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Life has been exciting and excruciating at the same time these past few months. Somethings inexplicable, others inexorable, but everything a learning event. Taking it a day at a time, with my assessment around the corner. I’ve completely given up preparing for it, already expecting the worse, even before stepping in!

The papers keep mentioning the overload of housemen in every hospital, and this has gotten me quite worried. If, in the current situation there are too many housemen, there is still so much work to be done that I have till date never gone back on time, how would it have been prior to this when there weren’t as many housemen?

Anyways, back to work. Things have been pretty okay, and I’m chugging along at a decent phase. Albeit I wish my progress was at the speed of which I chug down beer, the sad truth is, it’s a bit slower than that.

For starters, let it be known that I’m not a medical man. Every fiber in my being resonates to the tune of being a surgeon. The precision of the incision, the power of an excision, the beauty of each and every suture! Then again, I’ve not done my surgical posting, so we’ll just leave it for the future! Going into medical, I knew things are going to be a bit tedious, considering how much practical knowledge the Medical Posting demands, and how each and every decision we make affects the wellbeing of the patient we’re caring for.

Some cases are blatantly obvious, staring at you with large fixated eyes (much akin to Sasha’s), and others come with subtle symptoms easily missed with deadly ramifications. You need to always be on your toes. Competency is another thing because when you start your treatment, you want to make sure you’re doing the best for your patient. There is no room for complacency and incompetence. So you’ll always want to improve yourself.

Sometimes, you will feel that there is no end to all this work you’re doing. However, I find it very calming to know that there is beer at the end of the tunnel. When I feel I can’t go on, I just think of the ice cold pint that I can down at the end of the day, and it rejuvenates me, and I’m good to go for 12 more hours. Perhaps everyone needs to find out what regenerates them, and focus on that instead.

Recent times have been quite challenging. My ward is divided into Acute, Subacute, and 5 other cubicles, with each cubicles housing at the very minimum about 10 patients, with the possibility of extension beds to increase the numbers up to 15-16 per cubicle. Klang gets messy because we don’t turn anyone down, despite running way beyond capacity. Twin-edged blade really. Exposure to more cases, workload triples. I’ve been told Hospitals like Selayang and Sg. Buloh won’t allow admissions beyond the computerized maximum. Any extra admissions beyond capacity is dumped to places like Klang GH . It should be like this, as this will ensure patient care is not compromised due to overworked staff, but where will we send the sick people in need of care?

Anyways, recently I was put in charge of the Acute cubicle, and as the name implies, it is for acute unstable cases. Suffering from a STEMI, ICB, SEPTIC SHOCK, DKA, or generally being unstable will buy you a ticket into the acute cubicle. This basically implies TDS rounds, constant monitoring, quickly attending to any and all issues followed by an entire day of being on your toes.

Tapering Inotropes, Intubating, Resuscitating, Bagging, tracheostomy, it all can and has happened in here! My time in acute was exciting, as it was my first time managing the difficult cases by myself. Calling MO’s for anything is generally frowned upon, so taking care of everything by myself, and sometimes with the help of a senior colleague really bolstered my battered confidence.

These are things that no matter how many times you read in a book, is something that you must perform to learn. Of course I find myself experimenting with inotropes and the like, I’m able to gauge what kind of response I can get from a patient based on the dose I’m pushing, be it single strand, double strand, or multiple inotropes.

Procedures are the most fun of the lot. Of course I am not talking exclusively about the Per Rectums that we do and observe on a day to day basis. BMAT, Pleural Tap, Abdominal Paracentesis, Peritoneal Dialysis, CVP, Chest Tube, LP, Pleural Biopsy, so on and so forth.

“Watch Two, Do Two, Teach Two, You’ll Remember it for life” is the Mantra to live by.

When I did my first Abdominal Paracentesis, I felt manly, the second one, still had me tingling, today, every one I do has me relaxed throughout the procedure without too much worry. I tackle the safety points with greater ease, and am even comfortable navigating the branullae around to find the sweet spot for best drainage. I can still remember my first attempt, whilst successful took longer than humanly needed. This was because, I kept percussing 300x to ensure I was making the entry at a safe point, trying to avoid any major arteries and/or organs. When that was done, I just made a 60 degree incision, straight in and refused to budge the branullae in fear of rupturing nearby organs. Yes that’s right, at one point I thought I would push a grey branullae so deep inside that I would perforate intestines!

Today was a bit exciting, I was able to do my first Peritoneal Dialysis. Not Observe, but actually do . Of course the western world would scoff at us for still practicing this “barbaric” procedure, but to heck with that, I felt accomplished and manly (I find myself feeling manly quite a bit these days)! The only sad part was that the patient suffering from Advanced Renal Failure was a 23 year old young man. Presented with Urea of 56 and Creat of 1700, Potassium of 5.9 and severe Uremic Symptoms. I chased him (Insulin Chase or Lytic Cocktail), and started him on oral kalimate. Few hours later after the chase, Potassium was 5.3. Looking forward to see him complete 60 cycles of PD at 1.5% bags, and a downward trend of his RP.

Of course, I had to work 4 hours after my shift ended before we could get to the PD but it was well worth it. There is great satisfaction in knowing that I’ve helped this young man, and he will walk out of this hospital after finishing his PD simply shadows over working 4 extra hours after your shift has ended. Speaking of which, I have till date, never gone back on time when my shift ends, with 3-4 hours over time appearing to be the norm.

I’m glad I have job satisfaction at the end of the day, because without that, every demotivating thing that occurs during housemanship will lead anyone to the extent of quitting (and many have). With assessment around the corner, I’ve decided to simply forget about it. My thinking on it is simple, come what may, I’ll just do my job and sit for my assessment. If the powers that be believe I’m good to go, that’s great, if they think I need more time in Medical, that’s fine too, I’m not going to let it bother me anymore. At the end of the day, the more I gain at work, the better it is for me!

To those of you who have sat for your assessment and passed, Congratulations . To those who have yet to sit for it, the best of luck, and may anyone but Beelzebub guide you to success. For those of you who have sat for your assessment and are held back, here’s to you knowing more than anyone else ever will from your department!

For the rest of you who’ve had a walk in the park getting through, congratulations too Please publish your hospital lists so the future generations can follow through your footsteps!

This entry was posted on Sunday, December 11th, 2011 at 3:52 pm and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.