Xiao’s Blog

….. when things don’t go my way even I put so much effort and time into it. I realised I had a pretty short fuse. I am more angry at myself than being disappointed.

Had 22 patients on my list today. Rostered to work from 0800 till 1545 due to stinginess of the department. Blah…blah… managed to save so and so much money from not paying overtime. Managed to discharge 5 patients today. Completed 4 d/c summaries. Did a referral to ID. Reviewed one patient. Spoken with 3 pharmacists regarding d/c medications for the 5 patients. Got an authority medication approved for one. Skipped Grand round today. Skipped lunch. Skipped toilet. Skipped water. Spoken with Urology regarding one patient with hematuria. Had one consultant ward round. Managed to sit down at 1630 for a breather…… got back home only to realise that there were still 2 referrals to be made.

Hate to leave things to tomorrow really. Lack of time is not an excuse. The registrar is not going to be too impressed tomorrow, considering he even skipped his teaching time for patients with exam in 3 weeks. Damn it.

Gotta buck up more.

Gen Med started not exactly the way I wanted nor expected. Did not expect it to be that bad. Of course, the first time of the year holding the pager. However, it wasnt the pager that frustated me through the week. Somehow, I felt incompetent: not able to finish the discharge summaries, referrals not made properly, chasing the ward round all the time yet not knowing exactly what was going on with some of the patients. Chaos is an understatement. I didn’t feel like I was practising medicine at all. In fact, I misplaced my stethoscope one morning and did not realise it was missing until the time to head home. Just showed that I had not been using my stethoscope at all, which was pretty sad. Made worse coming off such an educational rotation in Emergency. I had expected the Gen Med job to fare slightly worse, but not to that extent.

In order to save cost, the hospital implemented a rather peculiar system. Either the system is deficient, which is something I am pretty convinced of at this point in time,  or I am going to take a little bit of time adjusting to it. A meeting with the clinical director seemed to make the situation worse, probably wiping out whatever motivation we had to go the extra mile prior to the meeting.

Anyhow, shall look forward to 2nd week and see how things go.

Arrivederci.

22 weeks of Emergency rotation done!

Finally, I am moving upstairs into the ward. Spent a little bit too much time in the “dungeon” of the hospital. A few of my patients were amused by my description of ED as a dungeon. Well, it is definitely a place of organised chaos, ambulances lining up in the ramp, patients streaming in through the door, the main computer screen showing the never ending list of patients, as if mocking us the doctors in the ED, by adding 2 patients to each patient we managed to clear. Phones buzzing, nurses shouting, loose papers on the floor.

I must admit I’ve learned plenty during these 22 weeks of ED, probably a different ballgame to the interns in the wards. Emergency Dept is the first point of contact for patients,and more often than not, the patients’ care would be largely determined by the ED physician. An ischemic chest pain for the cardiologists, an acute abdomen for the Gen Surg, after determining it’s not an O&G problem, etc… etc… If there’s such position as a Diagnostician as held by Dr. Gregory House in the House medical drama, it would be the ED physician in real life. Yet, for some unknown reasons,an ED physician are always known as “just” an ED physician. And a neurosurgeon wouln’t be known as “just” a neurosurgeon.

As a junior doctor in the Emergency, one thing that I think would be different from the work in the ward would be the amount of responsiblity and decision making I have to make with regards to patient’s care in the ED, of course, with consultation with the more senior staffs when I am stumped. I had the chance to do various things while in the ED most memorably would be the countless sutures

On Monday, I would be finally picking up my pager, which, I know I would come to hate sooner than later. It just doesn’t feel complete being a doctor without the dreaded pager. Gen Med here I come!

~.~.~.~.~

Gotta start preparing for my application for next year soon.

Arrivederci.

Doing some readings in my past time. Thought might as well jot it down here for future references.

In the last decade, there have been a few respiratory viruses making their rounds throughout the world: The SARS virus, H5N1 and now H1N1.

SARS virus - the famous Severe Acute Respiratory Syndrome virus, which I can vividly recall the TV broadcasting the situation in China where the healthcare workers were quarantined BY the Chinese government that reportedly tried to downplay its severity until it was too late. SARS virus is a Coronavirus (SARS CoV), a positive sensed, stranded, enveloped RNA virus. Its 2003 outbreak affected 8000+ cases with 900+ death, giving us a mortality rate of roughly 11 percent. 6 years since its global introduction, there is NO human vaccine that’s been successfully produced to date.

H5N1 - “The Avian Influenza”, “The Bird Flu” is a an Influenza Type A virus, a negative sensed, single stranded, segmented orthomyxoviridae RNA virus. It’s considered an unstable virus with high rate of mutation since its introduction. As of May 2009, it has 373 cases with 233 deaths, giving a mortality of roughly 62%. It has however limited human-to-human transmission potiential with cases thus far have a trend of being reported in cluster. Its high mutation rate allows it higher probability of reassorting with other strains and co-infecting a host organism such as pig. Human vaccines exist but its efficacy has yet been tested in a pandemic scale.

The 2009 H1n1 virus - the current trend, the “Swine Flu” is an Influenza Type A virus, similiar to the H5N1, a negative sensed, single stranded, segmented orthomyxoviridae RNA virus. Not much I can read about it. Said to be a highly unstable virus as well. It has affected 21000+ cases thus far, with 100+ deaths giving it a mortality rate of roughly 0.5%. Work on vaccine is under way.

So there conclude the 3 viruses I’ve read about a little bit today. So what’s the deal with the H1N1 virus, its mortality pales in comparison with its more famous brethens. I thought about it for a while. For that, perhaps, we need to go back to the basics of epidemiology of disease. It’s a world of fair trade. A disease that’s highly virulent and pathogenic would “have burned itself out”, due to its high mortality and morbidity rate resulting in lower incidence and prevalence as time passes. There is less case present to cause more cases, in short.

The H1N1, on the other hand, belongs to the high prevalence, low virulence group. As it has a lower mortality and morbidity rate, it would have a very high incidence and prevalence. As mentioned before, these 2 viruses have very high mutation rate and share a common host organism in pig. If you cross the 2 viruses…… you get the idea.

I quote one of the consultants, we woulda shit our pants when “pigs really fly.”

God bless me as I am now on the frontline (the Emergency Dept, the cheapest ones the hospital can employ at that)

Then again, I am not an infectious disease specialist. Fair to say, I am not an expert in this subject. All right, time to go back to the more interesting topics in my study - Acute management of chest pain in ED……

Arrivederci.

I do have a lot of things I’d love to say face to face but for now a big THANK YOU would have to do.

Arrivederci.

I used to believe in one thing :” The older you get, the lesser friends you have.”

It was an interesting observation I made during my secondary school years, looking at Dad, Mum, aunts and uncles. Back at that time, my time was so jam packed with activities : studies, basketball, uniform units while I observe the adults and elderlies spending most of their time at home. I probably spent 80% of my time awake outside my home. I had a few phone numbers in my pocket which I could always call up to arrange some sort of activities : movies, basketball, cybercafe or just to talk nonsense on the phone.

As the years went by, slowly but surely, friends somehow dwindle in numbers, down to a few friends whom you probably meet and talk every month, a couple whom you just say hello every few months and another few more you always try to meet and say hi every year.

I am starting to understand the reason behind my observation. As one gets older, one’s responsiblity turns more inward: responsiblity to one’s family, building your own family in parallel with your career. Probably that’s where I am right now - buidling a career. As for building a family, well, still working on it - a long way to go with that:)

~.~.~.~.~

I was having a conversation with one of the senior doctors in the Emergency Dept. He actually graduated from my clinical school way back in 2003. He actually pointed out a rather disturbing fact to me when I mentioned to him I would be going for the physician pathway- there’s no job at the top, at consultant level. There are quite a number of qualified consultants who couldn’t get consultant jobs in the hospitals just because there is no vacancy. Thus, assuming that I pass my exit exam in FRACP in the next 10 years, I would be jobless. Unless I am willing to work as a registrar till there’s a vacancy opening up.

Anyway, I think I got carried away a little bit. Now time to start planning and applying for residency next year.

~.~.~.~.~

Got a few things on my to do list. Custom built a gaming PC. Wash my car and ?repair the scratches on bumper. Cut my hair. Clean my room. Read up on a couple of things : Management of muscular tear, ACLS.

Till next update,

Arrivederci.