New Hospital?

A while ago, there was this elderly gentleman who came in to the ED with chief complaint of body weakness that started after a sudden fall.

After a while,

Patient: Excuse me, can you please tell me in which hospital I am
Me: You are in the emergency department in *hospital name*
Patient: Oh I see
Me: Do you live anywhere nearby?
Patient: Yes I do live very close. I thought the ambulance brought me to another hospital because the place looks brand new!

I couldn't help but chuckle...The hospital I am currently placed at is pretty old. According to one article I previously read, it was built in 1882 and of course, since then, there have been quite a number of renovations.

The ECG Machine

Usually the student nurses are the ones who push the ECG machine around in the ER and they're usually the ones who put on the leads, ect... I, being a med student, usually helps in placing the limb leads and often, I'm more interested in the ECG itself (woops)

So today in the red zone, there were no student nurses and the nurse had disappeared for a while so we (me along with my medic friends) were the ones who had to do the ECG. That's quite easy actually, the leads were put in the correct positions, the wires correctly positioned...but somehow, when I pressed start, nothing happened...

I was quite puzzled for a while when I realized that I didn't plug the machine into the socket! Woopsie...

*stupid meeee*

Fire safety, soldiers and tutorials

The day in the emergency department starts off with a small prayer at 8 am sharp followed by some statistics about the previous day; number of admissions, ambulance calls, etc...

Today was no different, except that I arrived one or two minutes after 8, and the morning meeting had already started! Tomorrow, I will be on time! Urgh I hate being late and have always made it a point to be punctual but I wonder what has been happening to me recently...

The day in the ER was alright, even though I don't think I learnt as much as the previous days. We had to attend a talk on fire safety and I had no idea what the speaker was talking about as it was all in Bahasa Malayu. I guess some of the things he said were funny because the audience laughed a few times. 

I was placed in the green zone today.  There was an english speaking patient who came in with a chief complaint of chest pain.  After a while, it was quite clear that he his problem might be psychiatric in nature. The story he had to tell seemed interesting but I was chased out of the cubicle. So, I have no idea what happened to him. 

The rest of the patients came in mostly complaining of chest pain or shortness of breath.  

A funny story though is that a soldier came in to the yellow zone after having experienced a fit. He was talking in malay, so I had a very faint idea of what he was saying. I understood  that he said his body was aching but I wasn't sure what he added. The rest of the medical students and a houseman all walked off. Another fellow medical student turned to me and said 'run. run'. It turned out that the patient threatened that if he was not given pain killers, he would punch someone. He added that he did punch a doctor some time back! I'm guessing that's the reason why every body walked away all of a sudden...

The afternoon tutorials were way more interesting. The topic was basic life support and advanced cardiac life support. Definitely something interesting and exciting! The tutor gave us several scenarios and took us along the different algorithms. 

It makes me wonder how I will act if a patient collapses in an air plane...I understand what needs to be done in such a scenario and I can even recite it out for you, but if it really happens, I wonder if panic will strike me and paralyze me. Well, it is probably to avoid these situations of panic that we are trained several times during med school.

So that concludes my day. Time to relax now and go through the ACLS guidelines one more time.

A day in the ER

Last night was bad. A night full of nightmares and needless to say, when my alarm went off at 6 am, it was hard for me to even open my eyes.

I still had time ahead of me. My shift was not supposed to start until 8 am and that left me with almost 2 hours to get ready. Unfortunately, I was so tired that I fell back asleep and woke up at 7.45 am! Of course I was late. And of course, of all days, it was today that there had to be a clinical skills workshop for the medical officers. Medical students were also asked to joined.

I arrived at the skills lab 15 minutes late and when I entered, everyone looked at me! Awkward! 

Anyway, it was actually quite interesting and a variety of scenarios were simulated and the management plan briefly outlined.

A funny or not so funny simulation was that once the patient/dummy was pronounced dead, after a while, the mannequin started to make some noise. You can imagine the uproar in the class! And the specialist indeed said that it once happened to him that after failed resuscitation, he declared the death of a patient, who somehow revived a while later! And the patient remained alive for another 24 hours before moving on.

Indeed, it has happened various other times and this phenomenon is actually called Lazarus syndrome. It is basically when a patient's blood circulation restores itself after a failed attempts of resuscitations.

Later in the afternoon, during the ward rounds, the consultant also mentioned that he heard of a similar case whereby a dead patient was sent to the mortuary and the patient came back to life! 

This is why he said, that after declaring the death of a patient, he/she should be monitored for another hour or two to confirm the death of the patient.

This is starting to sound spooky now! Let's move on, I do not want to have anymore night mares tonight.

The rest of the day was quite interesting as well. I did have an opportunity to see patients coming in with various conditions, such as atrial fibrillation, injuries, sepsis, ect... 

Another story I want to share with you was that I breeched the universal precaution today! And I didn't even have a choice :(

One of the doctors was doing an ABG and I was standing somewhere nearby. After obtaining the blood sample, she rushed me to apply pressure on the puncture site...of course, I was without gloves! *Scream* I made sure I was not bleeding from my fingers and washed my hands thoroughly afterwards. I wonder why some doctors rarely wear gloves or even worse, wash their hands before and after touching patients!

The universal precautions definitely need to be reinforced! 

A lesson I learnt today was to make my own judgement as other doctors can also make mistakes. As one of my friends once told me, I have to trust my own clinical examination and judgement and not let myself be biased with what others have to say. Indeed, from now on, no matter how tired I am, I will think before I agree with the doctors!

There are of course many many more stories in the ER that happens but if I keep on writing, the post will never be over...

I wonder what the rest of week 2 in the ER has in store! So, stay tune for more :)

Death

It was maybe around 10.30 am yesterday, I can’t clearly remember the time. The buzzer went off three times, which meant that a patient was entering the red zone.  Some of the staff and most students ran to the zone, and so did I. 

What I saw was definitely not what I expected. The first thing I noticed was that an exchange student was doing chest compressions on a patient. The whole team was working on resuscitating the latter. It looked nothing like in the movies. It was somehow chaotic but the staff knew what was to be done. No one panicked and people were still going on with their usual conversation as if it was absolutely normal.

After a few cycles, the patient was unable to be resuscitated. No one actually called the time of death, as it is usually done in the movies. It was all over in a few minutes.

And this was the first time that I saw a person pass away in front of me…

I always expected it to be traumatic and I thought I would have trouble holding my tears, but it was not. There was a peaceful atmosphere in the room. I knew that the medical team did their best and that it was time for the patient to move on.

Later on, when I was following the ER physician on his teaching rounds, it was initially hard to focus on what he was saying as the patient’s wife was crying and screaming nearby. I almost had tears in my eyes but I reminded myself that this is what doctors experience on a daily basis. We can’t let ourselves be affected about what happens to a patient as this can endanger the lives of the remaining patients in the wards.

So yes, it was my first experience where I saw a patient move on. It made me realise once more that life is indeed short and that it can come to a stop at any time.

Psychiatry

So I met up with a friend today at lunch and I was telling him that I wanted to do psychiatry as my elective but I wasn't able to get a placement in psychiatry and I got oncology instead, which was my second choice.

In the cafeteria
Friend: Psychiatry? You wanted to do psych as an elective?
Me: Yeah, I like psychiatry. It's really nice
Friend: Really? Are you mad?
Me: Huh? What's wrong with psych?
Friend: Well you're seriously the first one saying that psych is interesting
Me: *Roll eyes*

Honestly, yes, I don't know a lot of people who like psychiatry. In fact, most of them hate it. A few more example:

In the library last year
Friend who likes psych: I'm doing psych as an elective
Me: Oh lucky you!
Other friend: *Laughs out loud* So basically you're doing nothing for your elective
Me: Sigh

Waiting for the lift
Me: How do you find psych?
Friend at the end of his psychiatry posting: It's alright, you don't need to think too much
Me: Uhuh yeah I guess so (but then I was also thinking *If there was nothing much to think of, why did our class dragged on for so long?)

Ok so I get it, psychiatry is not famous among medical students. But how about in the world of doctors? Yeah the other specialists do back-stab each other!  *evil grin*

In the lecture theater, going through some exam questions
Pediatrician: Oh that question cannot be a child psychiatry problem because it's short and to the point. There is always a long paragraph if it's dealing with psychiatry.
Audience: *laughed out loud*

Discussing the previous day mock OSCE
O&G specialist: Come on, was it that hard to see that the picture showed a uterus? Ok maybe it was hard. Let's ask a psychiatrist and see if he'll be able to recognize the organ
Me: *OMG did she just say that?*
Psychiatrist - maintained his composure and didn't utter any comment.

Well, you know what? I bet psychiatrist spend a great making fun of other doctors who have no clue how to manage a psychiatric patient.

One example of a clueless O&G specialist about psychiatric diseases:

In the clinics
Medical Officer: This patient came in with blah blah blah and she is a known case of depression
Specialist: Ah depression. You have to be careful about what you tell her.Otherwise she might turn into schizophrenia
Me *Trying so hard not to laugh*

What else is left to say? Psychiatry is definitely not one of those specialties that people want to get into. As for me, I still think that it was one of my most interesting and amazing posting so far!

Stress

The surgeon says: Our job is the most stressful. Standing for hours operating on patients and when it's time to go home, another patient in urgent surgery rushes in.

The physician says: Our job is the most stressful. The other departments refer too many of their patients to us. Don't they know how to treat a simple pneumonia?

The obstetrician says: Our job is the most stressful. We deal with 2 lives while the other doctors only have to worry about one life.

The emergency physician says: Our job is the most stressful. We work under a lot of stress and we're the front liners!

I can't help but be amused!

Emergency Rotation Day 1

It’s time to say byebye to Ob/Gyn and hello to Emergency!

Here is an account of what happened today.

I roughly woke up around 5 am because of a strange dream that I can’t really remember but I’m pretty sure it involved medicine…maybe I should consider it a nightmare? I don’t know but that’s beside the point.  I laid down in bed until 6.30 am when it was time to get ready and have breakfast.

We had a small intro/orientation which lasted less than two hours and we were then sent to our wards.

First note to self: Do not wear skirts or dresses. It’s way too cold inside and knowing how cold intolerant I am, wearing dresses would be like committing suicide. Do not wear high heels too (doesn't really apply to me since I hardly ever wear them). 

I must say that the staff is quite nice and it’s actually hard to know who are the specialists or the medical officers. They all wear that black jacket with their name stitched on it. I guess after a week, I will be familiar with the staff.

Anyway so moving to the interesting part of what actually happens in the ED. Well it is basically divided into three zones: red, yellow and green where patients are sent according to their medical emergency. Red means very serious patient!

So one of the first patients I saw came in with sepsis secondary to necrotizing fasciitis. The house officer asked me to put on my gloves and feel the crepitus over the skin lesion. I was so ‘excited’ that I was having trouble putting on my gloves and when she hurried me, well I ended up putting my gloves the wrong way! I hope no one noticed… well I was also asked to describe the smell of the lesion. The smell must have been pretty strong because even with a blocked nose, I was able to smell it just by standing next to the patient. The patient was then transferred to the wards for further management.

The next patient was a young lady who came in with a chief complaint of heavy per vaginal bleeding. Her hematocrit was low and she was tachycardic. An abdominal ultrasound was done with showed some kind of cyst but no definite diagnosis could be made.

In the meanwhile, another elderly lady came in complaining of shortness of breath and chest pain. It was quite hard to get a history from her. She mainly replied ‘don’t know’ to everything. An ECG was done for her, which showed some kind of heart block (I think). This brings me to the second note to self: revise ECG! I was unable to make a diagnosis based on the ECG, which is quite embarrassing, considering I’m now in final year.

I have no idea what happened to the last two patients because the specialists wanted to meet all of the students and gave a small presentation. And he stressssssed on being professional and wearing a proper attire.

And that is the end of my first day in the emergency department. I hope that it’ll be as good as the other rotations and I’m pretty sure it will give me an opportunity to refine my procedural skills!

Preparing for Ob/Gyn

My ob/gyn rotation is finally over. Those three weeks were indeed quite interesting and I've had the opportunity of seeing a vast number of patients with diagnoses ranging from cervical cancer to ovarian teratoma to molar pregnancy.

So how should you prepare yourself prior to an ob/gyn rotation?

I find it easier to study according to the wards I was placed in; for example, while being in the gynecology wards, it makes more sense to study gynecology rather than obstetrics.

The books/resources I used were:
1. Gynaecology by Ten Teachers
2. Obstetrics by Ten Teachers
3. Women's health. A core curriculum
4. Emedicine

Reading List for Gyneacology
- The menstrual cycle
- Abnormal bleeding
- Dysmennorhoea
- STIs
- Contraception
- Infertility
- Miscarriages
- Early complications in pregnancy
- Genital prolapse
- Incontinence
- Menopause
- Cancers (cervical, breast, ovarian)

Reading List for Obstetrics
- Antenatal care
- Medical diseases during pregnancy
- Labour and Delivery (Make sure to know how to read a partogram and a CTG)
- Preterm Birth
- Obstetrics emergencies

Ob/gyn allows you to have a very good hands on experience, so make sure you grab every opportunity to learn.

Good luck!

The Labour Room

Ah the interesting unethical things you see in the labour room!

A lady in labour was slapped by the medical officer for not pushing adequately! A slap! I mean come on, it was her first time in labour and wouldn't it be more correct to explain to her gently how to push rather than slapping and shouting at her? Besides pregnancy and birth are 'supposed' to be a great experiences but for this particular patient, it certainly was not!

The other thing that leaves me baffled is the fact that vaginal exams are conducted in front of 15 other people during ward rounds! I can't imagine how embarrassing it must be for the patients... Besides what is the point of 15 people observing a VE? It's all about feeling for the cervix, ect...

And of course, it's so obvious how single mothers are stigmatized by most of the medical personnel. Are we not supposed to respect patients and their choices?

These are only a few of the many similar experiences I witnessed so far... And I guess, there will be more