Work, again

My job is sort of a hectic one I guess. I work 7 days a week. Half days on weekends if I'm not on call. I've not applied for a single day of leave. Although Market Place is just 1.2 km away from where I stay, I've only been there once since I started working in June.

It's even worse when I was in the ward 23 in which the consultant would come at 7 am. This means I had to wake up at 5.30 am and punch in by 6 am. Just nice for me to review my patient before he arrived. 

Medicine was kinda frightening in the beginning.Yet, with the passing of time, you know what to do. You roughly know what's urgent and what's not. 

In the Malaysian hospital setting, there's such a word called 'jonah' which literally means bad luck. When people say you're jonah, it means that emergencies tend to happen more when you're on call. And yours truthfully is definitely someone well-known for my jonah-ness. 

I still remember there was once I had to attend to a lady with dengue fever with compensated shock and another woman in the same cubicle with massive lower GI bleed with impending shock simultaneously. And the thing I dislike most is having to attend to patients who need multiple immediate referrals at very ungodly hours. Because it means you won't get to sleep the whole night. 

Despite all the tension, there's joy. I've been working in the coronary rehabilitation ward for the past 1 week. I had a great learning experience. Got to see things like atrial flutter, ventricular bigemminy, sick sinus syndrome and ventricular tachycardia. There's once I did a carotid massage for my patient who developed supraventricular tachycardia (SVT) and it's thrilling to see on the cardiac monitor how it instantly disappeared.

Yes. It's very rewarding to be able to do good to your patients. Simple things like correction of potassium levels and rehydration in dengue fever. Nothing heroic. But, you will feel great because you know you have the ability to help people with your medical knowledge, albeit at the biochemical or cellular level which is not noticeable.

And did I mention about the hot and sweet registrar I've been working under for the past one week? Totally my type. And I even helped him punch in and out. Haha. Perhaps, part of my joy came from him.

My new boyfriend

I am so in love with my iPhone 4.

I really really do.

And I can't stop Grindr-ing. The guys on Grindr are so different than those on Axcest. At least, there're no kids. You tend to meet more mature and financially sound guys. And the interesting thing is, they're mostly hot.

I'm still waiting for one those with six-packs to buzz me. Which will always be a fantasy because I guess they only approach guys with similarly perfect bodies. Perhaps one you can take the initiative to?

It's kinda exciting sometimes when you realize there's a hot gay guy less then 500 metres away from you. However, as conservative as I've always been, I don't think I'll go beyond the 'boundary'. Not yet.

Today, something pretty embarrassing happened.

I actually missed the diagnosis of tricuspid regurgitation in a chap with decompensated congestive cardiac failure secondary to chronic rheumatic heart disease complicated with atrial fibrillation and prosthetic valve dysfunction. I should have referred to the echocardiogram before I presented the case to the cardiologist. 

Well, he impressed us with his ability to come out with the provisional diagnosis of tricuspid regurgitation just by placing his stethoscope on the patient's praecordium. Awesome.

Hmm. Why didn't I think of that when all my physical examination findings actually pointed towards that diagnosis? The pansystolic murmur at the left lower sternal edge? the tender enlarged liver (though it wasn't pulsatile) ? the elevated jugular venous pressure? the gross ascites and bilateral pitting edema? 

But then, I guess I'm excusable because that wasn't a very direct case. He'd had his aortic and mitral valves replaced. I could hear a cacophony of ejection systolic murmur and clicks here and there produced by the mechanical valves.

In medicine, you may know something theoretically. You may know all the manoeuvres to accentuate certain types of cardiac murmurs. But, when you actually see the patient, it's really not that simple. A lot of practice is needed. You may know everything in the textbook ( which I don't). Yet, if the patient is uncooperative or if you fail to present your findings confidently to the examiner, that's the end of the story. You've got to make an impression. That's why I feel so stressed, you see.

I learnt my lesson today. 

I will improve. =)

Exam's on Monday. No more Grindr-ing.

Elective posting: Day 2

I feel very previledged for having the opportunity to meet Dr. Shitsumiji, a consultant cardiologist from Osaka, Japan who came here to perform several live demonstrations on percutaneous coronary intervention (PCI).

I had a great liking for him. I guess my preference for gay Japanese pornography can explain that. He's quite handsome for his age. I didn't know one could be a consultant at such a young age. I'm very impressed by his professionalism and the confidence he exudes. We even took a picture with him.

I noticed that the specialists or consultants here are very friendly and humble in comparison to those in Malaysia. The specialists in our teaching hospital back in Malaysia tend to overlook our presence. Many of them don't bother much about us and they only teach us only when they're in the mood. Thus, we really have to stand on our own feet.

I saw KP during lunch time. He came to my table by mistake. My heart fibrillated a bit. I hope he didn't notice that I was staring at him. Ahaks. And Faculty King's back was facing me. Well, Dr. D has already suggested that I add Faculty King on Facebook after reading my previous post. It seems that Faculty King is kinda popular among the gay med students in KL too. But, I've ignored the request to avoid unnecessary embarassment.

Yet, I wonder if Faculty King is gay because two of our mutual friends on Facebook are gay. Is that confirmatory of his sexuality?

Eye candies!

Today is the first day of my elective posting in Taiwan. There's a group of UKM medical students here too. They're a year my junior.

2 of the guys are damn hot. One of them is even the faculty king. A female colleague of mine is already drooling profusely. I can see the desperation in her eyes.

Well, I guess I'm just like her.

I'll spend my first week here in the Cardiology department. Hope I'll learn something useful apart from ogling at the cute Taiwanese guys here.

I desperately hope that I'll have the opportunity to get acquainted to the faculty king and the other equally cute guy named Winson.

The kids

Medicine has always been thrilling to me, be it internal medicine or paediatrics.

However, in internal medicine, almost half of the patients in the ward are there due to self-inflicted damages. You see people with chronic obstructive pulmonary disease due to chronic smoking. Chronic liver disease due to alcoholism. Uncontrolled type 2 diabetes mellitus. Sexually transmitted infections. AIDS.

However, in paediatrics, the picture is rather different. Stanley had biliary atresia and his liver is now cirrhotic although surgery had been done. For some reason, his mother refused to let Stanley undergo liver transplant though she knew that's the only option available to increase the lifespan of Stanley and without which his liver would definitely fail. She spoke to me so nonchalantly which reflected her courage and readiness for whatever that might come. I turned to look at Stanley. He shot a handsome smile as if he had lived his life to its fullest and didn't seem to be afraid of death.

There's another adorable girl with end-stage renal failure secondary to late cresenteric glomerulonephritis. The puffy girl with lupus nephritis who looked so depressed as a result of long-term steroid therapy. The constantly centrally cyanotic girl with pulmonary atresia whose mother declined to have her heart lesions surgically corrected.

The children are deprived of so many things in life that I've taken for granted. I don't know how they cope with their illnesses as such a tender age. It's sorta saddening to look at their angelical faces under which lie the suffering and torment only their mothers can understand.

I cried

N.B.: Thalassaemia major is a genetic blood disorder that's very common in Sabah. The haemoglobin levels become very low due to increased red blood cell destruction, necessitating repeated blood transfusions for life prolongation. It's incurable and non-communicable. Thalassaemics don't live long. In the end, their hearts invariably fail.

He collapsed.

The doctor and nurses pumped in all sorts of drugs into his veins and did a cardiopulmonary resuscitation (CPR) to save him. His ECG reading was bizarre. Ventricular fibrillation ? An endotracheal intubation was done as he was unable to breathe spontaneously.

It's an emergency.

I could hear the hysterical cries of his mother as SL and I took turns to do the chest compressions.

He suffered from beta-thalassaemia major and had developed severe decompensated heart failure and acute pulmonary oedema. A few thalassaemic patients, whom he'd got acquainted to while being hospitalized, looked from afar, stunned and helpless. I guess the situation must have freaked them out, knowing that that's how their lives were going to end.

The doctor managed to stabilize him. But, I knew deep in my heart that his prognosis was bad. The nurses left him to fill up some forms. I guess there're some routine blood investigations to be done. I volunteered to do the bag ventilation for him as there's no mechanical ventilator in the ward.

Everyone left. I suspected the doctor had relinquished all hope in reviving him. I did the bagging patiently for the next 45 minutes. Who knows there might be a miracle? This sounds ridiculous, but it's an idealism all medical students are supposed to have.

I took a hard look at his almost lifeless body. His nasal bridge was depressed. His cheekbones and forehead were prominent and his liver was huge, all of which were due to extra-medullary haemopoiesis characteristic of the disease. Iron deposition secondary to repeated blood transfusions had put on a slate-grey coat upon his skin. He opened his eyes wide to stare at me thrice. A reflex that ached my heart.

Uncontrollably, tears welled up in my eyes. I didn't see that coming, seriously. I hastily dabbed my tears and pretended to wipe away the perspiration on my forehead when a staff nurse suddenly barged in.

He died in the A&E department half an hour later.

Miracles rarely happen.

They make the ward a beautiful place

As I draw near them, some of them pretend to sleep. Some of them give me a derisive smile and the please-fuck-off look upon learning the fact that I actually am just a student. Some of them appear to be delirious and uninterested without bothering to answer any of my questions. Some of them get fed up when I am already halfway doing the history taking. These, are what happen in the ward. It is typical of the patients to be impolite to medical students.

It hurts at times, to be scorned and treated with hostility. Really.

Nonetheless, there are patients who make me feel damn great about myself. They are people who guide me how to insert my 2 fingers into their vaginas, people who greet me with an encouraging smile despite my failure in taking their blood (by venipuncture), and dying patients with valvular heart disease who allow me to appreciate their cardiac murmurs…and so on.

I still remember that pleasant and friendly woman with cervical carcinoma in pregnancy who died 3 days after I took her history. I still remember that 46-year-old nulliparous woman with an ovarian mass the size of a football and whose malignancy had yet to be confirmed, that agreed without a second thought to become the subject for our bedside teaching. That warm and chatty lady immobilized by paraplegia in the orthopaedic ward. That amiable boy with atrial septal defect complicated by thalassaemia major in the medical ward.

These are people to whom I feel eternal gratitude and who make the ward a beautiful place I enjoy going.