Tag Archives: district hospital

The Drunkards of Mordor

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“A drunk driver is very dangerous. So is a drunk backseat driver if he’s persuasive”
Demetri Martin

On a quiet night in ED as my nurses are having their Nurses Day celebration nearby and my MAs gladly taking over their duties for a while.. a call came in :

Requesting for 3 ambulance!

I was super excited. The fire brigade teams were already despatched at the scene of accident and after assessing the severity of the condition had requested for medical team help. When the patients came , I was a tad disappointed. They were 4 big, drunkard , attention seeking men who were honestly not seriously injured.

This means:

  • the whole village would come and think they sustain serious injuries. Most common problem is a lung contusion to which the patient would have difficulty to breath (common ). While we  will give them pain relief thay would blindly insist on an ambulance service to the tertiary hospital for further treatment. this is the time when even the most macho men would become sissies. pondan.
  • security guards become useless. unable to handle the crowd of relatives thus endangering the safety of doctors and staff
  • answering the same question again and again from the same family but different people. apa lah yang susah gilak nak faham. mok diulang byk2 kali. sidak eksiden tok satu hal juak. dah tauk mabuk.. gago mok nereb.
  • having uncooperative patients. ‘kenapa mau ambik darah saya?’ ‘saya tidak mau xray’ ‘sakit!! sakit!!’ cuci lukak kau ngan spirit bok tauk,
  • other patients waiting time is increased, they’ll get upset or angry

All in all, as mentioned earlier. NO one sustained serious injury but boy do they exaggerate their pain. Most importantly, not one of the four drunkards who came in admitted to being the driver. Everyone was in the passenger seat! Morons.

The Diving Midwife

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“I am in no mood to be deceived any longer by the crafty devil and false character whose greatest pleasure is to take advantage of everyone”
Camille Claudel

Or as how its correctly put in Bahasa Melayu , ‘Bidan Terjun’.

I wonder if its written on my face literally, the phrase ‘Bidan Terjun Available’ for some people seem to think that its okay to

  • change my shift to the least favourable time on the last minute
  • ask me to cover the clinic on the last minute
  • ask me to cover the wards on the last minute
  • be on call on the dot on the last minute

Thank God as of now I havent been told to like give a presentation on the last minute. Id totally axe the person.

Perhaps I should tattoo my forehead with ‘Not Single Anymore. I Now have commitments!’. Mind you, I am not asking for a lee-way or special treatment. Im not asking for less calls per month. Im not asking to be on the morning shift at all times. Im just asking for some form of consideration. Time to prepare. To plan on;

  • who will babysit my child whilst Im gone for the sudden night shift or oncall
  • when and how I am to carry my other Wifely and Motherly errands
  • personal study time
  • my own sleep time so I could still function as a human being
  • preparing meals (though now is less significant as beloved MIL prepares em all.. he he)
  • what to wear the next day!!

For I totally understand that being a doctor and a mother/wife at the same time is demanding and needs proper time management. As of now, Im hoping that if I become good in one aspect of my life, Id become better in the other. I wish the latter would rest on the responsibilities as a wife/mother.

A weekday call in ED

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“A doctor who cannot take a good history and a patient who cannot give one are in danger of giving and receiving bad treatment”

A weekday call in the Emergency Department (ED) means that Im the sole gatekeeper of the hospital together with my armies of Medical Assistants (MA) and Nurses. So it is very important to have a good team : Team Minci Activated!

Here, my call would start at 4PM. And end the next day at 4PM too.

My colleagues from the morning shift would handover their cases (if any) so I may continue to see to their management and ensure that the patient is either;

  • Admitted to the wards
  • Discharged with another memo to come back to ED for a review of their symptoms or repeat a particular investigation
  • Discharged with a referral to the nearest polyclinic
  • Referred to the tertiary centre (GH Malacca)

Things are usually at a calm and steady pace between this hour and 9pm. To this short moments of sanity, I owe my gratitude to the polyclinic next door for their extended hours service till 9Pm. Its after 9PM when the chaos begins.

Illness and maladies that walk through the door may include;

  • a simple straightforward flu, fever, cough
  • asthmatics requiring nebs
  • change of dressings
  • pain of all sorts : eye, back, stomach, leg and the top most important : CHEST PAIN
  • trauma/assault cases
  • very old people with electrolyte imbalances
  • sick kids
  • malingerers

YUp. Malingerers. The best friend of hypochondriacs. Whose symptoms are exaggerated with an aim for one piece of paper. The medical certificate. Easily identified as they start narrating their tall stories regarding their illness only to refuse any form of blood taking or investigation (as we see fit) and only wanted a days rest for all the perp to go away. Kenjar! gambong!

So things would take on its toll after 9PM and by 12MN, Id be hoping for no more new cases to come in. I would try to clear all cases as early as possible for I not only want to get some rest ( so I could filter what Ive seen and learnt for the day) but so as my Team Minci for the night could get a few winks of sleep too just in case a major trauma walks in.

On a so called good day, my ED (mind you, this is district) would be quiet by 3 AM, frequented mostly by asthmatics in the early hours of the morning. On a bad day, Id still be up till 8AM!!

And last night was a good night. Heh.

Stand a little taller

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“Blame someone else and get on with your life”
Alan Woods

A colleague was miserable at work today. He had all the best intentions and effort to help a particular patient the other day, only to receive a phonecall today from the patients daughter in a very undermining tone, “Im calling you to inform you that my mother had a brain bleed. I hope you’d be able to provide an answer to that. As to how you missed it”. The accusation to me was harsh. This daughter had all the means (financially) for first class medical care. Instead, she made her mother came to our little hospital with no CTB facility and dare point out that it was my colleagues fault. Total.

Well. As doctors.. this is one of the risk or cons of the job. People remember you for your mistakes, not the many other million good things you’ve done for the patient.

The phonecall caused my colleague to be in great distress as he tried to remember WHO the patient was and WHAT the presenting complaint was. Patients are not androids. They dont give straightforward and precise medical history.

Some came with fever and stomache pain, only to be diagnosed as having a heart attack.

Those with poor appetite ended up having a malignancy.

What seemed to be a simple nausea and vomiting episode ended up with one having a bleed in the brain.

On top of having to find the significance in their long winding history, we also have bear and grin the pain of having to face patients who are not bothered at all to remember the medications they eat. Worse still, having about 15 items on the prescription list for a supply of 2 months, only to default their medication. Then, default their followup which is precious time for other patients who would appreciate such appointments.

Irresponsible patients dont get hacked. Ini tidak adil!

ED tales

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Nurse Haleh Adams:

“I’ve been doin’ this job for 17 years, honey. Doctors come and go, but nurses make this place run. We don’t get much credit or pay. We see a lot of misery, a lot of dyin’, but we come back every day. I’ve given up bein’ appreciated, but I sure as hell won’t let any of us be taken for granted”

-ER TV SHOW-

The Emergency Department (ED) here is not as glamorous as what most of us would see in the US TV series, ER. Especially when you’re living in an area where the people just love going to ED for the simplest complaint. Such as a straightforward dry skin or cough and get free medication. At the same time, trying their luck for an MC. Photobucket Hello.. WHERE IS THE URGENCY IN THIS?? Nama pun unit kecemasan.. nangga muka pun sekda riak cemas.

ARgHHH.. Kepak eh kerja mcm tok ujung minggu. Macam blh expect jak sidak tok dtg ED semata2 mok MC. Pemalas na jak urang Msia tok paduhal when it comes to work. Honestly, why cant they take pride in doing their work [read: menjalankan amanah]. For I remember during my years studying in the UK, the enthusiasm shines through eventhough you’re working as a cashier in Tesco. Or when you’re picking up the trash in the neighbourhood. My goodness. How could the ‘spirit’ not resonate here as well? Is salary a factor? Well… it could be. But really, if you hate your job so much….QUIT.

That was one of the advice I gave to 2 of my patients.

Having to deal with malingering patients is one thing, having to fulfil the ‘order ubat’ from them is another.

Can you give me panadol?

Can you add on some vitamins?

Can you give me ubat batuk, selsema and panadol untuk simpan jadi stok kat rumah?

Photobucket

One other thing that irks me is that some patients come in with all the ‘serious ailments’ from every part of the body. When we suggested tests and possible admissions … they would refuse because they only want the BLOODY MC!! Photobucket tolonglah.. go to the private clinic.

Rant. Rant. Rant. Ngerepak. ngerepak.ngerepak. At the end of the day, terpaksa juak insaf.

Dr. Luka Kovac:

Our job is to save lives not to judge them.

SIGHHHHHHHHHHH