Finally
I get to post something after 2 whole weeks!
First
A shout out to the med student who's doing an elective at our department who mentioned to me that he reads my blog.
I was really sick that day and super-crabby. I would've chatted with you more if I'd had a voice.
I'm getting better now, so please let me know who you are 'cos there're so many tall, thin, bespectacled male students in the ER I can't pick you out yet! :)
Second
I've succumbed to The Dark Side, i.e. I now prophylactically dose myself with antibiotics the minute I get the flu.
Yes, yes, I always preach that Abx don't work if it's a viral infection, blah blah blah, but I seem to get whacked with really fierce bugs now that I've hit 30, and suffer tremendously for a week until I take Erythromycin then recover at super speed.
So it's been EES 800mg bd for the last few days. Didn't take MC. No fever or myalgia or the usual incapacitating fatigue. It's a miracle! :D
Third
TV Updates:
Supernatural - airs 4th May on AXN. Looks terrific. aliendoc take note!
Lost - hated the pilot, but the 2nd and 3rd episodes have been extremely enjoyable, even to the point of surpassing those from the previous season. I'm hooked.
Grey's Anatomy - made me cry the other night. I couldn't bloody believe it. :)
American Idol 5 - Taylor rules, woohoo! Only he and Kellie Pickler have been completely safe thus far. I personally think Kellie doesn't deserve to stay since she's only good at country and nothing else while the rest have upped their games and shown admirable versatility. Pity about Ace being kicked out. Will miss that dazzling smile.
Fourth
DVD reviews ( short ):
The Chronicles Of Narnia - started off slow and boring but managed to salvage its dignity in the final battle scene. A tad childish for my taste though.
The Family Stone - really liked this one. A family comedy with a twist. Reminded me a little of While You Were Sleeping, but Bill Pullman's way cuter. :)
The Constant Gardener - riveting. Ralph Fiennes is gorgeous once more ( looked quite anorexic a few years back ), Rachel Weisz is exquisite, the directing superb. Too bad about the damn depressing ending.
March Of The Penguins - falls just a hair shy of the so-cute-it's-cheesy line, but very educational and sweet. However, where poignant foreign films are concerned, nothing beats Children Of Heaven in my book.
Just Like Heaven - now THIS falls right over the cheesy-cute border. Way, way, WAAAAY south of the border. Yech.
Red Eye - Daft, but Cillian Murphy's great to watch. Those eyes are just plain scary, man.
The Exorcism Of Emily Rose - promising beginning which degenerates into dullsville in the last quarter. Based on a true story, we're informed. I'd just like to know why the "spiritual attacks" on the priest and his lawyer never escalated further.
Fifth
Work.
&^*%$#@&
It isn't the patients this time. I've had really nice people under my care this week.
However, certain "people upstairs" made my blood boil. Venom dripping beneath a calm tone of voice. Running a clinic taking priority over reviewing a critically ill patient in resus.
2 cases which were referred to subspecialties for the sole purpose of admission which subsequently got discharged without our knowledge, only to have one return for worsening symptoms ( lucky thing she didn't collapse from the total white cell count of 30,000 ), while another got recalled when we discovered she was sent home despite suspicious clinical signs ( corroborated by the abnormal x-ray report the very next morning ).
The upside - at least there's one - is being allotted one extra day off starting next month! ( Thank goodness )
And we've got more MOs this round! Quantity's settled. Now to assess and work on the quality.
( P.S. We've decided to start written tests next rotation, so make sure you study, 'cos we're pretty sick of people not bothering to read up and just treating us like walking textbooks. Don't you want to learn anything from the posting, even if you didn't choose to be here and hate it? I've been in that situation before, but hey, when life gives you lemons, make lemonade man. )
Last But Not Least
Many many congratulations to my fellow registrar who recently married and who'll be going on her honeymoon next week.
"Things'll happen soon for you too," she reassured me. To which I replied, "No rush. Really."
Really, there's no rush. I'm either way too busy, too tired, too sick or too cranky to think about a relationship. Hang out once in a while -- no problem. The occasional formal function -- cool.
Commitment? Err, let me think about that for another year. Or two. Or five.
In closing, I just want to officially declare that Jason Mraz is now my absolute favourite singer, beating Sting off the top spot.
This came about after I purchased his FABULOUS 'live' album, Tonight Not Again, which has been blasting non-stop in my car for the past 2 weeks.
Will review that another day.
Over and out.
Thursday, April 06, 2006
HE'S SAFE, WOOHOO!
But I have to admit I was REALLY nervous this week. Sure, Taylor's a great singer with loads of fans, but his choice of Take Me Home, Country Road wasn't exactly inspired, and the vocals were so-so at best.
Still, the Soul Patrol pulled through and kept him safe! :)
Best performances this week:
Ace Young - who sounded like Kenny Loggins ( excellent )
Chris Daughtry - doing a slow number ( reminded me of Guns 'N Roses' Patience )
Am kinda glad Mandisa's out. Yes, she has a voice, but I don't think she's Idol material. However, I hope she secures a recording deal and carves out a successful career path for herself. Wish she could've thought through last night's wardrobe selection though -- all that wobbling flesh made me a little queasy.
Watch For It
This is one TV show I'm looking forward to seeing.
Fascinating premise, good-looking leads ( Jared Padalecki is one of my favourite alumni from "Gilmore Girls" ), and loads of paranormal characters to boot. Sounds like it's received pretty good reviews so far, but didn't hit the Top 10 for 2005. Oh heck, "Numb3rs" didn't either, but I love it to death.
"Supernatural" trailers are already airing over AXN Channel 19 during prime-time. Likely to start its 1st season run in May.
Other Returnees
CSI: New York
Season 2 just began on AXN Tuesday 10pm. Terrific, as always, but it's undergone some major changes since its dark-and-depressingly-rainy atmosphere a year ago. This time round, the colours are prominently brighter, Stella Bonasera flashes skin ( lots of it ), the medical examiner joins the field team, and the new ME is a Chinese dude who looks like the leader of a Hong Kong triad. Seriously, he's a butcher. But likeable, haha.
Think there's a new young lady on board too. Guess Aiden ( the pouty Hispanic chick ) got swapped. As long as Danny Messer and Don Flack stay on, I'm happy. :)
Lost 2
2-hour pilot irritated a little, but that's just me.
J.J. Abrams seems to have a knack for alienating fans -- "Felicity" got tiresome halfway through season 2, while "Alias" bored me after season 3.
All this mumbo-jumbo about the mysterious numbers and some weird relationship between surgeon Jack and this Australian dude he met jogging in a stadium back home is too out there for my taste.
But at least they got the stupid hatch open. At last.
Grey's Anatomy
I'm actually starting to like this as much as I love "House" ( gasp, oh no! ). :D
I give credit to Sandra Oh, whose performance in Monday's episode ( post salpingectomy for an ectopic pregnancy ) had me in stitches. Does she deserve the Golden Globe and Screen Actors Guild Awards or what?
So, when the re-runs started on Starworld Channel 18 last night ( 9pm, in case you're wondering ), I found myself chuckling along as I relived the interns' first 48 hours at work.
It's a good show after all. :)
New PAP Candidate Unveiled
Someone asked if this means our department will get bullied less now that we have "a connection". Err, maybe. Heh heh. :)
Congratulations to Dr. Lateef. She's more than capable and guaranteed to put her best foot forward for her country.
Happy April Fool's!
Played a joke on some friends last week, causing major ripples through my JC class. Will spare you the details, but in short, it achieved an important goal and illustrated other people's good faith in my credibility -- apologies for taking advantage of that! Class gathering being planned, so see you guys soon.
Part-Time -- Sort Of
Through some quirk in the roster, I was bestowed with 4 days off this week. It's a much-needed break, but will result in a 9-day stretch of non-stop shifts next week.
Anyhow, I've got a couple of rented DVDs to enjoy ( "Chronicles of Narnia" among them ), and really should get some paperwork done.
ER issues will be discussed another time.
But I have to admit I was REALLY nervous this week. Sure, Taylor's a great singer with loads of fans, but his choice of Take Me Home, Country Road wasn't exactly inspired, and the vocals were so-so at best.
Still, the Soul Patrol pulled through and kept him safe! :)
Best performances this week:
Ace Young - who sounded like Kenny Loggins ( excellent )
Chris Daughtry - doing a slow number ( reminded me of Guns 'N Roses' Patience )
Am kinda glad Mandisa's out. Yes, she has a voice, but I don't think she's Idol material. However, I hope she secures a recording deal and carves out a successful career path for herself. Wish she could've thought through last night's wardrobe selection though -- all that wobbling flesh made me a little queasy.
Watch For It
This is one TV show I'm looking forward to seeing.
Fascinating premise, good-looking leads ( Jared Padalecki is one of my favourite alumni from "Gilmore Girls" ), and loads of paranormal characters to boot. Sounds like it's received pretty good reviews so far, but didn't hit the Top 10 for 2005. Oh heck, "Numb3rs" didn't either, but I love it to death.
"Supernatural" trailers are already airing over AXN Channel 19 during prime-time. Likely to start its 1st season run in May.
Other Returnees
CSI: New York
Season 2 just began on AXN Tuesday 10pm. Terrific, as always, but it's undergone some major changes since its dark-and-depressingly-rainy atmosphere a year ago. This time round, the colours are prominently brighter, Stella Bonasera flashes skin ( lots of it ), the medical examiner joins the field team, and the new ME is a Chinese dude who looks like the leader of a Hong Kong triad. Seriously, he's a butcher. But likeable, haha.
Think there's a new young lady on board too. Guess Aiden ( the pouty Hispanic chick ) got swapped. As long as Danny Messer and Don Flack stay on, I'm happy. :)
Lost 2
2-hour pilot irritated a little, but that's just me.
J.J. Abrams seems to have a knack for alienating fans -- "Felicity" got tiresome halfway through season 2, while "Alias" bored me after season 3.
All this mumbo-jumbo about the mysterious numbers and some weird relationship between surgeon Jack and this Australian dude he met jogging in a stadium back home is too out there for my taste.
But at least they got the stupid hatch open. At last.
Grey's Anatomy
I'm actually starting to like this as much as I love "House" ( gasp, oh no! ). :D
I give credit to Sandra Oh, whose performance in Monday's episode ( post salpingectomy for an ectopic pregnancy ) had me in stitches. Does she deserve the Golden Globe and Screen Actors Guild Awards or what?
So, when the re-runs started on Starworld Channel 18 last night ( 9pm, in case you're wondering ), I found myself chuckling along as I relived the interns' first 48 hours at work.
It's a good show after all. :)
New PAP Candidate Unveiled
Someone asked if this means our department will get bullied less now that we have "a connection". Err, maybe. Heh heh. :)
Congratulations to Dr. Lateef. She's more than capable and guaranteed to put her best foot forward for her country.
Happy April Fool's!
Played a joke on some friends last week, causing major ripples through my JC class. Will spare you the details, but in short, it achieved an important goal and illustrated other people's good faith in my credibility -- apologies for taking advantage of that! Class gathering being planned, so see you guys soon.
Part-Time -- Sort Of
Through some quirk in the roster, I was bestowed with 4 days off this week. It's a much-needed break, but will result in a 9-day stretch of non-stop shifts next week.
Anyhow, I've got a couple of rented DVDs to enjoy ( "Chronicles of Narnia" among them ), and really should get some paperwork done.
ER issues will be discussed another time.
Saturday, April 01, 2006
Soul Patrol!
If you're wondering who the original Soul Patrollers are, look no further than the official Taylor Hicks fansite, which I think is the best of its kind since Clay Aiken's.
No surprises over this weeks' elimination of Lisa Tucker. I keep hoping Bucky will get booted off, but he's always safe.
Taylor, on the other hand, is apparently leading by unbeatable margins in the votes. According to Idolforums.com, he commands at least 30-40% of the phone-in tallies across the U.S., while Chris and Kellie alternate 2nd place with a much lower 15-20%.
Haven't followed an AI season this closely since 2003. Who wants to bet that Taylor will win this year? :)
The New Batch
Scrolled through the MOPEX list yesterday. Saw a couple of familiar names, one of whom SMS-ed me just as I came across his name, heh heh. Looking forward to meeting the next group, but my patience is wearing thin nowadays, so whoever learns the fastest and shows the highest EQ will definitely become my favourite. I could care less about the number of A's you got. Totally irrelevant where clinical acumen is concerned.
ER Issues -- Continued
It's interesting how a case of obvious acute osteomyelitis bounced back to me the other day, citing the reason that "since the patient is not keen for surgery and needs further DM control", he should be admitted to the medical unit instead.
First of all, his DM isn't controlled because he defaulted treatment. Second, acute OM ( if I remember correctly ) falls under the purview of orthopaedics, unless the guy has some other serious condition which ortho can't handle ( e.g. acute coronary syndrome, renal failure, acute stroke ).
Sometime last year, a case of a 100-year-old woman with a perforated viscus was still accepted by General Surgery, even though it was understood that management would be conservative. The surgeons never once told us to "admit to medical 'cos there's nothing else we can do".
So I informed my consultant about the ortho input, and she gave me the go-ahead to ship the patient up to the ortho ward. Checking up on his records a few days later, I found out that he consented to a ray amputation.
Yeesh.
There's a lot of tension between A&E and other specialties, more so in certain hospitals. Sometimes, I wish all ER physicians could be granted admission rights to whichever department they choose, but with the shortage of beds and yes, significant number of unwarranted admissions ( usually by our MOs ), such an arrangement might prove disastrous.
However, the inpatient teams should also understand our own difficult situation. ERs are predominantly run by medical officers, many of whom are junior, most of whom have little training in the field of emergency medicine ( which encompasses everything from medicine to surgery to paediatrics ). Personalities range from paranoid ( admitting or asking the seniors about EVERY case they see ) to complacent ( NOT asking or admitting ) to dangerous ( missing an AMI or acute abdomen ).
Sure, they keep saying the senior ER doctors SHOULD or MUST vet all admissions, but does anyone bother to look at the big picture? We have the HIGHEST number of P1 cases in the country. The resus room is constantly packed to the brim with critically ill patients. P2 is no better -- compounded by the backlog of cases stuck in observation waiting for beds in the wards ( which still don't discharge enough and often not till after 2pm ).
So the REALLY IMPORTANT question is, if you'd like the seniors to do the best job they possibly can at gatekeeping, how many seniors are you willing to employ, 'cos the current number is far from sufficient. One professor went so far as to suggest that all ERs be run EXCLUSIVELY by emergency medicine specialists, but I propose that we still retain a realistic number of medical officers, preferably those who are more senior and basic specialty trainees.
Why did they stop rotating MOTs through A&E anyhow? It's a useful posting after all. Surgeons need to know how to manage medical conditions while internists would benefit from learning about acute abdomens and fractures, instead of just referring hundreds of blue letters all over the place.
Just being honest here. Feel free to comment.
On the upside, I had a very constructive session with a group of ENT specialists a few days ago. Our task was to draw up some guidelines for referrals in the P3 area ( consultation ) after a couple of PR problems surfaced.
I totally agree that patients have unreasonable expectations, some propagated by the referring GPs and OPS doctors, some reinforced by our own A&E MOs. The key is to follow these guidelines, consult us seniors if there's any deviation, and at all costs, DON'T MAKE ANY PROMISES!!! I've batted away quite a few nonsense referrals myself, sometimes even making lousy excuses when the subspecialty MO / Registrar is the one who's being a little unreasonable and refuses to see the patient. "Oh, the doctor upstairs is VERY busy. S/he's resuscitating or operating or whatever." -- even though I could hear him/her chomping on his/her dinner during our phone conversation.
One of the ENT guys hit the nail on the head when he said, "It goes both ways." Yes, the A&E makes boo-boo's on and off, but the other departments make their own mistakes too. Rather than turn it into a slug-fest where everyone tried to pin the tail on the donkey or whack the pinata, the various HODs need to discuss the issues in a civilized manner instead of making false accusations and bullying the A&E into doing things we know are wrong and downright stupid.
Perhaps a good way of defusing the situation would be what the ENT people did: ask the Registrars from ENT and A&E to do the troubleshooting then feedback to the HODs. Kinda like an ambassadorship of sorts. :)
Gotta Wait A Little Longer
Yes, Jamie Cullum's concert's been postponed, but as long as it doesn't clash with my overseas trip, I'm happy. Much prefer the new venue. Let's hope it sells out so we'll all have a rollicking good time. I've got 2nd row seats, woohoo!
If you're wondering who the original Soul Patrollers are, look no further than the official Taylor Hicks fansite, which I think is the best of its kind since Clay Aiken's.
No surprises over this weeks' elimination of Lisa Tucker. I keep hoping Bucky will get booted off, but he's always safe.
Taylor, on the other hand, is apparently leading by unbeatable margins in the votes. According to Idolforums.com, he commands at least 30-40% of the phone-in tallies across the U.S., while Chris and Kellie alternate 2nd place with a much lower 15-20%.
Haven't followed an AI season this closely since 2003. Who wants to bet that Taylor will win this year? :)
The New Batch
Scrolled through the MOPEX list yesterday. Saw a couple of familiar names, one of whom SMS-ed me just as I came across his name, heh heh. Looking forward to meeting the next group, but my patience is wearing thin nowadays, so whoever learns the fastest and shows the highest EQ will definitely become my favourite. I could care less about the number of A's you got. Totally irrelevant where clinical acumen is concerned.
ER Issues -- Continued
It's interesting how a case of obvious acute osteomyelitis bounced back to me the other day, citing the reason that "since the patient is not keen for surgery and needs further DM control", he should be admitted to the medical unit instead.
First of all, his DM isn't controlled because he defaulted treatment. Second, acute OM ( if I remember correctly ) falls under the purview of orthopaedics, unless the guy has some other serious condition which ortho can't handle ( e.g. acute coronary syndrome, renal failure, acute stroke ).
Sometime last year, a case of a 100-year-old woman with a perforated viscus was still accepted by General Surgery, even though it was understood that management would be conservative. The surgeons never once told us to "admit to medical 'cos there's nothing else we can do".
So I informed my consultant about the ortho input, and she gave me the go-ahead to ship the patient up to the ortho ward. Checking up on his records a few days later, I found out that he consented to a ray amputation.
Yeesh.
There's a lot of tension between A&E and other specialties, more so in certain hospitals. Sometimes, I wish all ER physicians could be granted admission rights to whichever department they choose, but with the shortage of beds and yes, significant number of unwarranted admissions ( usually by our MOs ), such an arrangement might prove disastrous.
However, the inpatient teams should also understand our own difficult situation. ERs are predominantly run by medical officers, many of whom are junior, most of whom have little training in the field of emergency medicine ( which encompasses everything from medicine to surgery to paediatrics ). Personalities range from paranoid ( admitting or asking the seniors about EVERY case they see ) to complacent ( NOT asking or admitting ) to dangerous ( missing an AMI or acute abdomen ).
Sure, they keep saying the senior ER doctors SHOULD or MUST vet all admissions, but does anyone bother to look at the big picture? We have the HIGHEST number of P1 cases in the country. The resus room is constantly packed to the brim with critically ill patients. P2 is no better -- compounded by the backlog of cases stuck in observation waiting for beds in the wards ( which still don't discharge enough and often not till after 2pm ).
So the REALLY IMPORTANT question is, if you'd like the seniors to do the best job they possibly can at gatekeeping, how many seniors are you willing to employ, 'cos the current number is far from sufficient. One professor went so far as to suggest that all ERs be run EXCLUSIVELY by emergency medicine specialists, but I propose that we still retain a realistic number of medical officers, preferably those who are more senior and basic specialty trainees.
Why did they stop rotating MOTs through A&E anyhow? It's a useful posting after all. Surgeons need to know how to manage medical conditions while internists would benefit from learning about acute abdomens and fractures, instead of just referring hundreds of blue letters all over the place.
Just being honest here. Feel free to comment.
On the upside, I had a very constructive session with a group of ENT specialists a few days ago. Our task was to draw up some guidelines for referrals in the P3 area ( consultation ) after a couple of PR problems surfaced.
I totally agree that patients have unreasonable expectations, some propagated by the referring GPs and OPS doctors, some reinforced by our own A&E MOs. The key is to follow these guidelines, consult us seniors if there's any deviation, and at all costs, DON'T MAKE ANY PROMISES!!! I've batted away quite a few nonsense referrals myself, sometimes even making lousy excuses when the subspecialty MO / Registrar is the one who's being a little unreasonable and refuses to see the patient. "Oh, the doctor upstairs is VERY busy. S/he's resuscitating or operating or whatever." -- even though I could hear him/her chomping on his/her dinner during our phone conversation.
One of the ENT guys hit the nail on the head when he said, "It goes both ways." Yes, the A&E makes boo-boo's on and off, but the other departments make their own mistakes too. Rather than turn it into a slug-fest where everyone tried to pin the tail on the donkey or whack the pinata, the various HODs need to discuss the issues in a civilized manner instead of making false accusations and bullying the A&E into doing things we know are wrong and downright stupid.
Perhaps a good way of defusing the situation would be what the ENT people did: ask the Registrars from ENT and A&E to do the troubleshooting then feedback to the HODs. Kinda like an ambassadorship of sorts. :)
Gotta Wait A Little Longer
Yes, Jamie Cullum's concert's been postponed, but as long as it doesn't clash with my overseas trip, I'm happy. Much prefer the new venue. Let's hope it sells out so we'll all have a rollicking good time. I've got 2nd row seats, woohoo!
Subscribe to:
Posts (Atom)
