Hospitals 101

August 21, 2007

The more I see it, the more my life is morphing into an episode of Scrubs.

After spending a few years doing my training in various hospitals and health care centres, I’m starting to see a pattern emerging. There’re always a bunch of people with really colourful personalities and characters that sometimes you wonder if you’re actually unknowingly starring in some TV medical series sometime somewhere. Here’s a few that I bump into on a fairly regular basis (and sometimes more than one of them in each category too) :-

The Vanishing Big Shot.

This category usually fits the head of the department. He’s always the big fella who’s at your orientation day singing praises and extending his welcome on behalf of the hospital. Often seen enthusiastically taking questions fielded by new students and staff alike and portraying the image of the approachable boss.

The irony is, when you really have a problem, he’s nowhere to be seen. On a trouble-free day, he’d give you a big smile and go “How are you finding this rotation so far?” to which we’d nod appreciatively and comes the “Oh this rotation rocks!”. The boss would then laugh with much glee, and went on his merry way. On a screwed-up day however, he does as what his namesake describes; he vanishes.

Mind you, that this is not about the department head intentionally ‘disappears’ to avoid dealing with issues – it’s just one of those life’s unexplained phenomenon which fates his uncontactable status on the same day as you would screw up. Trust me.

The Scarily Helpful Nurse.

Man, I’ve met one of them so far and that’s scary enough. Look, it’s very good and extremely fortunate of me to know such a helpful person but this person pops up near me once too often for comfort. I know that the ward is not a huge place and we’re all gonna bump into each other but this guy purposely goes out of his way to walk up to you and enquires if everything is going fine. Honestly, I wouldn’t be that apprehensive if he didn’t have that ‘frozen’ stare which bores down on you when he talks. His expressionless face-mask belies his generous verbal offers of assistance. It’s almost like he has taken it upon himself to sheperd me through each day of my training.

Him: Oh hello there! How’s everything?

Me: Oh hello! Um so far so good I think.

Him: *gives the scary stare* Hmmm…doesn’t sound like you’re doing alright.

Me: *immediately regreting my earlier reply and mentally noted to myself to give a more affirmative answer next time round* Oh no I’m fine, serious.

Him: *unflinching* Really? Hmmm.

Me: Yah, I mean, it’s just my first week of being rostered to this ward so it’d take a bit of time to get used to. You know *nods convincingly*

Him: Is everything alright with your studies…? *turns his head to the side, something like he’s looking through a scope at you etc*

Me: Yah it is, no problem. I’m just pretty green here but in due time I’ll be fine.

Him: Hmmm…I see. I’m sure you’ll be.

Me: *grins* Yah. So, which area are you working at today? *changes the subject*

Him: Me? I’m found everywhere *smiles*

Me: Ah wow *smiles back*

Off he goes on his stuff. I’m pretty sure we both smiled for totally different reasons back there. Phew. He does this like 80% of the time which I find a little bit intimidating. As much as I appreciate the concern, one of the last things I needed would be to be quizzed and interrogated just cause I happened to be walking down the same corridor as he does. Looking at the bright side, he’s just being overwhelmingly helpful so it can’t be that bad right?

Having said all that, I find myself doing quick sneak peeks down any corridor that I’m about to walk into. Some may call it phobia, and even some could call it paranoia. I call it instinct.

The Starry-eyed Junior Medical Student

I realised that they often can be divided very roughly into 2 categories; the amazingly confident ones, and the extremely shy ones.

They’re often present during ward rounds where they’d tag along with the team consisting of a consultant, a registrar (senior doctor), an intern (newbie doctor), and a final year medical student (me!). I am usually alright with the junior’s attendance (usually I’m most happy for them to join in) until they started making me look bad.

Not too long ago was there a shining example of this. I had 2 junior students with me; one was the bold brave gung-ho type (a.k.a. Mr. Confident) while there other was the quiet and bashful kind (a.k.a. Mr. Shy). We were doing our rounds like the usual and the consultant joins in halfway throughout the process. While we were discussing each of the patient’s plan of management, the consultant was grilling everyone with questions except for the juniors. I’m all up for learning opportunities except that I realised each time when we get an answer wrong, Mr. Confident would SMILE.

It started with the consultant throwing questions at the registrar.

Consultant: What would you do if the patient develops X complications? How likely?

Registrar: *answers confidently* I would do etc etc etc..

Consultant: Well, nooooo…

Mr. Confident smiles. Pardon me, but it’s not one of those ‘polite’ smiles (well it could hardly pass for that anyway) that you’d give sympathetically when someone gives a wrong answer. His smile was akin to a deliriously delighted kid having an open-jawed smile as if someone as about to toss a candy into his mouth.

Registrar: Oh..um *thinks somemore* Then I’d do a etc etc etc

Consultant: Hmm…nope.

Mr. Confident’s smile just expanded by half it’s original size.

Consultant: Think about it. What does the patient have? What are you most concerned about? *turns to look at the intern*

Intern: Mmm…I first would do etc etc then check it everyday to monitor the levels etc

Consultant: Umm…that’s not what I’m getting at here.

Ah, the smile grew on Mr. Confident’s face. You know, we were all standing on one side of the patient’s bed with the consultant being on the other side of it. The juniors strategically stood by the foot of the bed, and Mr. Confident’s head rocked back and forth as the conversation ping-ponged between us and the consultant along with his increasing smile/glee/jaw problem/what not.

Same thing happened when I answered a question wrongly later during the rounds. I saw the smirk on Mr. Confident’s face (Mr. Shy however, blinked sympathetically – if there’s such a thing for lack of a better description). I spent the next 15 seconds attempting to project to him telepathically saying “Don’t laugh, it would happen to you next time”. Ah well.

I am pretty sure I didn’t smirk like that at the seniors when I was a junior medical student. I was far too busy day-dreaming during rounds.

The Indecisive Patient

Mmm…not sure if I should laugh or cry. Either way it’s worth a tale of its own.

There I was, wheeling an IV trolley towards this fella as he needs to have a drip inserted. I thought before I set up the materials I’d better go ask for his consent first. So I did.

Me: Hello there Mr. A. I’ve been told that you need a drip in you. Is it okie if I put one in?

Him: Who are you?

Me: I’m the final year med student, sir.

Him: *frowns* Can’t the doc do it?

Me: Ah he could, but they thought it’d be good practice for me. This is the only way to learn.

Him: You’re gonna be a doc right? Ah well I guess. Ok go ahead.

Me: Thanks.

So I laid out the stuffs that I needed: the cannulation needle, some gauze, dressing pack, skin tape, gauze, syringe, saline, etc. I’ve already put the tourniquet on and am already swabbing the area with some antiseptic.

With the needle ready, I looked up to the patient. “Okie here goes. Expect a sharp sting”.

Suddenly patient sits up in bed. He pointed to the urine container. “I need to pee”.

Oh okie, I put down the needle and told him I’ll leave him to it and come back in a few minutes. As I was drawing the curtains around him for cover, he went “Um never mind, just get it over and done with” as he placed the empty container by his bed.

I peeked inside. “You sure? I could wait you know”, I told him. He waved me over and encouraged me to proceed. Okie.

So there I was again, having to check for the vein as I undid the tourniquet earlier when he said he needed to pee so he could move his arms better. Happy that I found a pretty visible vein, I swabbed the area again and picked up the needle.

My eyes were fixed over the greenish blood vessel under his skin when I felt him jolting. He was pointing animatedly to something over my shoulder.

“Ah! I see my friend!”, squealed he, as I looked out of the window to see a red car driving into the hospital’s parking area. I smiled at the patient and assured him that his friend should be up at the ward to say hello, I’m sure. The needle’s now steadied over his arm.

Me: Alrighty, here goes.

Him: …..I think I need to pee.

Me: Oh. Okie. Lemme undo the tourniquet.

I returned the needle to the trolley for the third time and handed him the urine container. As I was about to stand to leave, I saw him gazing into the urine container.

Him: Hmm…I think I’ll wait. You better go ahead and finish your stuff.

Me: *doubting him* You sure? If your bladder can’t hold it’s best I leave you to it first.

Him: *sets the container down yet again* No, you do your stuff. I’m alright.

Me: You absolutely sure?

Him: Yeah yeah go for it.

Me: Okie. Right.

I told myself if he ever reaches for the container and NOT pee again, it’s gonna be the first time I’ll ever convince/coax/plead a patient to urinate once and for all. Thankfully, the patient didn’t exhibit anymore sudden random fleeting desires to empty his bladder till I was done. Looking back, maybe he got a bit nervous prior to having a needle put into him? No idea *shrugs*

A mischevious part of me thought about hanging a shiny plaque above his bed emblazoned with the words:-

‘To pee, or not to pee…That is the question’

Hehehehe XD

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Nightime.

When the land is silent and the air is still.

At the end of the day, everything comes to a closure. For some, it marks the temporary break from the daily grind. For some, it could just mean another day spent. And for some, it makes no difference.

For me, nightime is when the soul calms and the mind unwinds.

I’d always fancy the idea of decking out at somewhere out in the open in the middle of the night, when the air is crisp and cool. A lil’ blanket or a thin rug spread out unto the grassy field and I’d lay back and gaze up into the night sky.

Imagine, it’d appear as if you’re looking into an infinite velvet space peppered with twinkling stars; all glittering in its subdued brilliance. Occasional light breeze then caresses the skin as the eyes remain fixed upon the other end of the earth.

I believe this would be a really great way to soothe the mind and soul. For some, it could be a form of escapism where one is momentarily lost beyond the stillness of the night. For some, it could be a safe and tranquil heaven for the mind to work its magic. And for some, it would be the perfect backdrop for a simple yet meaningful banter between two good ol’ souls – be it the hopes and the journey between two lovers, or the dreams and aspirations between two childhood friends.

Life is really and truly a roller coaster ride. For every win, there could be another greater success. For every loss, there could be yet another deeper heartbreak. No one knows for sure what tomorrow would bring. We’d all understand that in each of our own lives there is a form of routine to it; the degree of predictability. But then again, there is only so much that we could expect for a certainty. Sometimes it only takes a very minute change to turn a day into something out of the ordinary. 

I’d take one day at a time; one step at a time. I believe that for every eventual outcome, we all each would have to walk down our own paths. It is considered prudent and wise to look ahead, but sometimes  you could be so intent on the finishing line that the appreciation for every step towards may be lost. I could understand that we can be so driven to achieve something till we single-mindedly occupy ourselves with nothing else except for that notion.

Life trains a man to be both a realist and an idealist; to aim and hope for the ideal best, yet to acknowledge realities and prepare for the worst.

All part and parcel of the journey, of course. But while I’m at it, I thought it’d be a good idea to occasionally veer off the path and unto the grass. I’d look back at the road travelled and appreciate that I am where it has taken me; and look ahead and anticipate  here onwards how it would be.

Nightime provides the silent mirror to both recollect, and to gaze into.

If I lay here,
If I just lay here,
Would you lie with me
And just forget the world?

– from the song Chasing Cars by Snow Patrol –

 

‘Dear teacher, my son is under a doctor’s care and should not attend P.E. today. Please execute him’.

I’ve chanced upon a bunch of actual notes which were written by parents to explain their child’s absence from school. Some of these are unintentionally funny due to errors in spelling and grammar, while the others are just plain hilarious (or they’re written by parents who really couldn’t give a hoot). This collection was formed through enthusiastic submissions of the notes by teachers in a particular state of the U.S.A.; be it for educational or entertainment value.

Here they are.

Please excuse Roland for missing school today. He fell from a tree and misplaced his hip. Did they check the tree??

Chris could not come to school cause he has an acre on his side.

Carlos was absent yesterday because he was playing football. He hurt his growing part. Hmm.

Please excuse Lisa for being absent. She was sick and I took her to the doctor and have her shot. Tough love.

Irving was absent from school yesterday because he missed his bust.

I had to keep Billie home because we’re gonna go Christmas shopping and I don’t know what size she would wear.

John was absent because he had two teeth taken out from his face. Who’s teeth was it?

Dear school: Please ekscuse Johnny being absent on Jan 28, 29, 30, 31, 32, and also 33.

Please excuse Jennifer for missing school yesterday. We forgot to get the Sunday paper off the porch, and when we found it on Monday, we thought it was Sunday.

Please excuse Jimmy for being sick. It was his father’s fault.

And my personal favourite…

Please excuse Pedro for being absent yesterday. He had diahre dyrea direathe the shits.

That’s all, folks! :D

All in a day’s work.

ED’s a busy busy place. The impression you create when you stand still is instantaneous. Suddenly you look like you have nothing to do. Either that, or you don’t have a clue on what to do.

A typical shift in the emergency department includes tons of walking around and being on your feet like 95% of the time. People are always whizzing past you and vice versa. Due to the fast paced order and environment I’m in, not everything is always what it seems to be.

I was walking hurriedly (how appropriate) past a row of cubicles and I spied a lot of white sheets as I went past the confinement room. The confinement room is a stronghold-like room where it’s used to house uncooperative/violent/mentally agitated patients, and the door is a heavy-looking huge slab of white with semi-frosted glass panels.

I immediately back-tracked my steps and peered carefully through the glass.

I saw a figure in bed, all tightly wrapped up in the sheets. A dead body, I thought.

Next to the bed I could see a lady in a chair, resting her forehead on her hand as she sat very quietly and motionless. Her eyes were closed; as though in deep prayer.

She must be a relative of the deceased. I slowly backed away from the door and began to head towards the main workstation to resume my work. It is very likely that the deceased patient has been re-allocated to that room in particular as it is quiet and the relatives would have their space for a while.

I was scanning through the list of patients up on the whiteboard and my eyes fell on a young patient who is presenting with double vision. Great. I remember needing to perform an eye examination as part of my assessment somewhere down the line and this patient would be a nice opportunity. Whipping out my drug-company-freebie pen, I jotted down the cubicle number on my palm and proceeded towards the direction of that patient.

Eh, it’s that same cubicle as before. The confinement room.

Hmm? Maybe I was mistaken. I could still see the lady from before still in her seat; eyes downcast. Back to the board to double check, I figured. A slight frown was starting to etch over my face; I was pretty sure I got the number right.

Nope, I wasn’t mistaken. The patient assigned to that room really did came to the ED with double vision.

I blinked furiously while maintaining my gaze at the whiteboard. Death due to double vision? I mean, I knew there could be a lot of underlying cranial/systemic pathologies which could manifest itself as a disturbance to one’s vision but…hmm. I honestly didn’t expect the patient to deteriorate so quickly having just presented himself with double vision in the first place.

I stood outside the door. Should I go in to check? Would it seem insensitive and inappropriate to stride in to double check the deceased’s identity while they’re grieving?

Being indecisive, I find myself looking through the glass again. My hand was already clutching the door handle and I was about to pull the door open when I saw something very very shocking/disturbing/what have you etc.

The wrapped-up body MOVED. Oh my gawd.

I was stunned in place as I saw the figure shifting around in bed, and suddenly the lady whom was seated next to him started talking to him. In the next subsequent moments I realised a few things:-

1. The patient really came in with double vision. He found the place pretty cold so he wrapped himself up with the sheets and lay in bed with his back facing the door.

2. The lady next to him, turned out to be his mum. She had actually fallen asleep on the chair earlier when I saw her, which is of course a thousand miles away from anywhere near grieving/praying/mourning.

3. The room. The patient was allocated to that room due to the shortage of free beds in the other cubicles. Nothing to do with the family wanting some time or a quiet place whatsoever.

So that’s how it actually was.

I swear I almost peed myself when I saw him moving. I guess this shows that you don’t need to have double vision to do a double (or triple!) take.

Quirks of the past weeks

August 7, 2007

Here comes August.

I have been pretty occupied with a bunch of stuffs during the past few weeks. Mainly been busy due to work for my current rotation (emergency medicine), where as other times I would be occupied with a few questions in relation to the working life next year. Fortunately however, that I finally gained some closure to some of my doubts. My internship is finally a certainty so that ‘s good news 😀 Prior to that, it was filled with a bucket of “what if?”.

Ah…being in the dark and all uncertain is indeed anxiety-provoking. I understand that there are some things you can do about, where as others we would have to let it be and allow the results or finality to reveal itself with given time. But still, the waiting is definitely not a fun process to go through. So when I finally knew for sure, that was a huge relief.

Now, life in the Emergency Department.

To be honest, I find my emergency medicine rotation pretty nice. We would get thrown into the deep end of the pool where we’d have to learn very quickly on how to deal with a specific case. I find that in my field of work, the best way to really learn is to go out there and do it yourself. The learning curve is indeed very steep but then again every one of us started out the very same way. The nature of the job requires a huge pool of knowledge so when it comes to medical students like us (newbies!), it could feel like we each have a huge mountain to climb.

Looking at the bright side, we (one part our own efforts; other part out of necessity) ended up learning a huge amount of stuffs in a short period of time. Not bad for efficiency right?

One thing about emergency medicine is that all the patients you see are in the Emergency Department (ED) itself. If they get admitted, they’re no longer under your responsibility as they’d be under whichever ward they’re at. This makes things much more convenient for a lazy bugger like me.

What happens is that when you receive a patient in ED, you would of course stabilise and treat the patient. If the patient’s ailment proves to be minor, he or she would be discharged post-treatment and that’s it. If it proves to be something pretty major or serious or spectacularly mind-boggling, then most likely the patient would need to be admitted to the hospital. Once you’ve made the referral and the receiving ward confirms that “Yes, this patient warrants an admission”, then that’s it too as now the patient has been released from your care unto theirs.

So in other words, the ED is where people get sorted out based on their need to receive ongoing treatment (admission) or to be prompted back to their muffin and cupcakes (home!).  But of course before any of that happens, the patients would have to be stabilised (especially when heavily injured/medical emergency i.e. heart attack) and assessed before any decision is made.

The ED is where you chance upon extraordinary patients, and sometimes extraordinary staff.

I have seen one patient who came into the ED cause he could not stop hiccuping. I was reading his notes before I went to call him in and was actually half-amused at what I saw written there. It seems that he has been having his hiccups for almost a week. With my overactive imagination I imagined some guy doing whoops all over the place which somehow was promptly replaced by an image of a seal. Oops.

I called him in and wow, they weren’t kidding. He was hiccuping so hard and so quickly (one after another!) till he couldn’t breathe properly. He’d double over and tremble with each passing hiccup. While talking to the patient to get a good history of what could possibly bring on this hic-hic spree, I was racking my brains inside. What’s with the hiccups? I pondered.

In my entire almost 5 years of medical training, I have never come across any hiccupy ailments ever. Until now, of course.

Funny how much we all had read about heart attacks, strokes, appendicitis, asthma, fractured limbs, the works etc so much so that when faced with something as innocent-looking (or sounding) as hiccups…we’re hopelessly clueless.

I thought the above to myself and laughed (of course I did scampered away from the patient’s field of vision and laughed to myself so he wouldn’t think he’s my source of amusement). What do I do? I went off to ask the consultant.

Me: I have a guy who’s been hiccuping for a week now etc etc

Consultant: So what treatment do you recommend?

Me: *with a helpless half-smile* I HONESTLY don’t know.

Consultant: Hmm.

Guess what? The consultant planted himself at the work desk and proceed to google a cure for hiccups. He clicked on the first result which popped up and began to read through it. I was standing right behind him glancing over at the screen as well. The ‘Mr. Glee’s (name has been changed) 100% guarantee to hiccups!’s page was filled with instructions on how the forceful swallowing of water would treat hiccups. It said something about getting a cup of water and pinching your nose before taking a quick huge gulp down.

You can’t be serious, I murmured to myself.

The consultant closed the webpage, slapped his knees and said “Why don’t you give it a try? Then come tell me if it doesn’t work”.

My eyebrow-raising reflex kicked in and I had to quickly force a frown in an attempt to disguise my subtle “HAH??” reaction a split second earlier. Okie then, worth a try anyway cause we’re clueless.

I filled a cup of water and was lingering along the corridor for a few seconds. What would the patient say? I don’t think he’d come into ED expecting to get some home remedy fix-up. Nevertheless, I proceeded.

“Are you kidding me?!?”, said a shocked he. Half-resignation, half-disbelief.

Ah, I saw this coming. He mentioned that he has tried almost everything, certainly this water gulping trick but was still cooperative enough to give it another go. It didn’t work.

The patient groaned and buried his head in his hands. I just managed an “Oh” in acknowledgement of the failure and headed back to report.

A mischevious part of me almost wanted to blurt out to the patient “Well guess what, you just disproved the method’s 100% guarantee!” with much glee but of course, ahem, that would be professionally inappropriate. If not professional suicide.

Told the consultant it didn’t work, and he wrote down a prescription for a muscle relaxant/anti-convulsant. We thought hey since hiccups are caused by diaphragmatic spasms so maybe this would work. The patient popped the pill and we waited like 10-15 minutes for it to work.

Not a single hic was heard after that.

Brilliant. The patient was very grateful. I could see his face was all red and flushed from the forced hiccups. He took a few deep breaths and savoured the time when he could actually inhale and exhale without any interruption. The hiccups were so severe that he hasn’t been eating properly for the past few days as he could not keep the food down long enough. Wow.

So folks, sometimes I think working in the ED is almost like being a handyman or a fix-it kid for medical odd-jobs. You see stuffs ranging from the funny to the bizzare with an equally fascinating range of proposed treatment to match them.

These kinda incidents make my shifts more interesting, and it certainly feels good to be able to resolve the weird and wonderful cases no matter how simple it may be. They are not your usual casualties or medical emergencies per se, hence it makes them out of the ordinary.

And what do you do when you see the extraordinary? You’d do the extraordinary.