A year has gone by – rather quickly in hindsight. There has been many changes that I got involved in so hence the long drought.

It wasn’t exactly a straightforward phase for me. There has been some heavy contemplation, lots of idle pondering, few uncertainties, some hesitation, a couple of decisions, and a lot of mixed feelings thrown in.

This is probably the prologue of an impending rant.

Work in progress...check back soon!

MURPHY’S LAW of being an intern:-

After 5pm is when the patient finally decides to let you know that they’ve been having chest pains all along.

When you think you’ve got everything on your trolley, you’re wrong. There is always something left behind.

Some nurses are really efficient. They page you for every single minute change in the obs. Example: “Patient’s blood pressure dropped from 145 systolic to 140. You happy with that?” – Ya very.

Just when you need to pee very badly, a MET call happens.

10 minutes before you finish for the day, a patient churns out a highly worrisome ECG.

The day you are late for work is the day all your consultants decide to have a morning round.

There is no better timing to have an itch on your back when you’re in sterile gloves inserting a urinary catheter.

A precious blood sample which was HIGHLY difficult to obtain gets discarded because you’ve forgot to stick a bradma on the tube – you were too busy rejoicing on your success after 8-10 tries.

You can tell a highly abnormal X-ray from what’s normal. It’s the ones in between that gives you the shits.

You’re about to prescribe a common drug for the patient with multiple allergies. You couldn’t remember what they were and neither could he.

Just when you couldn’t be more harassed, the family shows up ‘demanding to know what is going on’

You have no problem at all getting up-close examining the MRSA patient’s throat. Then he coughs on you.

There are about 10-15 things you still have to do. Suddenly your consultant pages you to head straight to theatre with urgency. You drop everything and rushed to get scrubbed up – to discover that the only instructions are “Here, hold this”, which you spent the next hour doing exactly just that.

Once out of the OT, you rush back to the wards to resume your work…only to realise you left your handover sheet somewhere in the changing room.

You walked all the way from one end to the other end of the hospital to see your single outlying patient. Upon arriving there, you were just informed that he got transferred to the ward that you’ve just walked from.

The file that you’re looking for is never there.

Patients whom are otherwise well would tell you every single little thing that is wrong with them. The truly sick ones would let you discover them for yourself.

It only takes a sunset for a sweet, frail, elderly patient to transform into The Terminator.

*     *     *

Past few working days were pretty screwed-up.

I’ve decided on a different manner of expressing/ranting/venting about this particular issue. I believe this would reflect how I felt more accurately at that point in time.

Thursday. 0700 hours.

Dragged my bum to work. Boh kau kun. I was wearily checking up all of my patient’s blood results on the hospital’s system when I realised one of the units was without an intern for the day.

Aiyo, cham liao lah. Tia tiok kio wa lang ki cover eh.

My unit has two interns; me and another colleague of mine who’s currently expecting her first child. The unit which one of us would have to cover consisted of over 20+ patients. Kia see lang.

Thursday. 0730 hours.

I’ve discussed this with my fellow colleague. We thought okie, we’ll go ahead with our own unit’s ward rounds and later BOTH of us would accompany the other unit’s registrar for his ward rounds. That way at least there’s 2 newbies whom would jointly cover as opposed to just one poor newbie. Sounds pretty okie.

0815 hours. Finished our ward rounds. Just realised that our unit has racked up an impressive list of to-do stuffs before the day ends. I told my pregnant colleague beh yau kin, wa zhe ge lang ki cover the other unit la.” The other unit has a heck a lot more patients, and it’d probably be a better idea if I’m the one covering (considering it’s only either one of us going over).

0820 hours. Met with the other registrar, informed him I’m the covering intern. Okie off we go for the rounds.

1000 hours. Wah kanasai. Chin chin si kanasai. So many patients with so many problems. This unit’s patient’s are all entirely new to me, and today the unit decided to discharge a third of their patients. This would mean approxmately 6-7 discharge summaries requiring submission.

Each of the discharge summaries require the poor newbie to fill in stuffs from A-Z about the patient. It isn’t usually that complex but in this case it is complicated by the circumstances that I’m only the stand-in for the day and I’ve no bloody clue what’s up with them (except for the fact that they’re going home).

1000-1100 hours. After the rounds, I had to retrace my steps with all the patients as I head to each of their wards to write the progress notes retrospectively. There isn’t usually much time for the intern to document the review etc as the registrar rattles off stuffs at bullet speed; most of the time I’d just scribble down on the handover sheet and we move on. I tried writing as fast as the registrar could speak and my writing siang ka sai ane kuan. I gave up, and told myself I’d make a mini rounds by myself thereafter to document stuffs in the file.

1100-1430 hours. Spent the entire time doing the discharge summaries. Quite jia lat because I had to sieve through their thick files in order to fill in the relevant information. By the time I’ve done half of them, my head was swimming with random information from the previous entires – ranging from where is their pain to whether they’re able to pangsai or not. Sometimes I get a bit mixed up between the patients whom came in with lau sai and those who really tat sai.

1500 hours. I remember this. Out of the blue I got a call from some angry nurse.

Nurse: Why haven’t you been answering your pager?!?

Me: Huh? But I haven’t been paged…*Aiya, CB, jiang wa chor simi*

Nurse: I have been paging you for the last 2 HOURS!

Me: Well I haven’t received any. What number did you page?

Nurse: 258.

Me: See, that ISN’T my pager. *HAH ki chiak sai la lu*

Nurse: WELL, whether it is your pager or not that’s another story. We have a clinic full of patients waiting for you.

Me: Whaaaaat?? You mean pre-admission clinic for this unit?? No one informed me about it! Oh crap!

Nurse: YEaaaahh well your patients are all waiting for you.

Me: WHat time does it meant to start? *KaNASAI! boh lang ka wa kong this unit’s clinic is today!*

Nurse: It started at 1pm *Niama , OH NOES!!*

Me: OMG I’m sorry. No one informed me they have a clinic today. I’ll be there RIGHT NOW.

I hung up, and hauled my sorry ass to the clinic which was situated across the road.

1530-1700 hours. I had managed to see all the patients within 1+ hours. Some were obviously boh song that their doc took such a long time to attend to them. I remembered literally bowing and apologising of the great delay due to some miscommunication. Thank goodness they’re alright after I’ve explained myself.

1700-1730 hours. Ran back into the hospital. My colleague (from my own unit) was waiting for me for a quick handover and it’s her day off tomorrow. She has been managing the unit by herself earlier today due to me being away elsewhere; we thought it would be beneficial for me to get a quick update as I’m the one alone in my unit tomorrow.

We were both rostered on till just 4pm but due to the circumstances everything was significantly delayed. Thankfully, the day is over.

Friday 0700 hours.

LIN LAO HIAH I was informed that the previous intern I was covering the day before is calling in sick today, and we’d have to cover again. It’s even worse today as there’s only 2 interns on today (usually we have 5) to cover across 3 units. This would mean we’d have about 30+ patients each. It certainly didn’t help that for some reason my home unit has increased its patient load by four-fold. Alamak.

0900 hours. Received a call from the admin. Apparently they’re trying to find some doc to replace the missing intern(s) and we were asked to cover till then.

Truth is, we are aware that they’re not gonna find anyone sometime soon. Due to budget saving attempts, it is highly unlikely for the admin to utilise a 3rd party pool of medical officers as they’re more expensive. If they can’t get someone internally to replace the interns, the the rest of us would be stretched to cover. Like yesterday. Tulan.

1200 hours. Por tor eiao. Boh chiak langsung. Mad rush sorting stuffs out across 3 units. For some reason the families decided to visit and requested to see the doctor. Trouble is I’m not their usual attending doctor and I am, yet again, clueless.

Patient’s family: Hi doc. How is my mum doing? *Aiyak, who’s your mum again ah?*

Me: Oh, she’s doing alright. Slowly getting there. *flicks through the handover sheet* Her blood results are normalising, so that is a good sign.

Patient’s family: What is the plan from here onwards?

Me: Good question. I’ll have to look through her file. I wish I’d be able to tell you off my head except that I’m not her usual attending doctor. *sigh*

Patient’s family: Oh I see. How’s the endoscopy results? She had a gastroscope done yesterday.

Me: Ah if I am not mistaken that turned out to be normal. *Flips the pages furiously searching for the scope report* Ah here it is….yes, it’s all normal (phew!).

Patient’s family: Oh…then what is the cause of the bleeding then?

Me: At the moment we’re not too sure. We were suspecting a gastro tract bleed except this was proven otherwise by the scope. She’s currently stable and we’re still investigating. Her bloods, like I mentioned, were normalising so this is certainly good news.

Patient’s family: Oh thank you doc. Thanks for your time.

Not every family meeting happened like the above. Some required me to haul 2-3 thick files belonging to the patient to read it out to the family. This, of course, is very time-consuming.

1530 hours. Admin called me up, requesting if I could do overtime till 7pm. I thought since I’m gonna be stuck here anyway sorting out stuffs so why not. Might as well get paid for it, hah.

1830 hours. What started as a usual medical review turned out to be a full-blown chaos as the patient was discovered to be having a heart attack. Suddenly we’ve the ICU and the cardio docs involved. Aiseh man, almost pangsai-kor.

2100 hours. Me and the other intern wearily stepped out of the hospital. Stuck at work for 14 hours with an empty stomach. I was too tired to drive myself home and thankfully, my fellow intern was kind enough to give me a lift home.

We thought of grabbing a quick bite to eat, so we drove up to the nearest McDonald’s drive-thru. Believe it or not, in our half-awake minds we paid for our food and proceeded to drive straight PAST the collection point without taking our food. It wasn’t till a few minutes later that we realised we just drove off without the food. PFFT.

Of course, we turned around. Spent a good while laughing our butts off over it.

Thankfully I’m not rostered on for this weekend. Otherwise I’m gonna be super sien.

Ever thought of the similarities?

Following post contains gratitious warcraft speak.

The Raid (Ward Rounds) – All preparation goes to ensuring this is pulled off satisfactorily. All team members would meet at a pre-designated spot. The senior doctor (raid leader) would ensure a game plan is set up prior to commencing. The interns (noobs) would be the ones organising the patients’ files holding information regarding the patient’s health and mana points (HP and MP). Some interns would need a cuppa (elixir of patient resistance) before starting the deal.

The Mob – The patients. Every one of them is different, yet similar (as in they all give you problems). More often than not, the success of a patient review depends on the approach (the first pull). If the entire team is efficient and balanced, usually the raid goes well. Always approach one patient at a time and do not leave till you’ve concluded the review in the event of aggro-ing more mobs than you can handle.

The Guild/Party – The treating team. It’s all about balance. Without the senior doctor (main healer/raid leader) in sight, things could awry very easily. If this is the case, then the noobs would have to step in to continue the raid. Full concentration is essential, no one appreciates a member being AFK. Usually with one or two men down, the party would be more prone to the liberal use of potions (handbooks/cheat notes).

The Non-Playable Character (NPC) - Other co-habitants of the realm. Typical of NPCs, they could make your job either much easier by giving you useful items (e.g. pharmacists) or by handing more work to you (quest-giving NPCs, e.g. demanding nurses). Due to the nature of the NPCs, they could frustrate you further due to the unable to attack target warning.

The Warrior - The surgeons. Full of rage, they are often a melee class where close combat is essential (surgery). Everything is hands on. Physical distance from the mob is a no-no. Proximity is essential to engage in combat. Warrior raids end as swiftly as they start due to the constant charge option.

The Rogue – The drug reps. Full of energy, they sneak up to you without you realising. Once they have engaged you, their incessant talking would make it difficult for one to escape (stun lock). It would be easier if you are aware of their presence (either mark or faerie fire) to make a quick getaway before they ambush you.

Health points (HP) – Physical endurance. Deteriorates over time when in a raid. Able to be replenished by some access to food or rest.

Mana points (MP) –  Corresponds directly to intelligence points. Usually the higher the level (e.g. senior doctor), the greater the mana pool as they tend to have more intelligence points. However, there are some really complicated patients (elite mobs) whom possess the ability to drain your mental capacity over a really short amount of time – sometimes instantaneously. This phenomenon is also known as mana burn.

HP+Mana Fountain – The Cafeteria. Self-explanatory.

Kiting – Referral. This is usually done when one is clueless/stumped/lazy when dealing with the patient (mob). The patient is being directed away from you and to elsewhere. Failure to kite properly would result in the aggro being returned to you.

Combat Log – Patient’s case/progress notes. Detailed interaction between you and the patient. Documentation of every medication and spell used.

Damage over Time (DoT) – Your pager. Every beep deals subsequent damage to one’s HP.

Lagger - Usually a noob, when he/she is a bit behind the rest of the group. Often seen going round in circles.

Windwalk – What you do when you see the clingy, demanding, unreasonable patient.

Out of Mana (OOM) – Mental shutdown. Often would need the person to sit, drink, and do nothing for a while to regenerate.

Illidan Stormrage – A delirious patient who’s a former champion kickboxer in his heyday. Unstoppable.

*     *     *

Don’t you think so?

Am back for the weekend. I’ve finally caught up with Naruto Shippuden.

I’ve been away on my rural rotation over the past few weeks. It’s not too far of a place, but far enough for me to decide it’s too much of a hassle to keep driving back and forth.

To be honest, so far it has been really good.

The hospital provides accomodation for visiting staff, and I’m fortunate to be allocated a fairly decent cottage (something like a well-furnished cabin). There’s bedding and towels; kitchen’s all stocked with crockery and cutlery. There’s a few rooms in one cottage and am currently sharing with 1-2 other doctors (one’s a fellow intern as well).

I got rostered on day shift for the very first week so I was the first to arrive. Initially I planned to move my stuffs in the day before, except that I ended up packing the entire night prior due to some fantastic form of procrastination. Kept telling myself “Another 10 minutes of YouTube wouldn’t hurt” except that in reality the 10 minutes eventually became something close to a few hours. Lazy bum, I know.

It’s a pretty pleasant drive once you get out of the metropolitan area. Soon I’m seeing huge fields of green and yellow pastures dotted with dairy cows (yup the black and white ones). There’s just so many of them and they all look alike (How can we be sure they are not capable of performing Kage Bunshin? Maybe they have us fooled for ages).

There’s much lush greenery to be appreciated, given that the weather is relatively warm and dry. You still get the odd driver pulling over by the roadside to take a leak.

I think the hospital has about 15 doctors at any one time.

It’s a pretty small place, where everyone knows everyone. There’s about 4 doctors in the ED while the rest are mainly scattered upstairs. People have been really warm and welcoming, which is really fantastic

Things are pretty laid-back here, although not the same can be said for what comes through the ED doors.

Things are bit different in the rural setting, you tend to see a lot more trauma cases (mainly arising from work/farmyard injuries). I remember spending roughly half of my time just suturing partially severed fingers and whatnot. The most recent case that I did suturing on was a guy who had his fingers caught in an automated chainlink. The motion hauled him across for a few feet before the bit of flesh gave way and freed him off it.

The hospital’s near a skiing resort, so we do get a fair bit of skiing injuries. Majority of them came in after taking a tumble through the snow. One fellow, however, stood out amongst the usual.

This is a fairly young kiddo. When I first had a look at him, I thought, “What an unusual position to be sitting in”. He was sitting upright on the bed, with both of his arms splayed out and palms upwards. I would’ve likened his posturing to one of those common meditative stances except that he looks too miserable to be in a zen-like state.

This is the story. He was drunk in expired grape juice (alcohol!) and had this brilliant idea of seeing if he could dive over a toboggan. So he took a few steps back (after putting down his beer bottle I presume) and started to run for the jump.

Jumped, he did. Dived over, he did not. Dive INTO, more like.

He somehow landed right on top of the hard toboggan with both of his arms out in front of him in an almost 90 degrees angle. Both arms absorbed almost all the impact and it started hurting like hell (in his words). He couldn’t move, as he couldn’t feel his arms.

Thankfully for him, he was found by the ski patrol. I took a look at the patrol report and someone wrote “Found in a push-up position”. It took a huge amount of morphine and a smack of sedatives to reduce both arms to a neutral position.

We did an Xray of both shoulders and well, both of them had popped outta their sockets. They were quite badly dislocated and may require reduction under a general anaesthetic.

Honestly, I haven’t done a shoulder reduction before so I needed some advice. The senior doctor on duty thought it’d be worth trying to manipulate both manually under sedation before leaving it for general anaesthetic. Okies.

Before you know it, the poor dude was surrounded by 4 doctors all ready to pop his shoulders back in. Thankfully we sedated him (cause it’d be bloody painful) and managed to somehow reduced both successfully (although at one stage the patient did screamed out while being semi-conscious). I had the grand job of holding his jaw up (as he was going into deep sedation with all those stuffs we’re giving him to knock him out) as the senior doctor wrangled his arm back in place.

The poor fellow must have felt really embarrassed. When we were discharging him, he received a round of advice from concerned/amused staff.

Patient : Bye guys….thanks.

Me : Don’t dive anymore okie?

Nurse : And don’t get drunk!

Another nurse : And not at night, please!

Ward clerk : Yeah no jumping!

Patient : *red faced* Um, I know. Bye and thanks.

Not everything would usually end that light-heartedly.

One cold winter morning, a nurse walked into ED and announced “I need a doctor to step out with me”.

I just started my shift not long ago, and have yet to be attached to any patient. I thought okie no problem. Apparently they wanted a doctor to see this patient outside.

She led the way, and we ended up in the car park. Along the way there, I was informed that I’ll be certifying a DOA (Dead on arrival).

I must say I’ve never examined a patient at the back of a van before, let alone a deceased one.

The undertaker pulled open the boot of the van and there he was, all wrapped up and on a stretcher. I looked at the undertaker questioningly, and went “Do I examine him right here?”.

“Yeah do your thing”, he hollered. His voice almost inaudible against the howling wind.

Okie. We unwrapped the plastic sheets. The man looked, well, dead. His face was dusky blue and motionless. This man had a collapse in the outdoors and they were unable to revive him. Sounded like he had a massive heart attack.

It was over in 10 minutes. Silent chest and unresponsive pupils. I made sure I listened to his chest for at least a good minute or so to minimise my chances of missing some signs of life. I could hear the undertaker in the background talking to the nurse about how one guy woke up and found himself in the morgue. Apparently he was just unconscious but was declared dead by…um, mistake. Yikes.

Certified him dead. Undertaker re-wrapped the body and we headed back in.

I did wonder, what if that guy’s family decided he is to be cremated (wrongly believing that he’s permanantly gone)…and if he hadn’t woken up in time? That’s gotta be one effing big screw-up, man.

Anyway, gotta get back to my packing.

Weekend’s the only time I’m able to do my laundry. Gotta do the washing, drying, and the ironing before tossing them all back into my bag for the coming week (at rural). I was spending way too much time this weekend watching anime (I think i sat through 15-20 episodes of Naruto Shippuden) and am gonna have to resort to some last-minute packing.

Hmmm…seems like the entire Konoha village is entrapped and they’re about to fight. I’ll uh…do my packing tomorrow I guess *smiles sheepishly*.

If only I knew Kage Bunshin.

“You are getting all the overnight handovers”

I peered at the list. There must be about 20 odd patients still lingering in the ED.

“Half of our doctors have taken leave today. We’re really short and you’re taking everything”

Oh wow. This would mean that I’d be the one sorting out all the overnight patients. The docs on duty the night before looked really weary and worn out. It looked like they had a pretty rough night. There were a few patients in the resuscitation cubicles; one was unconscious, one with very bad shortness of breath, and one whom had lost probably a few litres of blood overnight due to an assault.

I consoled myself. At least it’s the registrar who usually takes over the resus patients. The serious stuff.

“Hmm, registrar is busy. Okie Newbie, you take the resus patients”

You must be kidding me.

I mentally pictured my jaw dropping. There I was, in the middle of the morning handover, imagining myself demonstrating all sorts of horrific newbie incompetencies. It’s not easy juggling several patients in an acute setting, let alone now that I’ve suddenly got 20 plus in my hands.

Resus patient #1 – Unconscious patient. His heart arrested and staff were all jumping on him performing CPR. Unfortunately the effort was futile – patient died. According to the paramedics the patient had the arrest in the back of the ambulance and by the time he was brought to the ED it was approximately 20-30 minutes after.

Resus patient #2 – Came in with huge difficulty breathing. Patient was propped up in bed with a huge face mask strapped unto her face. Oxygen was trained via 2 huge lateral blue plastic tubings. She was leaning forward with her arms gripping the bedrails and breathing heavily. For a split second she reminded me of a scuba diver.

Resus patient #3 – Is missing. Or at least I thought he was till I was informed the surgeons have admitted him. This guy appeared in the ED overnight post-assault with a huge knife sticking out of his bum and blood gushing out of his wounds. Previous doctor was exclaiming there was ‘blood everywhere’ and waved animatedly for emphasis during handover. We can only imagine. As inappropriate as it was, the image of a chef sticking a knife into a hot bun came into my mind.

Random patient #1 – Was hard at work coughing till she heard a ‘crack’ followed by a ‘pop’ over her ribs. Chest X-ray didn’t quite show any obvious rib fractures (but then again it’s not easily picked up to begin with) although there was a small area of lung collapse. For further review and could be discharged home if pain is manageable. It’s not uncommon to pop a rib while coughing or sneezing a lil bit too hard. I’ve heard a case where a guy cracked his rib from laughing too hard (and another whom dislocated his jaw). Must be some really funny stuff.

Random patient #2 – Huge tooth abscess. Had a tooth abscess drainage done recently but wasn’t taking the prescribed antibiotics. The infection blown over and the patient ended up with a really swollen jaw (looked as though he hid a ping-pong ball in his cheek). Oral (facio-max) surgeon on-call remained uncontactable for the rest of the day and this guy needed an urgent transfer under another surgeon outside the hospital. The infection trailed up his nasal sinuses and is now discharging from his nostril. Not good.

Random patient #3 – Another jaw abscess except this is on the side opposite of the previous guy. Very huge and angry-looking swelling right under this guy’s jaw. He was in agony whenever he speaks and was obviously frustrated as he had multiple recurrent abcesses before this one. Both of these guys needed IV antibiotics and subsequently tranfers over to another hospital. I have a strong feeling there was a mix-up with the on-call roster of the oral surgeon; he didn’t appear on our on-call list although under the main system he apparently is.

Random patient #4 – I didn’t find him, he found me. I was at the work area writing case notes for another patient when he stood right in front of me.

“You a doctor?”, he said. I nodded. “I need to talk to you”.

He leaned towards me and whispered, “See that nurse over there? The one in pink?”.

I had a look. Yup I could see the part-time nurse donning the pink scrubs.

“Don’t let her anywhere near me. She turned up at my house trying to kill me“.

 I took a good look at him. His face was flushed and he looked absolutely determined with his point; speaking with such great conviction. Chances are he’s most likely one of the psychiatric patients who had wandered out from his cubicle and forming delusions throughout his trip. One part of my overactive imagination thought, ah what if it’s real? What if it’s a conspiracy?

My workload smacked me back to reality. I could have given him a mini lecture on the basis of delusions and one’s mental state but was plainly too lazy to even start. Too much to do, too little time.

“Okie, don’t worry. If there’s any concerns you could discuss this with the head nurse”, I mentioned.

The patient was agreeable to this and ventured back to his bed. Seemed pretty satisfied with the reply for someone whom was worried about a perceived murder attempt at him 2 minutes earlier.

Random patient #5 – Young guy whom was stabbed with a pair of scissors overnight. Story was some guy out the blue walked up to him and jabbed his abdo with the scissors. I took a look at the wound; appeared pretty superficial. Patient stated that he didn’t knew he was stabbed until he saw the pair of scissors held by his assailant afterwards. Yikes.

Couldn’t quite decide which one was more astonishing; the thought of scary dudes randomly stabbing people with scissors or my patient whom was still looking all bright and chirpy after being stabbed. Hmm.

Random patient #6 – The cute lady with asthma who just can’t help but to relieve everyone of her life story despite her shortness of breath. Having the hissing nebuliser mask on would usually deter anyone from talking but nah not this one.

She belongs to the category of patients whom would answer your questions with 5-10 minutes of irrelevant details of her day followed by the important bits that you’re looking for. This lady started with “I woke up one morning…” and followed up a re-enactment of the conversation that took place between her and the local bakery shop owner. Still not too sure when the shortness of breath started but I do know that she had french loaf for tea.

Random patient #7 – The patient with a very very demanding mum. All questions are to be directed to the domineering mother whom would be throwing in a demand at the end of almost every sentence. It was an interesting sight; the patient looked distressed, the mum looked pissed, while the granny just looked at the TV screen. The mum was adamant that the patient needs urgent medical attention ASAP by the senior doctor and was starting to get kinda preachy. I think we spent more time pacifying the mum above all else.

The patient is pregnant and was vomiting more frequent than usual. Mum took up the arms and started heckling the staff, ‘commanding’ the attendance of the senior specialist. Honestly, there were many more serious patients to be seen and there came a time where we told the mum straight up that they’d have to wait – they’re not really a priority at the moment. We left the room while the mum scoffed and sulked. Granny’s still watching the TV.

Random patient #8 – Hero. I first saw him with a cervical collar and a heavily bandaged head. News was he scooped up his lil’ son to escape from a wave and ended up running head first into a slab of jagged rocks. He was preoccupied with getting out of the way and didn’t realise he was running towards a huge rocky wall. Ended up lacerating his forehead and getting a concussion.

Thankfully the head and neck scans turned out to be normal overnight and he’s discharged home. I saw his lil’ bub visiting his papa in the morning and they looked really cute together. Awww.

Random patient #9 – This young guy has a cervical collar on as well but his story was nothing similar to the previous patient. After much interrogation and quizzing from the night doctors, he sheepishly revealed the history of his injury:-

1. He was chasing his girlfriend around the room.

2. Girlfriend hopped unto the bed and promptly off to the side.

3. Guy hopped unto the bed after his sweetie but was propelled head-first into the wall.

4. All fun ended there.

I had a look at the notes written by the previous doctor and saw “Head vs. wall“. Nice summary.

Random patient #10 – Now, this isn’t one of my patients BUT I was nearby when his attending doctor was discussing the case with the consultant. My ears picked up the words:-

“…testicles got stomped on by a horse…”

It was incredibly unfortunate to have that certain anatomy at the receiving end of a horse’s hooves, but also immensely lucky that further scans showed the testicles to be intact. Huge PHEW there.

These are the few that I could recall from that particular shift. The rest of the cases are not particularly outstanding (or maybe I’m just bit too lazy to think). I do have a story concerning swollen balls but I’ll save that for another day *grins*.

*     *     *

Random bit #1 : The Greek and the groin

As I was walking past one of the nurses’ workstation, I could see a mini-crowd building up in one of the rooms. I could hear a number of people talking all at once; couldn’t quite make out what they were saying. Curious, I poked my head in.

“What’s going on?”, I asked. There were 2-3 nurses all standing around this middle aged patient. All of them turned to look at the newest entry into their lil’ conversation.

The nurse closest to me threw her arms in the air. “I can’t understand what he wants. He’s been restless for the past hour.” she said, sounding exasperated.

I glanced at the patient. He just shook his head and shrugged.

“Hello mister, is everything okie?”, I started. Within 2 seconds I was greeted with some rapid-fire reply in a language that I couldn’t understand.

“He’s Greek”, said the male nurse. “Can’t quite understand nor speak English”.

The patient reached for his urine catheter. I instinctively grabbed his arm.

“You don’t want your catheter?”, I looked at him. I can understand it’s not a very comfortable thing to have a tube being stuck up your bladder, but if it’s overly painful for him then we’d have to remove it in case of an infection.

The patient just stared blankly at me.

I pointed to his bladder. “Is it painful?”.

He goes spurting his native language in a very purposeful manner. Trouble is, neither of us could understand Greek. The female nurse looked at me and said, “What does it sound like to you?”

I grinned. “Sounds like Greek to me”.

I pointed to his bladder again. “Pain?”.

To my surprise, the male nurse in the room started pointing to his own groin and emulating some pain response. He was clutching his groin and going “OW? OW?” while looking at the patient questioningly.

I knew immediately he was trying to help, but it just looked just downright funny and kinda wrong. He even did the mini squatting motion with every ‘Ow’ he made. The patient looked amused. He shrugged and shook his head.

After shooting some blanks for a while, we decided to call up his son whom would be our translator via the phone. Turns out that the patient was just amazingly persistent in wanting to know what time his family would be visiting him the next day. Ah.

Random bit #2 : My hand is numb, but then again maybe not.

I received a bundle of pages for this same complaint from the same patient. She was admitted for a fractured wrist and was on the waiting list for surgery the following day. First page in the series was from the nurse, raising concerns over the patient’s hand being numb.

Well it’s not a good thing for one’s hand to be numb, especially when you have it encased in a plaster cast. My first thought was the cast was probably put on a lil’ too tightly – impeding the blood circulation to some degree and/or pinching some nerve.

I headed downstairs to see the patient.

Patient : Oh, it was numb. Now it’s not.

Me : Eh, that was quick. Everything okie now?

Patient : Ya.

Me : Alrighty then. Just let one of us know if your hand’s feeling funny again okie?

Patient : Okie.

Seeing that everything appears to have settled, I headed back upstairs to another ward. Within 10 minutes, my pager beeped. Ah, the hand’s numb again.

Me : Hello. How’s the hand? Numb?

Patient : Ya. Um, just a little bit numb. But if I massage it, it goes away.

Me : Hmm…well it’s looking a lil’ bit swollen than previously. I have a feeling the cast is on a bit too tight.

Patient : Um, are you gonna saw it open? *looks anxious*

Me : There’s a good chance we’re gonna have to do it. The cast is keeping your fracture immobilised but if it’s gonna cut off your blood circulation then there’s more benefit of having it off than on. That could be the reason why you’re feeling a bit numb now.

Patient : Well…yes.

Me : Okie, I’ll discuss this with your treating team just to inform the senior doctor and getting approval to split the cast. If he gives the green light then we’ll do it.

Patient : …okie.

I made a quick phone call to the senior orthopaedic doctor explaining the situation. He told me to proceed so we gathered the equipments necessary for the procedure. This includes a few ’scary’-looking instruments like the plaster saw and the retractors.

Patient : While you were talking to the doctor, the numbness went away.

Me : Hmm.

I had a strong feeling that IF the cast is to remain on her, I’m gonna be getting a lot of subsequent pages overnight about her intermittent numbness. The cast looked tight to begin with, and the increasingly swollen hand is a big NO-NO. And besides, I can’t possibly keep running up and down the place playing hide and seek with the numbness.

Me : Ma’am, your hand appears to be more swollen now. The numbness appears to be coming on and off but I’m quite concerned still as swelling is another indication that your cast is on too tightly. The cuff is trapping your circulation and it needs to come off.

The patient hesitantly agreed. She was more worried about the sawing part which I could understand. The saw has a circular blade which actually works via vibration instead of an actual rotating motion as per the usual hardware saws. The blade is actually dull; covered in blunted serrations. But then again, a saw is still a saw through the eyes of the patient. The deafening noise that it makes while turned on didn’t help to alleviate her anxiety either.

After much grunting (from us) and much yelping (from the patient), the cast came loose sometime later. Swelling’s going down, and no recurrence of any numbness. Yippee.

I went to work in a dark-coloured shirt with dark blue pants. Left work looking many shades lighter with plaster cast powder all over me, accompanied with several white handprints on my bum (absent-mindedly dusted my hands on my pants). Looks funky though.

Random bit #3 : “Let’s go raid some towns!!”

Naw, it’s not a mad patient. It’s just one of the my fellow colleagues. I was in the ED and I caught sight of this tall lanky guy waving at me from across the room. I haven’t seen this fella for ages. He looked like he was about to burst with some fantastic news; hopping over with a huge grin on his face. The conversation went somewhat like this :-

Me : Hello! Whatcha doing here? *He’s normally in the ward*

Him : Oh no just accompanying the resident to see this patient. GUESS WHAT?

Me : Ah?

Him : I got my priest to level 65++!!! *enormous smirk*

Me : OH WOW! Which server are you playing at?

Him : Frostmourne. You should come and join too!

Note : The conversation was peppered with Warcraft-speak. I used to have a few characters on the World of Warcraft; once upon a time I was fairly active on my server. I froze my game account 1-2 years ago as I was having my exams and didn’t really pick it up again since.

Me : Hmm but I’m working funny hours, and I’m always catching up on sleep. Not too sure if..

Him : AW COME ON! My group is a good one and we’re doing a lot of dungeons. I mean, we have a good healer *pauses to acknowledge his priest*, we have a tank etc.

Me : Are you Horde?

Him : Alliance.

Me : MAN, I would wanna go Blood Elf!

He gave me a mock frown. If I’m taking up a Blood Elf it would mean I’d be playing against him instead as we’re from opposing factions. I told him I’d consider joining if I have enough time on my hands. Sleep has become increasingly scarce as I’m working, and I think a few more hours of sleep would edge over a few hours of Warcraft anytime (although I must admit, Warcraft won this face-off many times when I was still in med school).

We bid farewell and he left. My consultant came up to me, looking alarmed.

“WAS THAT YOUR PATIENT WHO JUST WALKED OUT??”

“Oh no no..that was a nurse.” I explained. He wasn’t wearing his uniform and he kinda looks the part of a patient about to pull a runner. “He carries an ID tag, just that..um, he turned up in full winter gear today. I know him, he’s the staff”.

The consultant looked somewhat amused. “Well, can’t tell the difference”.

Random bit #4 : What the…?!?

I was driving home one day from work. It was just after I’ve pulled a late shift and the roads were quiet. The car which was in front of my on the highway changed lanes and started slowing down considerably. He has deccelerated so much so that I’d be passing him very quickly. I stole a glance over as I overtook him.

Ah the bastard. He was making a really vulgar gesture at me. He had intentionally slowed down his car to perform his lil show. I saw him gesticulating once, and that was it.

I drove my normal speed; leaving him behind. I thought that was the end of it but I was wrong. The bored fella actually sped up right till he was parallel to me, and repeated the same idiot act again hoping I’d look over and be offended.

I continued my journey home, feigning being oblivious to him. It started to get really irritating as he got into this repetetive act of keeping up with me till we’re parallel – just to take his hands off the steering to rudely gesture across. This kept going for the next 10km approx. Geez.

In the back of my mind, I did think about what a horrendous shocker it’s gonna be for him if I’d suddenly pull out a gun and aimed it at him. It’d be almost like a scene from some movie where the street punk gets his reckoning. Oh well.

In reality, the most that I could do was to applaud his performance with the one finger salute. There were a few moments when I’d ALMOST flash the finger – except that the last thing I needed at that time of the night was to get into more trouble. So regretably, no.

Random bit #5 : Kindly ignore the runaway patient, thanks.

I was in the ED explaining to a patient’s family regarding his prognosis. Both wife and daughter were listening intently when all of the sudden there was a scream followed by a flash of white.

To my amusement, a female patient had just hopped out of her bed and begun chasing her nurse. The flash of white that I glimpsed was her half-undone hospital gown flailing after her. I shall refrain from commenting on the colour of her undies here.

I laughed sheepishly (the “ehehehe” kind). The daughter quickly resumed the discussion after a quick shrug whereas her mum spent the next few seconds looking over the yonder with that distinctive W.T.F. look on her face.

Random bit #6 : YOUR PENIS, I SAY!

An elderly gentleman came in to the ED with a really tender lower abdomen. He hasn’t really passed much urine over the past few days and we’re guessing he’s in urinary retention. I could feel his bladder was as huge and as solid as a rockmelon; he needed a bladder catheter in real quick.

Me : Okie you’re gonna need a catheter in your bladder. We need to drain the urine.

Patient looks at me wide-eyed.

Me : Oh, it’s a draining tube we’re going to insert up to your bladder. The pain’s from the retention.

Patient shook his head slightly and his voice boomed, “I CAN’T HEAR YOU I AM DEAF”.

The nurse poked her head between the curtains and gave me a sympathetic smile. “You’ll have to shout”.

Oh. I raised my voice a few times, getting louder with each subsequent attempt. He’s still shaking his head.

Patient : YOU WILL HAVE TO SPEAK UP DOC.

Me : I..uh…okie. YOU NEED A CATHETER. CAN HEAR ME?

He nodded. Good.

Me : WE NEED TO DRAIN THE URINE. TUBE UP YOUR BLADDER.

He nodded.

Me : I’LL GO GET THE EQUIPMENTS. BE RIGHT BACK.

He smiled and settled back in bed. When I got back, he’s still dressed in the sweater and jeans that he came in with. It’s be easier if we get him in a hospital gown (easy access, ahem!).

Me : YOU’LL NEED TO CHANGE INTO A GOWN.

Patient understood and removed his sweater. Next thing I know, he had the gown on with his jeans still underneath.

*The following conversation took place behind closed curtains but within a public observation ward. I’m pretty sure everyone within 10 feet could hear us as we were both shouting above the usual background chaos of the ED.*

Me : YOU NEED TO TAKE YOUR PANTS OFF.

Patient : YOU WANT ME TO TAKE MY PANTS OFF?

Me : YA THE CATHETER NEEDS TO BE TRAINED THROUGH YOUR…*points to his groin*

Patient : TUBE NEEDS TO GO UP WHERE?

Me : THROUGH YOUR PENIS, AND INTO THE BLADDER.

Patient : PEE-WHAT?

Me : …THE PENIS. URINARY TRACT.

Patient : OH I GET YOU. SO I TAKE MY PANTS OFF?

Me : YES PLEASE.

I was trying horrendously hard not to laugh. I could hear the few patients next door giggling, and a senior colleague of mine going E-HEE-HEE-HEE around the corner.

Random bit #6.5 : YOUR PENIS, I SAY (II)

I begun the procedure by prepping the the gentleman’s groin area with some antiseptic. Once done, I had to carefully retract the foreskin to visualise the uerthra.

Honestly, it’s not easy to retract the foreskin once it has been swabbed with some alcohol solution. Pardon me, but it keeps ‘wiggling’ (for lack of a better word) back up and obscuring the urethral opening. In practice, we can only use one hand to manipulate the foreskin as the other hand is ’sterile’ and all contact is restricted to catheter handling.

I had a few slippery attempts; the scene equally as awkward as it was amusing. Out of goodwill, the patient grabbed his previously-cleaned penis and retracted the foreskin.

*All verbal exchanges were done at a VERY HIGH volume as the patient is, well, deaf*

Patient : HERE LET ME HELP YOU.

The nurse groaned. I groaned. The patient had just contaminated the procedural area and we’d have to swab him again.

Me : OH NO LET GO. YOU CAN’T TOUCH IT.

Patient : HUH?

Me : LET GO OF YOUR PENIS SIR.

Patient : I LET GO? BUT THIS IS EASIER!

Nurse : NO NO WE HAVE TO CLEAN IT AGAIN.

Me : YOU JUST CONTAMINATED IT.

Patient : OH SORRY. I WANTED TO HELP.

Me : IT’S OKIE, JUST UM, SIT BACK.

I just had to laugh after that. It must have looked really peculiar and hilarious; to have the few of us shielded behind the curtains for the patient’s modesty/privacy but yet resorted to yelling out every single explicit detail. The irony.

Random bit #7 : To war with the finger

Yes, it’s the rectal exam. I happened to be performing one in every 2-3 patients lately. There was a shift where I believed to have probed the behind of every single patient I’ve seen – mainly elderly patients with bleeding from their behinds.

It isn’t a very tedious nor a difficult task to do, except that you’ve gotta be careful for yourself. You wouldn’t want to finish off a rectal exam getting excrement streaked on your sleeves. Given that rectal exams are unpleasant, patients tend to be anxious and they may tense up their abdo without realising it. When this happens, half the time this would induce a ‘mini propulsion of bowel gas’ (yup, the fart) causing any semi-liquid stools to be forced through between the anal spinchter and your finger.

What’s on the other end of your finger? You.

I have seen a senior doctor getting sprayed over his shirt and tie by the glorious brown stuff. It’s funny when you’re not on the receiving end, I must say.

What I’d usually do nowadays is to get a thick waterproof napkin; partly to shield the bed as well as to shield myself. I’d toss all the paraphernalia that’s hanging around my neck (ID tags, steth, pen, etc) and roll my sleeves way above the elbows. Double gloving is the order of the day when it comes to the hand that would be doing the honours. I’d often take a step back to estimate the ‘predicted faecal projection distance’ so I’d know how much I’d have to lean away.

One thing I didn’t mention, is that every rectal examination begins with the inspection of the anus.

Given that it’s usually not a very visible area (hence the term ’stick it where the shine don’t shine’), we’d have to peek at it really closely. It is during this time that I would be mentally chanting “Please don’t fart, please don’t fart, please don’t fart…” over and over again.

It may come across as funny here but I’m pretty sure anyone would’ve wished for the same thing if they’re in my shoes. The only thing worse than getting your shirt sprayed with stools… is to catch it with your face.

Ah yes.

Walking up those dimly lit corridors, I could see that the patients are being prepared for bed. The main lights for each room have been turned out and almost everyone is in bed – with the occasional exception of the odd patient whom would be seen easing himself with the urine container while forgetting to draw his bedside curtains.

Some patients have mastered the skill of using the urine container in the dark, where as the rest would, of course, be turning the night lights on. This decision is often paired with the fleeting assumption (or total indifference) that ‘it’s bedtime and everyone’s sleeping’ hence proceeding to pee with the curtains wide open. Thank goodness for the night light as they could see for themselves the direction of their pee – being oblivious that so could we.

The thing about working nights is you tend to deal with a greater number of confused elderly patients.

It’s one thing to manage their medical/surgical issues, it’s another thing to manage them as a person altogether. Most of the elderly patients that are on the ward are having dementia – some pleasantly demented (for lack of better description) while some are just difficult to deal with. A number of them would often wake up in the middle of the night appearing all confused. They’d often forget they’re in the hospital and are deluded that they’re being held captive against their will. Half of the time, this strong false belief would turn them into anything from the really aggressive (the worst) to the really clingy and demanding (not too bad, but still very time consuming to deal with). 

There is a phenomenon known as ’sundowning’ where patients with dementia experience extreme unrest and agitation during the night. This is often believed to be due to the lack of their usual daytime cues and prompts (e.g. staff informing them it’s lunch/dinner time, families visiting them, etc) and would often feel insecure (particularly to patients as it’s not their usual home environment). Coupled with impaired memory, these folks completely forgotten the reason they’re in the hospital and start to panic – some to the point of extreme paranoia.

What normally happens then? The patients then can be roughly divided into two categories. As I mentioned before, it’s mainly the paranoid and the aggressive for the purpose that they both stood out in their own way.

The paranoid.

Distribution across gender : Majority are female patients.

How to spot them : They are often seen either lying flat on their bed (I meant REALLY FLAT, like commandoes dropping to the ground to dodge bullets) or they have their arms and legs wrapped around their bed rails. Some wrap themselves around you.

The story : I was in my main ward in the middle of stuffs when I got a page from the nursing staff of another ward. I replied the page and the nurse I spoke to sounded a bit distressed. Apparently they’re splitting hairs over two patients whom decided to have a delirium episode on the same night. This is just after the previous night where 4-5 confused patients made the inconvenient decision of pulling out their IV lines. Sometimes it’s hard to believe it’s not a conspiracy.

Anyway there I was, running up the stairs while imagining all sorts (one included the patient holding a nurse hostage armed with the urine bottle). I arrived at the room and saw this elderly grandma being surrounded by half the ward’s staff. She looked up at me and hurriedly questioned, “Are you with THEM?”. I replied, explaining that I’m the doctor on duty tonight and she gestured as me to go closer to her.

The moment I’m within her arm’s length she had me locked into this vise-like grip. It was a bit awkward as she had me kneeling down by the side of her bed (she was gripping me by the wrist) and whispering to me about believing the nursing staff are out to kill her. Each time I tried to reply with an explanation she’d completely forego what I have to say and frantically shook her head and shaking my wrist; basically wanting me to be quiet in the event that the nursing staff would come to know of her delusions.  Not sure if she realised that in her haste her whispering became so horrendously audible that I’m pretty sure everyone around her heard everything.

The nurse whom was in charge of the patient decided to wheel the patient’s bed out to the front of the nurses workstation, hoping that some of the paranoia could be alleviated seeing that she’s in a brighter area with more staff to keep an eye on her. Throughout the entire distance of transfer, she wouldn’t let my wrist go and as a result I had to half-stoop (the bed was low) and half-walked alongside as if I am having a debilitating backache.

We had her bed against the corridor in plain view of all the nursing staff. My wrist is still being locked. My pager was beeping like crazy and I really had to be elsewhere.

Me : Okie, you’re here now and you’re safe. The nurses will take care of you, I promise.

Her : But they’re trying to kill me, I know it.

Me : Oh no, I’ve worked with them and they’re your nurses. They’re not here to harm you.

Her : Can you stay here with me?

Me : *Pager beeped again and I mentally groaned* I can’t. I have other patients to attend to.

Her : *squeezing my wrist even harder* No you can’t, they’ll kill me! Stay here Julie!

My name isn’t Julie, and I have no idea where she got that from.

Me : I’m not Julie.

Her : Oh? *lets go of my wrist and seizes my ID tag*

Me : It’s not Julie, see? I’m the doctor and I have other patients to see.

At this point, the nurse that is in charge of her walked past and greeted the patient.

Nurse : Hi darling *with a smile*

Her : *yanks my tag* See! They’re trying to kill me!

If this is a world with no consequences (or no karma cycle), I’d have a loudspeaker in her face hollering “OH GAWD WAKE UP PLEASE, GEEEEEEEEZ!!!”

Me : No they’re not.

Her : *tugs on my ID tag – sheesh* Will you be here?

Me : I will be around a bit to write up some notes in your file, but I’ll sit at the desk closest to you alright? At least you know where I am for now.

She finally let go of me, and I promptly scribbled some notes on her file to document the night’s events. I thought I’d be able to be done in 5 mins and leave but I ended up taking 30 mins because she kept calling out my name in 20 second intervals. She’d be grabbing my wrist or my thigh (sounds funny, I know) and I’d be spending the next 5 minutes clarifying that we’re not hired assassins.

Finally, we decided it would be a good idea to ring up the patient’s daughter so she could reassure her mum (and also to give us all a break). The nurse had the daughter on the cordless phone and passed it to the patient.

Me : It’s your daughter on the phone. It’s alright.

The patient took the phone and suddenly in a weird flash, the paranoia disappeared completely. She ended up happily chatting to the daughter and not flinching anymore at the supposed ‘killer’ nurse whom was standing by her bedside.

I took this chance to make my escape.

I can imagine how fearful it must be if you were to wake up in the middle of the night, not remembering where you were, and to be surrounded by unfamiliar environment. I can understand the panic and the paranoia associated with this as they feel incredibly unsafe and insecure with strangers attending to them.

Having said that, I, on the other hand, could not possibly be sitting there holding her hand (or having her gripping mine) throughout the entire night. Although it is very much part of our responsibility to reassure the patient, there is also a greater responsibility in recognising other patients to whom we owe a greater duty of care to (especially the very ill ones) and that would take precedence over a situation like the one i described.

The Aggresive/Grumpy/Cranky/Last Action Hero.

Distrubution across gender : 90% are male. All that testosterone.

How to spot them : They’re always caught in action. Either in the process of ripping out their lines/tubes, climbing over their bed rails, or knocking a staff out cold. Could potentially look like a scene from ‘Prison Break’ except that the lead is in a half-undone hospital gown.

The story : I got called to see a patient whom had a change in his presenting symptoms. The news was worrisome; patient had developed uneven pupils. This could indicate a change in cerebral perfusion to either one of the brain’s hemispheres – in other words, we’re suspecting a possible stroke.

I arrived at the ward and saw the elderly gentleman sitting by his bedside. The first thing that he said upon seeing me was to look at the nurse questioningly, saying “Your son?”.

Before I could say anything, the nurse replied, “No this is the doctor and it’s a SHE”.

I just had to grin. I introduced myself to the patient and informed him of our concerns. He showed indifference and was reluctant to have me examining him. I attempted to take a history from him at first, trying to elicit if there is any other neurological symptoms that I could pick up. The patient kept saying “no” to each and every symptom that I was questioning for, and I know I couldn’t take for granted that it really is a no to everything as he wasn’t very cooperative to begin with.

I tried to proceed with a quick examination but he became increasingly agitated. At one point he appeared to be tugging at his IV line and that was enough for us to grab his arms. The nurse tried persuading him to have an examination, but the patient kept waving the nurse away reasoning that “we should all go to bed”. He then pointed at me and asked, “How old are you?”

I smirked, and told him this is not about me.

Him : I don’t believe you’re the doctor. You look 16!

Honestly, I was beaming inside. It’s always good to know that I could still pass off looking like a kid, yay!

Anyway, I mentally smacked myself back to the current situation at hand. He asked for proof and I showed him my ID. He then started flicking my ID tag left, right, and center and mumbled something incoherently. Doesn’t appear like he’d take me seriously.

After spending some time haggling with him, I felt that the patient should have a brain scan done regardless of the examination findings so I called up the registrar and reported to him. The registrar also agreed to review the patient; maybe the patient would agree to be examined by a more senior looking doctor, hah.

Registrar came in, and there was a fleeting sign of hope as he allowed the registrar to examine him. Then he bailed out midway and refused once again. Sigh.

We organised a CT scan and felt that there is nothing much more to be done; subsequent management would depend rather heavily on the CT results. I informed the registrar that I’d update him on the scan results and we both parted ways – each of us having our workload dictated by our incessantly beeping pagers.

Half an hour later…

I got a page from the Radiology Department. The female after-hours radiographer was on the phone, sounding harrassed.

“Could you please come down to radiology now, your patient’s being very…uh, aggressive and difficult to manage. Please.”

To me, that effectively translated to :-

“He’s gone bonkers so let’s knock him out”.

So I ran. Cartwheeled through the radiology doors (okie, so maybe ‘walked’ is a more accurate word) to see the patient sitting upright on the CT bed; accompanying nurse was holding him down and negotiating while the radiographer looked just downright frustrated/pissed.

I patted the patient on the shoulder. I told him very clearly that we’re all worried (except for him) about his brain and we really need to do this scan. Like a kid, he kept shaking his head defiantly (almost proud, too) uttering “no” over and over again. Then came the little kicks and shoves.

I looked up to find myself being the target of half-pleading glances from the staff, as if to say “SEDATE him, PLEASE!”.

We can’t all just sit around in the CT room forever, so I wrote up a medication order for sedation. It took the 4 of us to pin him down while the nurse quickly administered the injection into his bum. When we released him, he appeared to be spending the next few seconds in a daze before his cranky self took over again.

He looked at me and said, “You should be very proud of yourself with what you’ve done. Your grandfather would turn in his grave if he knew”.

That remark hit a nerve (and prompted some reflex brow-raising). My grandparents are already deceased and somehow that comment just didn’t go down well with me. My head was swirling with all sorts of verbal comebacks that I could use, including “My grandpa would be so proud if I were to kungfu you right now”.

Hmmph. Anyway I didn’t reply much except for the professional-sounding “It’s in your best interest, Mr Cranky*” – *note : Pseudonym has been used to de-identify crankiness*.

For some weird reason, whenever we saw him fading out (swaying and slurring) he would prove us wrong by suddenly sitting upright and spewing abuse at us once again. In an alternate universe, I wouldn’t hesistate to smack him out cold so we could get it all over and done with (for his own best interest, I say). There is only so much crankiness we could take.

Needless to say, what would usually be a 10 minute visit to the CT room took us approximately 80-90 minutes with him.

The CT scan turned out to be normal. Good then.

The Miscellaneous.

Distribution across gender : Half-half, although any bad experience with either would make you more inclined to stereotype them for the rest of your career.

How to spot them : They are pretty good at appearing alright until their next move/speech assures you that they’re anything but that.

Story #1

I was walking through a room to check on a patient when the lady in the next bed called out to me.

“Where’s my husband??”, she demanded to know. This is at 4 am in the morning.

“Huh? Is he supposed to be here at this time?”, I asked.

“Isn’t he?”

“Uh well, it’s 4am and it’s not visiting hours for sure.”, I calmly explained.

“Oh really? I want to get out. Can you lower the bed rails for me? They’re keeping me in!”

Well, that’s exactly what the bed rails are for – to prevent patients falling outta their beds, as well as stopping elderly confused patients from their midnight urges to have walks and subsequently go missing.

I placed my hands on the rails. “Sorry, these rails are up to prevent you from falling off your bed. And I think you’re due for bedrest”.

She started being a bit fidgety. It kinda looked like she’s throwing a mini tantrum; sulking and all.

“It’s all you people’s fault for putting up the rails. Why, last week I broke my hip from hopping over the rails you know!” so she said.

“Then don’t hop, dearie”, I grinned back.

Either she got the hint or her mind was preoccupied with something else, as she went silent and appeared to be deep in thought. I gave her a quick smile and excused myself.

Story #2

This is more a case of severe short term memory loss than being confused. I have been this situation on a few occasions.

Usually it would start with me giving the patient a brief notice that they’ll be needing an IV cannula in. After obtaining their consent/setting up equipments/preparing the patient/etc, I would be just about to puncture their skin when their amnesia began to play in loops.

Patient : What’s that needle for?

Me : Oh *shows them the needle* this is to put a drip into your arm.

Patient : Oh. *Goes off day-dreaming*

Me : Okie, this is gonna be a sharp sting *The needle’s already on the skin*

Patient : What are you doing? *looks surprised*

Me : Huh? I’m…uh, about to do an IV for you.

Patient : Why?

Me : You need to be on the drip.

Patient : Oh. *Nods and goes off day-dreaming*

Me : Okie. Sharp sting coming through.

Patient : Wait, what’s the needle for? *A slight hint of panic in the voice*

Me : ? This is for your drip, remember? To put the IV cannula in.

Patient : Ah, I get it. Okie.

Me : Okie. Sharp s-t-i..

Patient : What are you doing to me? *Back to square one*

It could feel like your computer’s HD is rebooting itself every 10 seconds. What do you do?

I figured that the best way for me to get the job done as soon as possible would be to do a running commentary on everything I’m about to do. Requires continuous rambling (on top of whatever you need to do) to keep the attention ala ESPN sports commentator. Something like :-

“Okie cold alcohol coming through! Ah now that’s clean…Here look at the needle, this is to go into your veins…like this…Watch it, it’s going in. Oh look, can you see your blood? We’re in the vein, yay! Needle’s out, tape on…fingers crossed and hope it works! Is it or isn’t it? ……Yeeeeeeeeesss sir your IV is all good and ready to go! Thank you very much!”

Sometimes it doesn’t end there. There has been a few times where they’d rip out the freshly inserted IV out of their confusion/amnesia/etc - majority of the time are elderly patients. I’ve had the good fortune to be timely present to see how it happens.

Step 1: Patient busy doing their own thing (memory lapse often happens here).

Step 2 : Suddenly they caught sight of the foreign looking drip+cannula implanted at the  back of their hand.

Step 3 : Spends the next 5-10 seconds keenly staring at their hand in a very astonished manner. The expression that you see here varies greatly. Some just appeared to be intently examining it (akin to a kid finding a fancy marble), where as some looked like they’ve just found a Boeing 747 parked in front of their house one morning.

Step 4 : The curious ones (e.g. marble) would attempt to dismantle it. The stunned/shocked ones (e.g. Boeing 747) would violently yank the offending thing out.

Step 5 : Nurse comes to check on the patient and notices that the drip is now on the floor. Promptly pages for the lil’ newbie doc.

Step 6 : Newbie doc receives the not-so-surprising news (which could be up to the 3rd time for that one same patient). Spends the next 3 seconds deciding whether to laugh or cry.

Step 7 : Newbie doc then restarts the task of putting one in.

*     *     *

Haven’t had the chance to have a quiet shift so far, really.

It’s 5.35am.

Not quite able to sleep, neither am I meant to be sleeping at this time. I thought ‘Ah this would be the best time to finally write what I intended to’ so here I am.

I’ve changed over from doing Psychiatry and was thrown head first into the Surgery unit, doing mainly night shifts. I usually start my shift in the late evening; to be on my feet for the next 14 hours before I handover to the morning doctors (while trying not to yawn) and then heading home for some much needed sleep.

I’m already 3-4 weeks into my surgical nights rotation. Still fairly new to it, but there’s already plenty to muse about *grins*.

There wasn’t much of an orientation to night shift. The only formal instruction which I have received was to “Turn up and do what it is needed”. Needless to say, I was quite anxious prior to commencing this rotation as I was already imagining all the worst-case scenarios that could take place in the night.

I was browsing through my rostered shifts from the timetable that was given; half-rejoicing that I am getting more days off since I’m putting in more hours at a time…until I read the fine print below it.

Surgical interns are expected to cover ALL surgical beds in the hospital, including those in the Emergency Department.

It then promptly dawned upon me that I’d be the only intern skulking the corridors at night. This is matched by the equally scarce number of senior doctors on-call at the same time – solely because it’s night time and most patient’s are stable (or so we’d like to think!).

Given that most of the active planning and execution of the patients’ treatment plan are done during the day, there is a common belief that there’s nothing much to be done at night as patients should be sleeping and things should be quiet.

Honestly, no. Not from what I experienced at least.

There is no written rule for the patients sounding anything like ‘Thou shalt not fall sick after the sun goes down’. Aha – well yes, they are unwell to begin with but some of them could suddenly deteriorate through the night which makes me wanna pee in my pants sometimes.

As mentioned there’s only one intern from the surgical unit whom is around at any given night, and we would pick up our pager prior to starting each shift. I still remember my very first page happened right just within 10 seconds of me picking it up. It was the surgical registrar (whom was the only one on-call from his ranks too) and the instructions were swift.

“I have an emergency appendix now and I NEED help”.

Okie. So I ran and get myself changed into a spanking blue pair of scrubs. Walked hurriedly looking for the registrar; palpitations with every step that I took. Found him scrubbing by the sink and promptly joined him. We had a very brief self-introduction and I shelved all my plan for small talk seeing how sombre and serious he looked.

In my weird and overactive lil’ head, I imagined what would it be like if he’s as new as me (which thankfully he isn’t, of course).

*Fictitious conversation which in no way should ever take place prior to any surgery*

Newbie registrar : I’m new. What about you?

Newbie intern : I’m new too.  Gawd, so nervous! Think I feel like crapping in my pants now.

Newbie registrar : Now that makes the two of us.

*End of imaginary revelation by the surgical sink*

Anyway…to business. The patient was sedated and anaesthetised; draped and the procedure was ready to go. I saw the registrar making a quick incision near the hip and started to probe around to locate the appendix. He was gently pulling up some of the bowels, rocking them a lil to free them up and to reveal the appendix which would normally be attached to it at the illeocaecal junction (where the small bowel kinda joins with the beginning of your large bowel – the appendix normally hangs around there).

He was holding a portion of some pink bowel.

Me : What’s that?

Him : The caecum.

Me : Ah.

Unable to locate the appendix yet (this was done with a minimal sized incision so there’s actually very little view of the inner abdo) he then gently reintroduced that portion back in (although stuffing would be a more precise word) and started again with another portion of the bowel. He eases the new loop into view.

Me : What’s that?

Him : The caecum.

Me : Ah?

Well it did looked a lil bit different to me, but then again I hardly spend much time looking into people’s guts so can’t be too sure on how it looks like from all angles. I just realised that we each have about a good 4-6m length of intestines in total, and I had the good fortune of pointing to the exact same area twice.  What are the chances of that? Hmm.

I realised that when it comes to removing the appendix, it pretty much comes down to how soon we can find it. It can get pretty tiring with the registrar stuffing his fingers into the patient’s abdo, grunting as he tries to get a feel of that elusive tiny appendage of the intestine – and the intern who’s job is mainly to hold the retractors to keep the incision site opened as much as possible for better visibility. Trust me, it gets pretty tiring. I can’t bend my elbows to hold the retractors back (ala prying open 2 sliding foors) as by doing that my head would get into the way and block the surgeon’s view, so i kinda had to hold the retractors at a 90 degree angle (imagined trying to force open 2 sliding doors with your elbows locked straight) and keeping it there till the entire deal finishes. Phew.

Once done, I’m usually walking around (I’m covering 4-5 wards) checking the to do list on each of the ward’s white boards. Most of them are to refresh orders for medications or fluids, but you do also tend to get the scary stuff like patient has sudden chest pain or patient is having problem breathing or patient’s temperature is near 40 degrees Celsius. Trouble is, sometimes all of these happen at around the same time and you’d really have to prioritise which one to attend to (given they’re all quite nasty sounding) as well as making allowances for the time which you’d spend reviewing them.

In the beginning, it was pretty overwhelming. I was pretty much alone in the middle of the night, and clueless. Not a good combination to have, neither would it be a good one to be in. These kinda situations are often a true ’sink or swim’ rule where there is no way to go around it but to bite the bullet and throw yourself in. I must admit, it is a tremendously steep learning curve where it matters. We’d often feel quite horrible dealing with it for the first time, but coming away from it knowing that there were so much learnt. In terms of training, it can be viewed as a form of a necessary stress exposure where one couldn’t have been better without.

The main things I came across with night shift.

1. You do random stuffs.

The Good. This is pretty good form of training. Surgical patients have medical problems as well which I’d have to learn to manage – so I get a bit of both (medical and surgical) exposure, really. You’d hardly ever get bored I must say. There’s some bit of thrill crawling under the bed looking for the patient’s lost urine container. Expect everything, I’d think.

The Bad. Being so random means often I’d be running around the entire hospital doing a variety of things. It could get pretty dizzying at times as I can get about up to 30 pages within a shift and suddenly you’re wanted/needed all over the place. I often spend a good few minutes standing in the corridors just working out a list in order of attendance.

The Ugly. On my first night, I remembered receiving a call to pronounce a patient dead. That was really an eye-opener as I’ve never done it before, neither have I been familiar with the process. I know I have to deal with this sooner or later, just that I didn’t expect it to be this soon and at such an unsuspecting time. The patient was new to me and the nurse left me in the room with the patient to do my stuffs. Let’s just say that was the first time I entered a patient’s room without attempting to introduce myself.

I proceeded with examining the patient for signs of life (heart sounds, breath sounds, pulse, etc) and whipped out a pen-torch to check her pupils for a light response. She was still a bit warm when I examined her, and I just learnt that night that often a newly deceased’s eyes would remain open (previously closed as she passed away in her sleep) after I’ve done checking for a light reflex. I documented my findings and pronounced her dead – thought that was it.

Little did I know (or was I prepared for) that it was a reportable death which would mean I’d have to make a coroner’s report. This was all news to me and I remembered sitting in the dimly lit work area sifting through her file, looking for information to fill in the report form. This process of course would be less time-consuming if I were her regular treating doctor (the day team) but since I’m doing random night shifts (and my first night then too) – I was hopelessly clueless. It was a bit nerve-wrecking knowing that whatever you wrote in the report would be made viewable to the department of justice and there was much anxiety in trying to keep it as accurate as possible with such little knowledge that I have of the patient.

I filed the report. Had to contact the coroner’s office to inform them of her death and their impending case. I thought that should be about it but I was wrong.

Coroner’s office : Thank you for the information, Dr. Now I’ll just send over the police to take a statement from you.

Me : Oh…okie.

So there was I, giving a police statement for the first time in my life. Prior to this, I thought my first personal encounter with the police (if ever) would most likely be me trying to talk my way out of a speeding ticket. Apparently not.

2. You encounter all sorts of people.

The Good. After some mixing around and some chance encounters, you’d really get to know whom are the ones who look out for you, which is particularly reassuring for a newbie. People tend to be more understanding and patient when they know you’re a newbie; some are really keen to teach and night time is surprisingly not a bad time to do so as we’re not as caught up with the morning paperwork.

My rotation so far has familiarised me with the night nursing staff. Given that this would occur regardless of which shift I am on, somehow I find that we’re more at ease and laid-back with each other – this is most likely due to each of us having a general understanding that there’s less people staffed at night, so we’d all better get along as we’d be seeing/needing a lot more of each other. It’s also a lot easier to really get to know your colleagues when we’re within a relatively smaller group.

The Bad. Some people are, uh, difficult. I received this strange request from the ward one night to ‘talk to the patient’. I went upstairs to see this really disgruntled middle-aged guy whom was giving the nursing staff a hard time. He refused to be treated citing that he demanded to know the exact plan of his treatment, questioning every single detail he could pick out (from why are there 2 bags of drips instead of 1, why did they change the dose of his medications, etc). I could understand the rationale for some of his issues although I thought it looked a bit odd for him to bring all this up at midnight when none of his regular doctors are around.

Soon he started questioning the point of monitoring him (why did we took his blood pressure, why his pulse, etc) and suddenly he asked if he can use the phone to obtain legal advice. I told him he has all the right to obtain external advice and aid, just that I’m not too sure if there’s somebody on the other end of the line in the middle of the night. I gradually explained every single thing that I could with regards to why there is a need to monitor him etc (I find it ironic that he questioned the reason to keep him under observation when he was claiming that we’re delivering a subpar level of care apparently) and gone through a long-winded process of placating him to wait till morning comes for his regular treating team. I repeatedly explained to him that I would not be the best person to advise him of his long-term course of treatment as this would be best done by his regular consultant whom would be more knowledgable of his condition.

Fortunately, he became more reasonable. He waved as if going ‘I’ll have mercy on you, newbie” and settled back in his bed twiddling his fingers. This guy looks pretty determined to get what he wants (or hear what he wants to hear), or he just had the best episode of sleep-talking I have ever seen.

The Ugly. Ah, the meanies. Every now and then (hopefully not too often) you’d bump into people whom appears unstoppable at making your life difficult. I can understand that it’s at night, we’re all tired and hungry and sleepy but some are just bloody grumpy to no end. I’ve had a senior nurse who had shrieked at almost every single thing I was about to do with the reasoning that I looked like I’m about to do it wrongly. With an unbelievably ‘huge’ amount of faith and confidence that she had in me, she could very well be my best friend for life. Pfft.

What really irks me is that she’d morph into a very sweet and charming personality the moment the senior doctor makes an appearance. Suddenly she becomes very chummy and friendly with me, teasing and sharing jokes amongst us as if nothing has happened. Look, I’d really appreciate it if she’s being all warm and friendly towards me but that doesn’t mean that she should have a spade shoved up her arse each time the senior doctor isn’t around. Sheesh.

There are also patients who demonstrated a tremendous amount of confidence in your ability, mainly exhibited by heart-warming and encouraging questions/statements such as Are you sure you know what you’re doing or Can I have someone else more senior or even You haven’t done this before haven’t you?.

I can totally understand their concern, besides it is their health we’re talking about after all. But then again many of them do not realise that this is how we all learn in the first place – the highly regarded seniors and consultants all pretty much started out as newbies once upon a time as well, and they got to where they are now because of their level of experience and expertise. Having said that, I for one agree that some procedures and decisions should only be carried out by the seniors as it requires that level of experience for good decision-making…but um, all I was trying to do was to take some blood/put a drip into their arm. It is a simple basic procedure, but I think most of you out there (especially those in the medical field) would understand that it’s not fool-proof and it only gets better with practice.

So unknown to them (not consciously at least), they’re actually not helping us newbies to learn by denying the opportunity. Can’t level up as we tend to say in video-game talk.

3. Things are done differently at night.

The Good. Not much formalities. We all pretty much turn up in comfy casual clothes, which is good news for me as I wouldn’t have to bother much with the ironing (cause I am a lazy bum). It’s a nice change to be able to walk into work in shirt, jeans, and sneakers. No formal ward rounds, which would mean much less paperwork for me.

There is a relatively more relaxed atmosphere at work. I usually would bring a bucket-load of sweets and chocs to keep my energy up throughout the long night; passing them around to the much-delighted staff as we pored over our patients while nibbling away. No hustle-bustle like during the day when various teams of doctors scuttling around reviewing their patients and no waiting around for your unit to congregate to start a round. Just pop in and do whatever that needs to be done.

The Bad. As it is night time, you could become relatively busier as suddenly you find yourself needing to do everything (as opposed to sharing the responsibilities with the other intern from your team during the day). It’s a one-newbie show most of the time. It makes things more difficult when you have to cover the wide variety of surgical patients regardless of what unit they’re from (anything from the usual gastro to plastic surgery) and that could be quite a huge patient list to deal with.

The emergency department is also particularly busy at night as patients are directed/shunted to turn up at the ED as most clinics are closed after hours. I’m usually paged to the ED for any surgical admissions to finalise the paperwork for them to be transferred to the wards. Due to high patient intake, I find myself often facing pressure from the ED nurses to do the admissions as soon as possible (given that I’m stuck in the wards most of the time sorting out stuffs there) as there is a pressing need to empty the ED beds for new patients. Usually during the day, this could be discussed and negotiated with the other junior doctors on your team on whom would best available to go down to the ED to admit the patient. During after hours however, it would only have to be the one surg intern on duty (me!) as there isn’t anyone else. So needless to say, it can get immensely busy.

The Funny. There was a time when I had to prepare the patient for a surgery. This would include doing a cross match for blood in the event of heavy blood loss during surgery, as well as the insertion of a urinary catheter. Usually it’s fairly straightforward when it comes to putting in one, except that there is less light to work with at night. It would be ideal to actually just turn on the entire room’s lights but that would mean having to wake every patient in the room up – which would be inconvenient. So we normally just turn on a small bedside light located at the head of the bed, which would suffice most of the time. Most of the time, I say.

The lady whom I was supposed to insert a bladder catheter into was very pleasant and cooperative. I had the trolley and all the equipment set up and ready to go. Trouble was, it wasn’t very easy to locate the urethra under suboptimal lighting and I was straining my eyes trying to find it (trust me, it’s not as easy to find as we all thought it would be). I didn’t want to spend too much time fiddling around, and for a moment I had this grand idea of asking the patient to pee a bit so I could see where it’s coming from BUT there is a risk of getting my face sprayed with it so never mind. I still think it’s a brilliant idea though.

I asked the nurse to assist me in locating the urethra and she resourcefully turned up clutching some huge torchlight (when I say huge, I meant those heavy duty ones which people use when going camping or caving). I had to stop myself from grinning when the nurse proceeded to shine the beam centred between the patient’s legs so I could carry on with the task. The patient must have felt awfully weird to be in such a vulnerable position with legs splayed out wide and to have a personal ’spotlight’ on while 2-3 people doing a mini treasure hunt. She took it all in good humour, commenting that “I would normally enjoy all the attention except that it’s all down there”.

The powertorch helped, and we got the job done. Hehe.

Now that was a fairly long post. That’s all for now, folks! Stay tuned *grins*.

This wasn’t intended as the subsequent post BUT I think it’s way too interesting to pass up.

It all started when my friend and I were taking a train towards the city for the annual motorshow/car expo. It was a pretty warm day so we were kinda relieved to have stepped into the conveniently air-conditioned train, especially after spending some time  under the sun waiting for one.

We both sat down and indulged in occasional banter in the interim. There was a moment when I was looking straight ahead into the next carriage; daydreaming aimlessly. My friend was right next to me gazing off through the carriage window; and then it happened.

As she was right next to me, she was somewhat visible within my peripheral vision. She appeared to be turning her head towards me (as if gazing beyond me) and suddenly I saw her quickly turning away very abruptly. It was almost like an invisible jolt which sent her head immediately towards the other direction.

I got a bit curious and looked at her; enquiring. Not too sure if there was something which really made her looked away suddenly or was it a brilliantly swift muscle spasm.

She leaned towards me slightly and murmured in a very low voice.

“I think that guy…isn’t wearing any underwear”.

Upon hearing such an interesting/shocking/amusing/thought-provoking revelation – I, of course, turned to take a look.

Ah, indeed.

Directly diagonally across where we sat, there was this elderly gentleman whom planted himself quite comfortably in his seat – legs fairly apart. I could obviously see the reason for his choice of attire (simple polo shirt and very short bermudas) as the weather was approaching 40 degrees Celcius…but oh my.

There was a unanimous decision (although just between the 2 of us) that either his pants were way too short for an outing, or there was a mistake/high-fashion decision on his part on the obvious absence of underpants.

My neck did a 180 degree turn away too; it was like a reflex. In that extremely brief glance that I took, I captured a glimpse of an appendage that was, um, dangling/hanging/peeping out/what-have-you out of his right trouser leg. To be honest, I knew it was part of his male reproductive organs just that I couldn’t be sure which one.

The following conversation then took place between my friend and I.

Me : Eh…I saw something. You think that’s the balls?

Her : Hmm…not too sure.

Being me, I just had to take another quick look. Just to be certain, you know?

Me : Uh, not sure. Colour doesn’t look quite right. I don’t think it’s usually that pink.

Her : I don’t know actually…*she was trying hard not to laugh*

Suddenly, she groaned quite audibly and sanked in her seat.

Me : Hmm?

Her : He lifted his legs. Now you can see everything.

The elderly gentleman had just hoisted both of his legs up unto the empty seats opposite him. Voila. There is no way you can’t tell for sure now because they’re all exposed in their own glory for a swift and sure identification.

Me : Wow, no kidding! *tries hard not to laugh too obviously*

Her : Oh man…

Me : Actually, how can he NOT know it’s showing? I mean…it’s even resting on the seat!

Well, my arguement here is if it’s gonna be grazing (and maybe getting a lil squashed) against the seat’s cushion…I thought he must at least felt SOMETHING.

Her : *trying very hard to look away and forced an interest in the view outside*

It was not easy trying to remain calm and keep a straight face during that train ride. My friend trained her gaze at the window but I could see her mouth scrunching up trying to contain her amusement. I had to pull my cap over my face so I could at least have some release by laughing behind a make-shift screen.

We did contemplate on what we should/could do. I recalled my friend bringing up the discussion on if we should let him know of this lil’ unintended (we perceived it to be unintended) exposure, but was quick to dismiss it when I told her there is no way I’d be walking up to him going “Excuse me sir, but your penis is showing”. Sometimes, what you don’t know won’t hurt you. 

Thankfully, the gent arrived at his intended destination and promptly stood up to leave as the train taxi-ed up the station. As quickly as it came into view, it went into hiding equally quick too. It’s almost like now you see me, now you don’t.

We both sighed with relief. Partly for ourselves; partly for him.

I hope he headed straight back home from when he left the train.

*     *     *