are concerned!
However, specialist A speaks to specialist X and the latter takes the patient to ICU X ( will wonders never cease ).
There's a punchline though - because ICU X is full, the patient has to overflow to ICU A! So the ICU A nurses end up taking care of the same patient they're supposedly "incapable" of handling!
Har har har :)
The other case is under specialty D. An outpatient investigation is done, during which the patient develops an adverse reaction resulting in condition E.
Specialist D considers routing the patient to the ER for admission to specialty E, but admits to ward D first to expedite the process, refers to specialist E upstairs, hoping the case will be taken over.
Unfortunately, specialty E will have nothing to do with the case, preferring instead to drop in every other day to check the patient's progress.
One fine day, the patient gets condition F. VERY serious, gets intubated and sent to ICU F, managed by specialists F for 2 weeks before improving and getting sent back to general ward.
However, specialty F doesn't accept the case under their care, so specialty D asks if specialty E can take over, since condition E was the presenting problem, triggered the other complications and hasn't resolved as yet.
Specialty E says no, keep the patient under specialty D. Orders this and that, but to be carried out by specialty D, okay?
So the medical officer tells me the next time something like this happens again, don't be surprised if we end up seeing the patient in our ER.
Dude, I usually don't enjoy entertaining this sort of thing, but in view of what you've told me, I say do what you have to do. Whatever's best for the patient.
But please call ahead first. So I won't blow my top ( I scolded an oncology MO for the same thing before. Don't mess with me. ).
Ahh, I love unloading. :)
Miscellaneous
Have you heard of Bill and Barbara Pease? Some psychologist couple that wrote a bestselling book pretty similar to the "Men Are From Mars, Women Are From Venus" prototype. The Pease's effort is "Why Men Don't Talk and Women Can't Read Maps" ( I think ). Flipped through it at a salon and was pretty nauseated by some of their "statements".
Man's need to spread their seed is an evolutionary trait - ie. they can't help it! You can't blame them for wanting to sleep with everything in a skirt!
Err, yeah, right.
Equally demeaning views about women somewhere in there too. But I switched off at some point so don't ask me for examples.
I do remember what they wrote about "the perfect partner" though. Apparently a woman is safest with a "Chinese man who listens to classical music" and should stay away from "hardworking jazz pianists".
Obviously, the Peases haven't met Singaporean men before.
Hey, you could consider that a compliment of sorts. Heh. Heh.
Looks like I'm going to get set up no matter what. But I do find it interesting that this fellow's name got mentioned by 2 different people, both of whom think I'm a prime candidate for "matchmaking" purposes.
Ah well. We'll see what happens. But don't place any bets yet. :)
Photos For The Day
Just doing my part to publicize Patrizio Buanne's upcoming concert. This was taken at his showcase at the Grand Copthorne last August. LOVELY guy. :)
The rest are random pictures left over from the Italy trip. Thought they'd add some colour. Also runs with the overall Italian theme, haha.
Time for a juicy Mandarin orange. Enjoy your weekend.
Just started a week of annual leave. S-weet. :)
Congratulations In Order
For a good friend and A&E colleague, who just welcomed his baby boy into the world. Poor wife had a tough time though, but thank goodness everyone pulled through okay. Now if only he'd find the courage to pick the little neonate up! :)
Good wishes also go out to Hugh Laurie, who won his first Golden Globe for Best Actor ( TV Drama "House" ) 4 days ago. Did you catch his hilarious acceptance speech, where he stuffed a fistful of more than a hundred names on little strips of paper into his left pants pocket then randomly drew 3 out like a lotto? Think he thanked his hairstylist and a caterer, before moving on to his agent ( "Hmm, this isn't my handwriting." ). One of the best I've heard since Emma Thompson's Oscar speech for "Sense & Sensibility", Cuba Gooding Jr's for "Jerry Maguire", Matt Damon and Ben Affleck's for "Good Will Hunting" and Adrien Brody's for "The Pianist" ( although the kiss took up >50% of that one, heh ).
Surprise of the evening? Sandra Oh's win for her supporting role on "Grey's Anatomy" ( which, incidentally, also got nominated for Best Actor - Patrick Dempsey - and Best TV Drama ( no "House"! horrors! )). She looked equally stunned too. Not sure if she really deserved it, but heck, something for me to write about in my review.
American Idol 5
More of the same, but amazingly, still as entertaining as ever.
Loads of deluded tone-deaf Idol wannabes, with the occasional manic / effeminate ( bordering on transvestite ) / foul-mouthed character.
Can you guess who I've picked out?
2 fellows.
Both 17.
Both cute.
Both fans of the jazz genre.
One - Zachary Smits, who did a beautiful version of "I'm In The Mood For Love". Lush tenor vibrato, bedroom eyes, winsome smile, dark brown curls. No wonder Paula Abdul was drooling.
Two - David Radford, who sang "Summer Wind" ( one of my favourites, and Simon Cowell's too ). Sounded a little forced and bland, but he was trying to imitate his idol, Frank Sinatra, so it's hard to tell at this point. Definitely shows promise, especially when he crooned Dream A Little Dream in his car ( his friends listen to jazz as well, which is great ). He just needs to loosen up a bit.
Patrizio Show
It's confirmed! 22 February at the Esplanade Concert Hall. Tickets go on sale next week ( direct info from the record company ). Well worth the time and money. Don't miss!
ER Issues
Here's where I may shoot myself in the foot. :)
First, the less controversial stuff.
I saw a few "live cadavers" recently. Not exactly the Chinese New Year Dumping Syndrome as yet, but they're starting to trickle in, and it may really pour this coming week.
The lady I saw was in her 80s. Paramedics called in just before 8am at the tail end of my night shift as a standby for "drowsiness and low BP".
She was in one of THE worst states I've ever witnessed ( and I've seen my fair share of gross neglect in the elderly ). Absolutely parched, sandpaper tongue, skin that remained tented after a gentle pinch, sunken eyes and temples.
BP on arrival 60/40. Patient was gasping at a rate of maybe 10 breaths a minute. Man, she didn't look like she was going to last very long.
Good thing resus was empty at the time, so my 2 MOs and I ( plus a whole army of nurses ) went straight to work. Quick IV access, oxygen 100%, concurrent ECG and hypocount.
"Sugar's LOW," the nurse hollered.
"How low?" I asked.
"LOW, as in 'LO' on the hypocount machine. Unrecordable."
Aha! At least there was something we could treat! IV Dextrose 50% 40 ml stat, a pint of normal saline fast, and before we knew it, she turned pink, opened her eyes and nodded her head when we called her name. Respiratory rate 18 per minute. BP 100/65. She was even starting to move her upper limbs.
"Remember the old lady we saw the other day?" one of the MOs involved with the case asked me last night. "She's been discharged back to her family. But I can bet we'll see her again soon."
Or maybe her family won't call the ambulance next time.
Second, a pseudo-controversial issue.
Seems a patient got VERY worked up over some public comment made by a certain government official in the local paper, and shot in a lengthy essay detailing why s/he thinks this official's opinions are WRONG, WRONG, WRONG.
Something about a botched admission. Psychological distress caused by anticipation / anxiety / venepuncture. S/he even brought up an incident which occurred ONE YEAR AGO to further illustrate the point.
That's where I kena.
So I checked up this person's records on the computer. S/he made some sweeping statements about things I said, and turns out I remember this person quite well ( s/he has a rather unusual condition ). And besides, I'm quite paranoid where case-notes documentation is concerned, so I practically transcribed every conversation word for word.
In a word, I'm APPALLED.
The complaint pertaining to the ER experience makes up only a tiny part of the overall complaint ( which mainly pinpoints the ward ), but I managed to pick out a huge number of lies within a single paragraph.
Apparently, 20 minutes qualifies as a "long waiting time". An "urgent referral" from a GP warrants quick attention, I agree, but what s/he left out is that fact that s/he opted to wait FOUR ENTIRE DAYS before coming to the ER. S/he was so "sick" s/he managed to celebrate the Chinese New Year! ( By the way, this was the reason given when I asked why s/he didn't come to see us sooner. And yes, I typed it all in. Whew. )
Wait, there's more.
This is an educated young adult. Works in the civil service. Respected job.
But get this: I fully explained the management plan to him/her, after personally speaking to the specialist-on-call, who didn't think anything further needed to be done and requested an early outpatient review, which I thought was completely reasonable given the situation.
I ALWAYS inform the patient, or at least the patient's relatives, of the plan on discharge. I documented this in my notes ( "patient informed and agreeable" ), but s/he turns around and says I told him/her to consult the specialist on his/her own instead! Making it sound like I was totally bo-chap and negligent in some way!
Argh, my blood boiled for a full 5 minutes.
Anyhow, I submitted my reply ( no choice, since the official got a direct email and needed our answers ). But thanks to my obsessive-compulsive scribing, my ass is covered. Yay me.
Moving on...
Alex, this bit's for you. :)
So I had an interesting email exchange about the merits of direct admissions from ER to the ward versus reviews by the ward teams in the A&E prior to accepting cases.
Bottomline: There's no perfect, win-win scenario. Rather, it depends on how we adapt to whichever system we're working under.
After all, what's the use of having referrals from the ER prior to admission, if the ward teams either can't or won't review patients, or worse, refuse to accept clear-cut cases into their care, thus causing major problems for the ER and the patients themselves.
Admitting directly to the ward also has its drawbacks. I once did an Internal Med call as a house officer where I got swamped with 5 extremely sick patients at one go. There was an allergic reaction which progressed to anaphylactic shock, a severe asthmatic attack, one pulmonary oedema, another haemorrhagic stroke ( no scan in the ER, yeesh ), and a septic shock.
My MO and registrar were already mobilized, but we were hanging by a thread, and still had a whole string of other cases waiting to be seen. Details are blurry ( it happened 7 years ago ), but I probably saw the last patient of the night maybe 4 hours after s/he was sent up to the ward. Thank goodness everyone else after that nightmare bunch was stable and remained so till morning.
The ideal situation, of course, is to have all patients either reviewed by the ward teams in the ER itself, OR have them admitted directly upstairs and seen within the hour, BEFORE anything untoward happens.
What I suggest: document ER notes METICULOUSLY, call the ward teams if you're worried, maintain good relations with the various specialties, and put your foot down once in a while if it's warranted.
Here's the kicker:
True stories related by a consultant and a senior medical officer respectively.
Incident #1:
Patient has condition A. Scan done, awaiting bed in observation.
Unexpectedly, patient develops condition B. Wheeled back to resus and intubated.
Specialist A called because patient originally presented with A, so by right should go to ICU A.
But specialist A says "the nurses in ICU A cannot handle condition B", and wants the ER to call specialist B.
Specialist B, however, agrees that condition A should be treated by specialty A. Doesn't accept case to ICU B.
Specialist A called again, this time requested by the ER to come down to see patient personally ( original consult conducted via phone ). So s/he comes down, still doesn't take the case, then suggests admitting to specialty X, which has no real jurisdiction where conditions A and B are concerned!
However, specialist A speaks to specialist X and the latter takes the patient to ICU X ( will wonders never cease ).
There's a punchline though - because ICU X is full, the patient has to overflow to ICU A! So the ICU A nurses end up taking care of the same patient they're supposedly "incapable" of handling!
Har har har :)
The other case is under specialty D. An outpatient investigation is done, during which the patient develops an adverse reaction resulting in condition E.
Specialist D considers routing the patient to the ER for admission to specialty E, but admits to ward D first to expedite the process, refers to specialist E upstairs, hoping the case will be taken over.
Unfortunately, specialty E will have nothing to do with the case, preferring instead to drop in every other day to check the patient's progress.
One fine day, the patient gets condition F. VERY serious, gets intubated and sent to ICU F, managed by specialists F for 2 weeks before improving and getting sent back to general ward.
However, specialty F doesn't accept the case under their care, so specialty D asks if specialty E can take over, since condition E was the presenting problem, triggered the other complications and hasn't resolved as yet.
Specialty E says no, keep the patient under specialty D. Orders this and that, but to be carried out by specialty D, okay?
So the medical officer tells me the next time something like this happens again, don't be surprised if we end up seeing the patient in our ER.
Dude, I usually don't enjoy entertaining this sort of thing, but in view of what you've told me, I say do what you have to do. Whatever's best for the patient.
But please call ahead first. So I won't blow my top ( I scolded an oncology MO for the same thing before. Don't mess with me. ).
Ahh, I love unloading. :)
Miscellaneous
Have you heard of Bill and Barbara Pease? Some psychologist couple that wrote a bestselling book pretty similar to the "Men Are From Mars, Women Are From Venus" prototype. The Pease's effort is "Why Men Don't Talk and Women Can't Read Maps" ( I think ). Flipped through it at a salon and was pretty nauseated by some of their "statements".
Man's need to spread their seed is an evolutionary trait - ie. they can't help it! You can't blame them for wanting to sleep with everything in a skirt!
Err, yeah, right.
Equally demeaning views about women somewhere in there too. But I switched off at some point so don't ask me for examples.
I do remember what they wrote about "the perfect partner" though. Apparently a woman is safest with a "Chinese man who listens to classical music" and should stay away from "hardworking jazz pianists".
Obviously, the Peases haven't met Singaporean men before.
Hey, you could consider that a compliment of sorts. Heh. Heh.
Looks like I'm going to get set up no matter what. But I do find it interesting that this fellow's name got mentioned by 2 different people, both of whom think I'm a prime candidate for "matchmaking" purposes.
Ah well. We'll see what happens. But don't place any bets yet. :)
Photos For The Day
Just doing my part to publicize Patrizio Buanne's upcoming concert. This was taken at his showcase at the Grand Copthorne last August. LOVELY guy. :)
The rest are random pictures left over from the Italy trip. Thought they'd add some colour. Also runs with the overall Italian theme, haha.
Time for a juicy Mandarin orange. Enjoy your weekend.
Saturday, January 14, 2006
Ugh
First entry of the new year, and I'm down with the flu.
Ironically, the URTI comes a week AFTER I was practically coerced into taking the flu vaccine. Oh well, I gave more than adequate advance warning about going on medical leave should I get sick, so there.
So thanks, once again, to those of you who've been dropping by. Despite my increasingly erratic posting frequency.
What've I been up to since NYE?
The NYE Call
Let's see, the night itself was pretty eventful, yet nowhere as bad as we expected ( probably because one of the MOs on with us has unbelievably good karma ). There was a constant trickle of drunks and traumas, with the occasional nutcase.
Tonnes of kena-whacked-with-spray-cans ( so many that I decided to forget about formal T&S and just go with the Hair Apposition Technique / HAT instead ), kena-bashed-up-for-no-rhyme-or-reason, kena-bashed-up-because-someone-tried-toget-jiggy-with-someone-else's-woman, and one kena-stabbed-in-the-head.
The last was fascinating. Young fellow who claimed some "stranger" decided to stick a 20cm-knife with a 10-cm blade into his right parietal skull, before running away like a yellow-bellied coward.
He saw it fit to run all the way from the Esplanade to our esteemed establishment, was miraculously neurologically intact and, though intoxicated with booze, had the presence of mind to NOT yank the thing out of his head.
We did both skull x-rays and a CT brain. The former gave some indication of the depth of penetration into the cerebral parenchyma, but the latter - unfortunately - didn't. Here's a nice little lesson learnt: a metal blade emits a fierce beam of white light on computed tomography. So all we saw was the weapon going into the bone, then this fan-shaped ray that blotted out everything in its path.
"Hmm," I went.
"Hmm," the neurosurgical registrar concurred.
There's a happy ending to the story, so fret not. The poor guy underwent a craniotomy and a relatively straightforward "foreign body" removal. Last I checked, he was still alive and doing fine.
What Else I've Been Up To
Watched a whole lot of DVDs, for one.
In My Father's Den - NZ production. Compelling. I enjoyed it.
Maria Full Of Grace - stark portrayal of "drug mules" from Mexico. Interesting.
Wedding Crashers - daft, but hilarious. Love Owen Wilson. :)
Must Love Dogs - anything with my fav John Cusack is always a treat. Not his best, but I could care less.
War Of The Worlds - Not bad, but I keep getting this feeling that Spielberg is losing his touch just a tad. Did anyone think the scenes were forced, the ending way too cheesy?
I, Robot - Caught this on cable. Extremely good, I thought, despite its lukewarm box-office performance.
New TV Shows
Grey's Anatomy - Will be reviewing this in greater detail for the SMA News, but first impressions are mixed. A little silly, lots of scandalous affairs, the requisite mawkish reflections on being noble and so on. A definitely guilty pleasure. Airs Monday nights at 11pm on Channel 5. Try it out. ( Patrick Dempsey is hot. :))
4400 - Another Monday night feature, 9pm on cable's Starworld Channel 18. Season 2 is currently airing, but you could always catch Season 1 somewhere, somehow. Excellent series about 4400 ??alien abductees who are suddenly dumped back on Earth, only to discover that a significant number of returnees possess special abilities - some good, others evil. Lots of intrigue and emotional bonds formed and broke in the blink of an eye. Great acting and writing abound. It's my new addiction.
The Apprentice 4 - The Donald's back! And I know who won ( stumbled upon it by accident while watching Larry King Live, darn it ). Some of you may find the tasks repetitive, but us fans know the show's success hinges on the players, with their neuroses, narcissistic personalities and delusions of grandeur. Omarosa II got booted off early ( what's her name again? some Hispanic chick ), so it's up to the rest to keep viewers hooked. Catch them every Sunday night at 10pm on Channel 5.
Fare Thee Well
To "Numb3rs" and "House".
But the latest from "CSI" ( Las Vegas, that is ) is due in February, woohoo!
Other Updates
Radio ads have been running on Gold 90FM for an upcoming concert by Italian tenor Patrizio Buanne. Stay tuned for more details.
Robbie Williams' new album, Intesive Care( which I sat on for a few months before slotting it into my new car's pumping stereo ), is terrific. Loads better than Escapology, just a whisker shy of his best to-date, Sing When You're Winning. Returning to his pop roots and coming up with catchy melodies tinged with a little bit o' country, little bit o' rock, little bit o' dance -- it's a lovely mix topped off by RW's soaring vocals. Maybe it's my hi-fi's super speaker system, but Mr. Williams has never sounded this good before. Go get it. :)
New Links
Under the "Asian medical blogs" category.
Enjoy.
Picture Time
There is, of course, a good reason for my photo choice.
Clay Aiken's sophomore album release is slated for early 2006.
Something to look forward to. :)
Time to take my flu meds. Have a good weekend ( or what's left of it ).
First entry of the new year, and I'm down with the flu.
Ironically, the URTI comes a week AFTER I was practically coerced into taking the flu vaccine. Oh well, I gave more than adequate advance warning about going on medical leave should I get sick, so there.
So thanks, once again, to those of you who've been dropping by. Despite my increasingly erratic posting frequency.
What've I been up to since NYE?
The NYE Call
Let's see, the night itself was pretty eventful, yet nowhere as bad as we expected ( probably because one of the MOs on with us has unbelievably good karma ). There was a constant trickle of drunks and traumas, with the occasional nutcase.
Tonnes of kena-whacked-with-spray-cans ( so many that I decided to forget about formal T&S and just go with the Hair Apposition Technique / HAT instead ), kena-bashed-up-for-no-rhyme-or-reason, kena-bashed-up-because-someone-tried-toget-jiggy-with-someone-else's-woman, and one kena-stabbed-in-the-head.
The last was fascinating. Young fellow who claimed some "stranger" decided to stick a 20cm-knife with a 10-cm blade into his right parietal skull, before running away like a yellow-bellied coward.
He saw it fit to run all the way from the Esplanade to our esteemed establishment, was miraculously neurologically intact and, though intoxicated with booze, had the presence of mind to NOT yank the thing out of his head.
We did both skull x-rays and a CT brain. The former gave some indication of the depth of penetration into the cerebral parenchyma, but the latter - unfortunately - didn't. Here's a nice little lesson learnt: a metal blade emits a fierce beam of white light on computed tomography. So all we saw was the weapon going into the bone, then this fan-shaped ray that blotted out everything in its path.
"Hmm," I went.
"Hmm," the neurosurgical registrar concurred.
There's a happy ending to the story, so fret not. The poor guy underwent a craniotomy and a relatively straightforward "foreign body" removal. Last I checked, he was still alive and doing fine.
What Else I've Been Up To
Watched a whole lot of DVDs, for one.
In My Father's Den - NZ production. Compelling. I enjoyed it.
Maria Full Of Grace - stark portrayal of "drug mules" from Mexico. Interesting.
Wedding Crashers - daft, but hilarious. Love Owen Wilson. :)
Must Love Dogs - anything with my fav John Cusack is always a treat. Not his best, but I could care less.
War Of The Worlds - Not bad, but I keep getting this feeling that Spielberg is losing his touch just a tad. Did anyone think the scenes were forced, the ending way too cheesy?
I, Robot - Caught this on cable. Extremely good, I thought, despite its lukewarm box-office performance.
New TV Shows
Grey's Anatomy - Will be reviewing this in greater detail for the SMA News, but first impressions are mixed. A little silly, lots of scandalous affairs, the requisite mawkish reflections on being noble and so on. A definitely guilty pleasure. Airs Monday nights at 11pm on Channel 5. Try it out. ( Patrick Dempsey is hot. :))
4400 - Another Monday night feature, 9pm on cable's Starworld Channel 18. Season 2 is currently airing, but you could always catch Season 1 somewhere, somehow. Excellent series about 4400 ??alien abductees who are suddenly dumped back on Earth, only to discover that a significant number of returnees possess special abilities - some good, others evil. Lots of intrigue and emotional bonds formed and broke in the blink of an eye. Great acting and writing abound. It's my new addiction.
The Apprentice 4 - The Donald's back! And I know who won ( stumbled upon it by accident while watching Larry King Live, darn it ). Some of you may find the tasks repetitive, but us fans know the show's success hinges on the players, with their neuroses, narcissistic personalities and delusions of grandeur. Omarosa II got booted off early ( what's her name again? some Hispanic chick ), so it's up to the rest to keep viewers hooked. Catch them every Sunday night at 10pm on Channel 5.
Fare Thee Well
To "Numb3rs" and "House".
But the latest from "CSI" ( Las Vegas, that is ) is due in February, woohoo!
Other Updates
Radio ads have been running on Gold 90FM for an upcoming concert by Italian tenor Patrizio Buanne. Stay tuned for more details.
Robbie Williams' new album, Intesive Care( which I sat on for a few months before slotting it into my new car's pumping stereo ), is terrific. Loads better than Escapology, just a whisker shy of his best to-date, Sing When You're Winning. Returning to his pop roots and coming up with catchy melodies tinged with a little bit o' country, little bit o' rock, little bit o' dance -- it's a lovely mix topped off by RW's soaring vocals. Maybe it's my hi-fi's super speaker system, but Mr. Williams has never sounded this good before. Go get it. :)
New Links
Under the "Asian medical blogs" category.
Enjoy.
Picture Time
There is, of course, a good reason for my photo choice.
Clay Aiken's sophomore album release is slated for early 2006.
Something to look forward to. :)
Time to take my flu meds. Have a good weekend ( or what's left of it ).
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