May 24, 2015
Back to my little slice of zen.
Haven’t written for a quite a while. Work and training has kept me busy, and very often do I forget about this little corner of mine when there has been too many things swirling in my mind.
The older I become, the harder it is to retain the same sense of wonder that one used to have. Often we are caught up in the ways of the world that we are just rushing from one thing to the other; all for the sake of keeping up with everything around us. At what cost?
I had more zen back then. Life was simpler. Or it appeared simpler then. The escapist in me is wishing to break free in a parallel universe with no consequences just so I could be still in my thoughts.
My inner peace. Where time stood still.
* * *
“Peace comes from within, do not seek it without”
– Siddharta Gautama –
* * *
February 2, 2012
Gong Xi Fa Cai!
Wishing everyone a Happy, Healthy, and a Prosperous New Year!
September 25, 2011
I know it is done out of necessity, but sometimes it feels like it’s going on for ages.
Top 10 reasons why ward rounds take longer than they should :-
The patient that can’t stop talking. Some patients decided to indulge the team in their delightful homemade recipes when all we wanted to know is whether have they opened their bowels today. A simple yes/no question becomes this soapbox for the patient to explore their culinary roots out loud. Too time consuming to listen to, too impolite to tell the patient to ‘talk to the hand’
The consultant that can’t stop talking. I have an immense amount of respect for them. I truly value their desire to teach. But when they start going on about how their game of golf went over the weekend with a play-by-play commentary in the middle of ward rounds, I can’t help but mentally sigh. The most common scenario nowadays is they get so excited about the new iPad that they can’t help but do a live demonstration on its wonders. Then proceed to discuss the specs, and the apps. It’s not a bad conversation topic, except not the junior doctors are struggling to carry the files while waiting for the consultant to arrive at the decision whether to give the Frusemide or not.
The family members that can’t stop talking. I know they have a lot of questions, I understand that and we encourage the family to air their concerns anyway. Everything is alright and appropriate, until the day when you meet a bossy family member who decides to document everything you said and do in order to jump on you the moment something goes wrong. That still isn’t so bad, until you meet one whom keeps harassing you why the patient keeps burping and demanding a medication review on the spot.
The nurses who keeps pulling you away from your ward rounds. Often it is out of necessity, but on and off you get the trigger-happy nurse whom zooms in, tells you something trivial, and then expects you to do something about it right away. When you do maintained that you’ll see to it after your ward rounds, the nurse nodded and walks off to tell the patient’s family that the doctor will be there in ‘a few minutes’. Of course, failure to turn up in a few minutes would then result in you being swamped by enquiring family members in the middle of rounds.
The wandering/lost patient. Not in the room, not in the toilet, not in the corridors. The team then has to detour back on and off to check if the patient’s back. Some tend to return when it is close to 5pm, looking all fresh and bright as they had a ‘lovely spot of coffee in the sun’ while you’re looking like you could use a toilet break. Some are kidnapped by the physiotherapist.
The missing file/drug chart. Not at the nurses’ desk, not in the patient’s room, not in the medication room. This is not too much of a bother for a stable and well patient, unless there has been an event overnight and the patient is too sick to tell you what happened. The ward round then becomes a search party which sends the team in all directions. You will be surrounded by the files you don’t want, and never the one you need. When you do manage to locate the file, you find yourself having to wait in line while the social worker, speech pathologist, and the occupational therapist all have their turn.
There is never enough space to write your notes. The consultant is rattling off the management plan at the speed of light, including a couple of drug names which you’ve never heard in your entire life before – and then realise that you are at the last page of the progress notes with only three lines to spare. Either you squeeze your writing to the point which no one could read (including yourself), or you excuse yourself to run off to find more fresh pages to scribble on. Usually it is the latter.
Technology failure. That rare momentous occasion when the computer is lagging badly, or internal servers are down for maintenance. Your consultant wants to know the patient’s renal function before starting medication, your registrar wants to check the loading dose for the medication, and you want to know if the IT tech dude is asleep at his desk.
Coffee breaks. When a senior doctor says “I’m gonna get a cup of coffee”, no one protests. But I am pretty sure there are some of you out there whom would rather quickly get on and finish the ward rounds as soon as possible. The seniors would be sipping their favourite latte while the juniors smiling nervously to cover their anxieties over not having enough time later in the day to do the referrals.
The unsuspecting new admission. You walk into the room and see this new patient sitting up in bed, smiling back at you. You smiled back and say ‘How are you?’. In truth, no one has a clue who this patient is nor what are they here for. There are no admission notes, no previous history, and the only way to find out is to do a full admission yourself . One new admission takes as long as approximately 10 coffee breaks. If it is a patient that can’t stop talking, then it would probably take 10 coffee breaks plus lunch as well.
And now let’s do a poll :-
September 12, 2011
The skinny man reaches over his jug of water and points to the picture on the wall. “That’s my kids”, said he. We saw two kids, aged 7 and 9, standing around a birthday cake as he smiles at the camera. This was not too long ago; he was well built with a robust complexion.
“They are very cute”.
He smiled. Now a shadow of his former self. This is the same person as the one in the picture, yet now they are worlds apart. Fatigued and jaundiced as he lay frail on the bed. The cancer had already spread to his liver.
“I really want to go home. I know I only have a few months. There is nothing I want to do more than to go home to spend time with my kids”, he spoke in almost a whisper.
A soft sniffling can be heard coming from behind. I stood still, not wishing to turn around. Part of me not daring to ‘acknowledge’ the sorrow in the room – as his elderly mother shed tears over the harsh reality of his prognosis.
“We’ll get you as strong as we can quickly so you can go home soon”, reassured my consultant, “If things take a turn for the worse, you can come back to us for end of life care here”.
He nodded slowly and deeply, turning his gaze to the field beyond the window. As we headed out, I caught a glance of his parents behind me. The mother was wiping her eyes silently while his father wore a solemn expression over his aged face.
There is this inexplicable sinking feeling in me knowing that the next time I see him again, it won’t be for very much longer.
* * *
The young lady with long black hair looked up from her seat. A deep frown embedded over her forehead. Her eyes looked almost pleading.
“How long does he have left?” she asked, in heavy accented English.
I looked at my consultant whom shook her head. “We don’t really know for sure, but it might just be only a matter of days”.
The man is barely conscious. Every now and then he would mutter something in his sleep, and then heaviness would wash over him. We were told that he has been requesting for his son ever since he started deteriorating.
“My brother is still having issues with his visa. Hopefully it should be approved by today and he could fly out here to see our father…”, she trailed off, before hesitantly adding “…I hope he’ll be here in time”.
Soft chanting of monks filled the room. A small black player on loop can be seen placed by his pillow, no doubt containing incantations of religious scriptures. The atmosphere was heavy yet serene.
Wonder if the son will be here soon?
* * *
“Do you have any pain?”, we asked. Her eyes were half closed, eyelids occasionally fluttering. Was there a faintest hint of a nod?
We could hear her murmuring incomprehensibly between her laboured breaths. Her sister reached out and held her swollen arm; limbs severely edematous from the steroids. Pale, bed-bound, and completely devoid of hair, she looked much worse that day compared to a week ago.
I looked at the syringe driver which was humming by the bed. Continuous infusion of potent analgesics and sedatives were pumped through the subcutaneous butterfly cannula in her arm. Her pain had been unbearable, described as a burning sensation spreading across her chest. The cancer had spread beyond then.
Her family were gathered in the room. One of her daughters approached me with tears welling up in her eyes. “Is she able to hear us?”.
I looked at their mother in her semi-comatose state. Suddenly I became conscious of my own breathing given the stillness in the room as they were all waiting on me to speak.
“She has been in this unrousable state for some time, it is hard to recognise when she is truly asleep and when she is just merely closing her eyes at rest. We do not know when she is drifting in and out. I encourage all of you to keep talking to her as you do; I am certain there are times when she is listening, we are just not sure when. Keep talking, you never know.”, as I nodded to the family in assurance. They gave their thanks and I left the room.
Is she able to hear us? I don’t have the answer. But I know the answer that we needed.
* * *
The stories are reflections of a regular day in palliative care. It is moments like these when you deal with the very real face of mortality. Thoughts and insights often dwell on the vulnerability of the living being where disease and death spares no one. To the afflicted ones, time is extremely precious when there is little of it left.
The following are excerpts from a poem by William Knox :-
Oh, why should the spirit of mortal be proud?
Like a swift-fleeting meteor, a fast-flying cloud,
A flash of the lightning, a break of the wave,
He passes from life to his rest in the grave.
The leaves of the oak and the willow shall fade,
Be scattered around, and together be laid;
And the young and the old, the low and the high,
Shall molder to dust, and together shall lie.
The hand of the king that the sceptre hath borne,
The brow of the priest that the mitre hath worn,
The eye of the sage, and the heart of the brave,
Are hidden and lost in the depths of the grave.
The peasant, whose lot was to sow and to reap,
The herdsman, who climbed with his goats up the steep,
The beggar, who wandered in search of his bread,
Have faded away like the grass that we tread.
The saint, who enjoyed the communion of Heaven,
The sinner, who dared to remain unforgiven,
The wise and the foolish, the guilty and just,
Have quietly mingled their bones in the dust.
For we are the same that our fathers have been;
We see the same sights that our fathers have seen;
We drink the same stream, we feel the same sun,
And run the same course that our fathers have run.
Yea, hope and despondency, pleasure and pain,
Are mingled together in sunshine and rain;
And the smile and the tear, the song and the dirge,
Still follow each other, like surge upon surge.
’Tis the wink of an eye—’tis the draught of a breath—
From the blossom of health to the paleness of death,
From the gilded saloon to the bier and the shroud
Oh, why should the spirit of mortal be proud?
– From The Lonely Hearth, The Songs of Israel, Harp of Sion, and Other Poems –
May 22, 2011
“Can you believe it? A TRAINEE doctor!”
I was making my way to do a pre-op assessment on a patient one evening (yup, working late) and my mind wandered to the agonising decision on how many KFC drumsticks I should takeaway later. That thought was quickly put on hold as I walked into my patient’s cubicle.
In bed was the lady I’m looking for, an arm in a sling awaiting her surgery on the after-hours orthopaedic list. A young guy was sitting by her bedside reading the newspaper. Both looked up and nodded as I gave the wide wave and smile which (according to the nurses) is too cheerful for someone working late.
It was soon established that the lady speaks minimal English and the son (the young guy) would be helping to translate back and forth. I went through my usual questions probing her med/surg history, and then informed that I might be putting a larger cannula on her other arm closer to the time of surgery.
Immediately the son had gone into a rant.
He pointed to the back of his mum’s hand (where I could see a small band-aid) and started looking all annoyed. Looked like a previous unsuccessful IV attempt.
“Earlier some trainee doctor tried to put a drip in, and he didn’t do it right and it hurts my mum so much. Imagine, a trainee doctor! How ridiculous is that??”, sputtered he.
I glanced at the mum and saw that she was nodding at her son’s words.
“Well…this is the way that the trainees learn. They need the practice.”, as I offered the son an apologetic smile.
“But how can they do that at my mum’s expense! I mean, a trainee doctor, come on! Why can’t they send over a real doctor to do it??”.
Look, I could understand why the son is upset – but I also don’t think they understand that we have no other way to learn except to real life practice. As tempted as I was to start my lil’ own dialogue on the learning predicaments of med students/interns/the rest of us, I chose to minimise dwelling on it.
I sympathetically apologised to the mum for the inconvenience caused, but did briefly maintained the juniors are learning and skill is gained via experience. It was unfortunate/regrettable that the attempt caused her significant discomfort.
I probably could have mentioned that the consultants they see walking around now were once newbies; we all gotta start from somewhere. The other thing is from the manner the son speaks, it sounded like they were expecting any real doctor to be able to do an successful IV on first try – to the point where I’d expect the son to gasp in disbelief/horror should they ever witness a more senior doctor fail putting in the drip.
Yes, the more experienced the doc is, the chances are better at a successful attempt. But ‘real’ doctor or not – we are all still learning, and we are not infallible.
However, if unrealistic individuals still choose to persist in condemning the newbies…in a world with no consequences, we might need to use one of these :-
May 11, 2011
Threw my blanket to the side and immediately made an ‘eek’ face. It’s freezing COLD. Told myself I could use another 5-10 minutes hiding under the blanket.
So much for 5-10 minutes. Jumped outta bed and put the water flask to boil. Kitchen floor feels like ice. Ran back in my pink checkered oversized pyjamas and sought refuge with the blanket again.
Made some Milo. Had breakfast drink in bed while having a quick surf for online news.
Glunked the Milo and jumped into the shower. Thank goodness for hot water.
Reaching deep into my pile of fresh laundry looking for some warm clothes to throw on. Have been putting off folding the laundry for a long time. Been spending every morning shoulder-deep in mound of clothes trying to find a complete pair of socks. Today is no different.
Arrived at work. Late again. Sneaked into the change room ninja-style to avoid looking guiltily late.
Said hello to the first patient of the day. Apologised for sounding like a frog in the morning. Made small talk to relax them and then disintegrate whatever composure they’ve attained by showing them the cannulation needle. Rinse and repeat with every patient. Whisk them off to theatre.
Lunch time. Too lazy to walk to the cafeteria. Made some toast in the pantry with loads of butter and sprinkled on some sugar. It’s raining now. Feels cold still. The clouds look grey and unwelcoming outside. Wonder if it’d get warmer by the time I get off work.
Said hello to the second bunch of patients. Unanimous decision that today is freezing. Started ranting about how hard it is to get up on time for work. Got patients to feel nice and warm being indoors before poking them. Smiles disappear fairly quickly when they see you with holding the needle.
Surprisingly finished work on time. Decided to go home and YouTube under the warm blanket to rejoice on this rare occasion.
Putting this entry up on the blog. Back into my pyjamas and clown socks. In bed with my laptop. Just had a nice hot dinner (minced chicken noodles!) and now savouring the feeling of being a lazy bum. It’s raining heavily outside and able to feel some slight chill emanating from the glass window.
Decided to do a personal list on the few cons of having uncomfortably cold weather :-
1. It takes a lot of effort to leave the bed to go pee in the toilet in the middle of the night. When decidedly to do so, note that the decision comes after either an incredible amount of contemplation, or the risk of the exploding bladder.
2. Bed = comfort zone. Anywhere beyond is not.
3. Hearing rain pouring as you wake up. The thought of going to work on a cold wet day at 7am is as encouraging as being told you are first on the list for a rectal exam.
4. Constipation. I can feel a bowel motion coming on, but the everything clamps shut the moment I sit on the icy porcelain throne.
5. Ridiculously cold hands and feet.
6. Risk of head colds. Walking against the cold wind sometimes gives me this tight uncomfortable feeling across the forehead. Puts me in a prolonged frown with squinty eyes ala Clint Eastwood.
7. Perpetual state of extreme laziness. I have minimal motivation to move my bum anywhere. Just look at the state of my room.
May 4, 2011
First rant of 2011, diligent eh?
You won’t believe what drove me to writing again. Uh, well actually I thought of doing so for a long time now just that I keep procrastinating. But in all honesty, it was triggered by the news of Osama bin Laden’s demise. Seriously.
But not like what you’d expect.
2 days ago. I recall running up the corridors outside of the operating theatres while hurriedly pulling the scrub balaclava over my head. There was an orthopaedics list going on and they usually insist on everyone having a balaclava to minimise the risk of infection.
I stuffed my previous usual scrub cap in my pocket (the one that looks like a shower cap) and thought, “Instead of being a mushroom head, now we all look like Osama bin Laden“.
A couple of hours later, I saw a few theatre staff gathering round the TV in the tea room. CNN was on and the breaking news tag line carried the words “Osama bin Laden dead”. I remember this was just a few minutes before the Barack Obama goes on air to give a public address.
My mind backtracked to how he came up in my thoughts just before. Didn’t expect him to be declared dead so shortly after. Was mentally reeling by the news. It was a strange feeling.
Then I thought, man, I really gotta get back to blogging.
* * *
So what’s everyone up to nowadays?
I am still quite the YouTube junkie. Most of my days off work were spent browsing YouTube for really random stuffs. Anything from how to prepare sashimi to catching up on The Apprentice to watching a tournament clip of a Street Fighter match.
Incoming mini rambling on work.
Work has been a major energy-drainer (those long hours sap the life outta you). Whatever free time I have are mainly utilised to pay off my sleep debt and to indulge the glutton in me. One of my terrible habits is being really prone to missing meals when I am at work. When it gets busy I’d tell myself to wait another hour (and another, and another…) before I run off to grab a bite – only to end up doing a 12 hour shift straight without any food in between. Feels like I’ve enrolled myself into an accidental weight loss program.
I wear scrubs at work nowadays and although it’s very comfortable, I now have the familiar phobia of my pants suddenly unraveling and dropping to my ankles without warning. They come in different rough sizes but they’re kinda big on average. There are days when I arrive a bit late to work (another one of my bad habits) and the small pants are all snapped up. Next up would of course be the medium sized ones which fit me as well as you could fit a primary school kid in maternity wear. I then end up looking like a wannabe rapper for the rest of the day.
Oh ya, the lanyards.
I dunno about the rest, but I believe I’ve stuck too many things unto my lanyard/ID tag.
Firstly there’s always the usual standard photo ID tag with a magnetic swipe card. Not only do I realise I smile like a monkey, now others can see that for themselves too. There is also an ID access card for another affiliated hospital which I have secured to lanyard so I don’t end up misplacing it. So that’s Monkey v2.0.
Next comes a stack of laminated quick-reference cards (like drug doses, therapeutic levels, protocols, yada yada) which I think I carry about 15-20 of them. They’re all of a different colour (some in neon!) which I would flick and flash them quickly to confuse/stun the kiddies when they’re not cooperating. Makes them think I’m from Sesame Street.
Attached to the clip of the tag are my locker keys and another one which I now can’t remember what it’s for (was obviously daydreaming during orientation). They each come with their own bright identifying keychains. I tinkle when I walk.
I have also clipped a penlight and incidentally a malfunctioning pen – hasn’t been quite right since I dropped it down the stairs – to the the lanyard. Sometimes a spare hairclip too. And yes, the bulky pager.
Collectively from all of the above, I suspect my entire lanyard weighs close to a kilo. It jiggles/rattles when I walk, and when I turn around quickly I’m at risk of injuring others. It swings out in a style reminiscent of cattle swatting flies with their tail.
Oh, and now it also can be used as a nunchuck.
August 22, 2010
This is one for the bad days that we all have experienced at some point or another.
Ever felt like you’re in the wrong place?
Ever thought maybe you’re just not fitting in?
Ever felt that you are probably doing it all wrong?
Ever thought that you’re just not good enough?
Ever lost confidence in yourself?
Ever wondered, ‘why me’ ?
Ever wondered, ‘was it something that I had done/didn’t do’ ?
Ever felt as if it’s you against the entire world?
Ever thought ‘if things are alright then why do I feel like I’m still falling short’ ?
Ever felt so exhausted that you couldn’t see yourself keeping it up?
Ever doubted if you know what is it you wanted?
Ever felt that everyone else seems to have a clue except yourself?
Ever felt doubtful of the future?
Ever felt like escaping to someplace so nothing reaches you?
Ever wished for time to stand still until you’re prepared to move on?
Have you ever?
Then you’re human. Just like me.
August 8, 2010
In agony, he limped out to the roadside. The road was filled with cars and motorists. The equatorial sun was boring down on him; its glare blinding. He saw a hint of yellow and took the chance by waving at it. As it draws closer, he sighed of relief. He got into the cab and hurriedly gestured to the driver to go.
The driver turned around and asked, “Where are you going?”.
The man, face wrinkled in pain, silently mouthed the word ‘hospital’ But it was lost on the driver.
“Where do you want to go?”, asked the driver, starting to get a bit confused.
The man, huddled in the back seat with his arms over his belly, groaned and pointed to his abdomen and gestured frantically.
Rummaging through his bag, the man’s trembling hands managed to gather his notepad and scribbled the word ‘hospital’. He showed it to the driver.
The driver was illiterate.
The pain took over, and the man crumpled into a foetal position, sweating profusely. The driver picked up that he better send this man to the nearest hospital.
* * *
In the emergency room, a young doctor approaches the man. “What seems to be the problem?”.
The man looked up and pointed to his stomach, mouthing the word “pain”. His face was flushed.
The doctor rolled up his sleeves, “Pain? How long has it been? How bad is the pain?”.
The man shook his head sadly amidst his aches. The doctor’s words fell on deaf ears.
The man was my instructor. He is stone deaf.
Not too long ago, I had the opportunity to pursue a course in sign language. The above story was related by my instructor on some of his difficulties he had to encounter due to him being hearing impaired. We have all imagined how challenging everyday life can be when one of our 5 senses are lost, except that there is no absolute way to fully appreciate the weight of its implications unless we are them.
We can only imagine.
My instructor is one of the most optimistic person I have ever came across. He wasn’t born deaf, but lost his hearing due to a childhood infection at the age of 6 months. He described it as having ‘stones for ears’ where no sound passes through at all.
Some may think, deafness can’t be that bad. After all, you just can’t hear.
One just can’t hear, true. But this is something that is easily taken for granted.
People who are deaf from a very young age tend to become secondary mutes, as they are unable to speak due to the inability to hear how a word is vocalised in the first place. Some can be trained via a complex learning program where they mimic lip and tongue movements in an effort to vocalise some words – but often these are not easily accessible as locally qualified trainers are very few. These affects their educational opportunities immensely.
From a medical point of view, the hearing impaired are being indirectly marginalised due to the breakdown in communication. Not many medical personnel are equipped with the background to converse in sign language. Most of the time, a deaf interpreter would be called in and at times they may not be readily available during a crucial situation.
I have encountered a deaf patient whom was newly diagnosed with cancer. I remembered sitting with him for more than an hour writing back and forth on his huge notepad (which he keeps by his bedside to communicate with nursing staff) explaining the diagnosis and the plans for further investigation. Although necessary with the lengthy amount of time spent writing, I find that he is at a disadvantage as certain procedures and plans for him are being delayed due to the patient not being fully informed/discussed with (as many of the staff would rely on the hospital’s deaf interpreter).
The interpreter is only available via bookings and appointments and this is imposes some limitations to the patient’s accessibility to healthcare, as team would have to wait for the interpreter to be present to hold a discussion with the patient on his disease. These may take a couple of days.
* * *
“Everything has its wonders, even darkness and silence, and I learn, whatever state I may be in, therein to be content” – Helen Keller (1880-1968) American author, activist, lecturer, and the first deaf-blind person to earned a Bachelor of Arts degree.
* * *
I had the opportunity to do some volunteer work for a deaf charity recently and had an eye opening experience on how the deaf are perceived. We set up a booth where we were selling the charity’s merchandise to raise some money and I was paired with a deaf colleague as the in-between person to the patrons.
When I approached the passerby’s, a lot of them assumed I was one of the hearing impaired and hurriedly gestured “no” or smiled uncomfortably while walking away. It wasn’t until I said hello that they raised their brow in surprise. Those whom are more open to being approached are usually those whom have worked with the deaf before. Majority of the rest were observed to be appearing slightly at loss or flustered when approached by the deaf, as they wondered perplexedly on how communication would be taking place.
I am very glad that I took part in that project, as it helped to raise awareness of the deaf community. Working with them has been enjoyable and it grounded me on the fact that underneath it all they’re just like you and me (I know a deaf comedian). Once you overcome the communication aspect, their whole world opens up to you.
* * *
My instructor has shared with us his experience on visiting a special home which houses the blind-deaf. His heart went out to them as he saw how they managed their day to day activities.
Every room has an object tied and hung on the doorknob. For example, the kitchen would have a spoon tied to the door while the toilet door would have a toothbrush attached to it. The residents make their way around the place by running their hands along the walls and identify each room by feeling and recognising the distinguishing objects.
They communicate via sign language as well but to for them to ‘listen to you speak’, one must first take their hands and place it on yours before one starts signing. It is then they would slowly feel the movements of the gestures to recognise each sign in order to understand what you are telling them.
The visit left a huge impression on my instructor. It was a humbling experience. What seems to be the simple things in life are the things that we take for granted; once they leave us only do we realise how much they made up our world.
Beyond the sound of silence there is a world which many of us are blind to.
June 18, 2010
Expensive art by Chinese master stolen. CLICK link to view.
This is a rare oil painting done by Chinese master artist Xu BeiHong, stolen from the owner’s family home. This painting carries a great sentimental value as it is the only item left behind by the man in the painting to his descendants (previously was in the care of the current 3rd-4th generation prior to it being stolen).
Please urgently notify the authorities/Interpol if you’ve come across this painting (or know the whereabouts of this painting).