Xiao's Blog

Thanks to Jellio I went looking for the book “How to survive in anaesthesia: A guide for trainees” by Neville Robinson and George Hall. Just a couple to add to her list

Never start ananaesthetic until youhave seen the whites of the surgeon’s eyes.

Always pee before starting a list.

If you are feeling tired the three ‘S’s’ is a good reviver – a shit, a shave and a shower (politically incorrect but we do not know the female equivalent).

ABC of anaesthesia: always be cool, always be cocky!

Remember KISS – Keep It Simple, Stupid.

Anaesthesia is ‘awfully simple’ but when it goes wrong is ‘simply awful’.

If in doubt, ask for help. There is no place for arrogance in anaesthesia.

Big syringe, little syringe, white knob, blue knob, big purple knob – good for most things.

First rule of anaesthesia, if there is a chair in theatre, sit on it.

Never panic. This applies particularly when the patient is trying to die and you have no idea why.

Where there is cyanosis there is life – just!

If in doubt, take it out. This applies to tracheal tubes and many other things in life!

There are three things to respect in anaesthesia: the airway, the airway and the airway.

When all else fails, disconnect the catheter mount and blow down the tracheal tube.

Careless ‘torque’ costs lives – don’t let breathing tubes kink.

The laryngoscope is a tongue retractor, not a tooth extractor.

Nobody dies from failure to intubate the larynx, they die from failure to ventilate and oxygenate.

Fix tracheal tubes as if your life depended on it – the patient’s life does!

The first five causes of sudden hypoxia in an intubated, ventilated patientare the tube, the tube, the tube, the tube and finally the tube. The tracheal tube may be dislodged, disconnected, blocked, kinked or the cuff herniated.

‘Sniffing the morning air’ position for tracheal intubation can be described as the position of the head when taking the first sip from a pint of beer.

Never say to the patient ‘just a little prick’ before inserting a cannula, you are likely to be told that is exactly what you are!

Thiopentone solution can look like augmentin and antibiotics do not induce anaesthesia.

For a rapid sequence induction always have two doses of suxamethonium ready in case one goes over the floor/ceiling etc.

Be professional – try to emulate Humphrey Bogart’s definition of a professional as somebody who can still give their best performance when they feel least like it!

Arrivederci

It’s been a while I left my home, somewhere in the midst of the palm oil trees. This time, when I go back, probably a yearly occurrence since 5 years ago, I won’t be returning to the place I used to call home for a good last 2 decades. Yes, I would be still living among the palm oils, but in a different geography, of course.

Since young, I must say have been pretty pampered. I didn’t need to do my bed, wash my dishes, dirty clothes or even step into the kitchen. Granma was adamant that I do not ever step into HER kitchen. Food would magically appear and dirty dishes were magically done. What a life that was! However, I wasn’t exactly slack. I put a lot of hours into my studies then, for a dream that seemed so distant. Looking back, I was pretty delusional, never thinking I was working for a dream, more of an eventuality. All I need to do back then was just play, eat, study and sleep. Only worry that I had back then would be remembering to hand in my homework before its due date.

Growing up, much has changed. The magical dishwasher and laundry are not there anymore. In fact, they were never there too. In its place, it was my family supporting, feeding and looking after me back then. I was pampered perhaps, but definitely not spoilt. Homework that was never done well, never go down well with my strict parents. My parents were very stingy with my wants and toys too, but indefinitely generous when it comes to buying books.

When I started earning my paychecks, I realised there is a lot of things that would want my time after work. The dirty dishes, the dirty laundry, house cleaning and etc. The phone bills, the various insurances, the car service and maintenance schedule ; the continuous process of learning and studying and perpetual upgrading of knowledge and skills, all demand plenty of my time.

Then I realise if I don’t “work” for my food, I’ll have to go without it. Thus, going to the market, stocking up on fresh food and groceries, preparing and washing the vegetables, cutting and cleaning the meat and then finally cooking them. After that, I would need to clean up the kitchen too, make sure everything is kept properly and orderly in the refrigerator. It involved quite a bit of work, but I insist on home-cooked food, much to the surprise and benefit of my lovely housemate.

As I said, no matter how busy you are, how great a doctor/surgeon you are or gonna be, I believe nothing should displace the feeling of coming home to a hot and properly cooked food ready on the table. Of course, I can easily take away various food from the eateries at a small expense, but I prefer not to, despite its convenience. Partly, because, I want to make it feel like a home, away from my home. My housemate certainly doesn’t mind that either.

Of course, I missed being chauffeured back home by my Dad from school after a 7 hours school session and a 7 hours of gruelling basketball training thereafter, to a hot and pleasant dinner, on a regular basis. Then a hot bath would be ready for me with clean towel and fresh clothing before retiring to neatly made bed. Perhaps, that’s my family’s way of buying me the GameBoy, Walkman, Lego, Transformers and etc that I never come to own.

Ahh…. how I miss all of that. But, I guess all of us would have to grow up out of those, sometimes.

I reckoned I did and that wasn’t too long ago.

~.~.~.~.~

On another note, there are two doctors in the house now with an engineer in the making. Congratulation to my smart little brother.

Be afraid, be very afraid.

“Why so serious?” *cue evil Joker’s laugh* muahahahahaha.

“No matter how busy you are, how great a doctor or surgeon you are or gonna be, let’s not forget the feeling of coming home to a warm and home-cooked meal on the table after a lengthy day at work.”
-Xiao_zhai-

Back home in June! Arrivederci.

Medical nights shifts allow me a full week on and a full week off work, which is nice , during the week off of course. Would be heading back to the shift tomorrow.

I am looking to move away talking about work related stuffs now. Otherwise, it would be just work , work and work.

It’s been a pretty busy week off. Tidying up the loose bits and pieces of the trip to France i.e. transfers and accomodations. Still has a few things unsorted. A travel itinery would be next on the list. A friend recommended me to buy a LonelyPlanet book on France. Shall look to that.

Caught up with a couple of my friends. Movies. Coffees. Lunches. Dinners. Gossips. Talking crap. Datings. Meeting new friends. Karaoke.

~.~.~.~.~

Lucky me able to watch NBA playoff live on TV during this week off.

Cleveland has been eliminated. To be honest, looking at Lebron, I was disappointed for his lack of fight. He’s such a talented player yet he doesn’t come across to me as one who wants to win. Kobe, on the other hand, for all his ball hogging and negative headlines, is heck of a worker and a winner. I don’t think there’s any worse loser than KB24 in the NBA at the moment. That fella I think is the worst and sorest loser.

Prediction : Lakers in 5

Phoenix Suns had been pretty good, sweeping SA Spurs in the previous round. However, I reckon Suns would be undermatched with Lakers.I managed to catch Game 1 live on TV. Was a bit surprised Suns started Brook Lopez at Center for the first time since returning to injury. They are thus able to put Amare at PF where he would definitely own and overpower any other PF in the league. Good news for Suns, of course. More firepower in the inside to compete with the Lakers.

But Suns are still undermatched in the inside, with 2 seven footers to match up to in the Lakers team. In Game 1, Amare adjusted and played pretty well, his mid-range jumpers were hot, rather than going up against the larger Lakers. That woulda downplay Lakers’ strength on the inside.

Two, Suns has no defensive stopper for KB24. In the run-up to the match, they were promoting Grant Hill as the Suns’s stopper to KB24. That was new, Grant Hill was never known to be a defensive stopper to me compared to Shane Battier, of course. How did he do? KB24 lit up the scoreboard that night. Suns is seriously undermatched for KB24.

On the other hand, Suns has a certain Run N’ Gun PG, Steve Nash. Matched up against Derek Fisher. One on one, I had no doubt, Steve Nash gotta pawn Derek, anytime, just like what Russell Westbrook and Deron Williams did in the previous rounds. How did Fisher do? He exceeded expectation that night. He had his hands active all night. Nash did not actually breeze by him as expected.

Why Lakers?

A certain number 24 player, who by the way, is playing with a broken finger, a banged up knee and ankle.

Lebron oughta take note from him. That is what I called effort.

~.~.~.~.~

Celtics and Orlando?

I was telling a friend of mine the other day. Very hard to call, because of the ways both teams have been playing.

Celtics is a team of seasoned veterans, playing the grinding basketball where their motto is literally – “Offense wins you fans, defense wins you championships” sorta thing. Good team and chemistry. Reliable role players. Improving Rondo. They managed to shut down the Cavs in the last round. A team consisting of KG, Paul Pierce and Ray Allen needs not further mentioning about their CVs. But I reckon they have a few bench players who would match up favorably against Magic.

Glenn Davis is not everyone’s dream inside player, but the few times I watch him on videos, he would be a big problem for a lot of teams’ “better” inside players. He isn’t that tall for a post player. Strength-wise, he would do well but definitely not the strongest out there. But one thing he brings : he attacks the basket relentlessly whether he gets blocked or fouled hard. The commentator mentioned that 30% of his shots are blocked, yet I still see him attacking the basket, again and again. That would give the Magic a little bit of problem and foul trouble. Definitely a good player to have on any team.

Orlando Magic is my dream team, in the sense that a team I would like to play in. A team of one dominant center surrounding by 4 shooters. I would love to play in this team, as a shooter of course.

Dwight Howard currently is probably the most dominant inside player, physically and defensively. However, his offense is still questionable. Decision making too. To be fair to him, he is still a rough diamond. With a dominant inside presence, most teams would have to double team on him, thus allowing one of the shooters an open look. As much as I love 3 points shooting teams, they are a bit unpredictable, when they are hot, they are incredibly hot. Not even a championship calibre team can shut them down. When they are not, they are incredibly cold as well. It is what the shooters call rhythm. If I am to choose, I wouldn’t want a team that depends on 3pt shots to win. Too unpredictable. Attacking the basket would be a better option with a layup off the board.

I was saying Celtics in 6. But now that Celtics had swept the 2 home games of Magic. Looks like it is going to be a sweep for Celtics.

That’s all for now, folks.

Arrivederci.

I walked out of the hospital today, feeling a heavy load off my shoulders.

Twice, earlier in the course of the day, I had tears welled in my eyes. For two very different reason, as well.

First, was my patient. I considered her as my responsibility because, I was the one co-ordinating the various teams.  I ran the ward while my registrar was not around and down in the clinics. I spoke to the family, updating them.

After a month plus in hospital, we still couldn’t figure out the answer. I am afraid time’s running out. She was remarkably even when all the objective measurements seem to suggest otherwise. She is now in ICU on Norad to maintain her hemodynamics just 24 hours after we thought that things were looking much better. She must be septic, somewhere. But all 30+ blood/line/swap cultures had been negative! And she spiked temperatures no matter what antimicrobials she was put on. We had trials of Tazosin, Vancomycin, Meropenem, Fluconazole, Posaconazole, Caspofungin, Metronidazole treating for an assumed infection, somewhere.

The only clue we had are microabscesses in the spleen, which would be suggestive of fungal infections. She was put on antifungals with almost no effect. Was planning to go in with an U/S guided aspirate but patient was deemed too high risk for bleeding due to thrombocytopenia. Now that her cells had recovered, perhaps, we can go ahead with a guided aspirate for diagnostic purpose. Would she be fit for a splenectomy if needed, considering that she is now only 3 weeks post emergency laporotomy for perforated small bowel? Questions… questions… questions….

The second time in the day was after I walked out of the Prof’s room with his words still ringing in my ears

“You’ve done a remarkable job. I’ve got a meeting due to start 5 minutes again. So we will sit down with your registrar on Monday for a proper formal assessment. It would be a loss to our unit when you’ve moved onto another rotation.”

I think that was the highest compliment I’ve ever received. Straight from a Professor’s mouth!

Fantastico!

Now to keep things tight for one more week.

Arrivederci.

Which is easier? Be nice or just to tell the other person to just fuck off?

……Shall I speak to the DPT? Aim for FRACP 2012 or 2013?

……My patient is really sick. Good thing I made the right call. Call a MET on her minutes after my registrar left the ward after ward round. In ICU at the moment. Hope she pulls through.

……Crazy Easter Monday shift. In fact, it’s been real crazy whole week thus far. Today is a good day. Hopefully tomorrow things stay the same.

……Need to plan for Euro trip

……Approached by the HMO manager to postpone my annual leave by doing another week of medical nights, which I accepted. Hopefully,I didn’t make the wrong choice there and the shifts won’t be too bad. He was very thankful and would try his very best to get me the rotations I want next year, if I do stay. Well, I’ve got an excellent rotations this year despite being a new staff there.

…… IELTS

…….Driving test

…….Study for exam

…….New fridge this weekend

……. Last week of Hematology rotation next week. I have mixed feelings about my registrar. At times, she is good. But the number of times, my pages went unanswered do get on my nerves. There are only so many times where I can force myself to think that she’s busy.

…….Medical at @lfred 2011?

…….I am awesome!

Arrivederci.

Nearing 2 months now into my Hematology rotation. It’s been really stressful over the last 2 weeks. Sick patients. Really sick patients. As much as I aspire to be, I am not a Hematology registrar, which is an Advanced Trainee job, a post FRACP job.

There are decisions I can’t make, things I can’t explain, information I have no idea what to do with. Once, the consultant was so pissed that he wasn’t informed about the sick patient. Well, I did inform the on-call registrar, who didn’t think it was worth escalating to consultant. Oh well, I did my part.

There are few things that chirp me up a little during the difficult times.

Like the time when the ICU registrar for one of the nights, informed one of the nurses to pass me a compliment for a job well done when I came on for work.

While I was writing my notes on the bench, there was this Endocrinology registrar whom I worked with before back in Franga, just dropped me a few random words :

R : Xiao, there’s this patient I thought you might be interested to see in level 5.
X : Huh…?*stunned*
R : He has excellent eye signs. The scenario would be : Please perform a cranial nerves examination on this patient, with particular attention to his eyes.
X: Err….. is that a referral for Hematology?
R : Oh, pardon me. Did you not pass your exam?
X : Huh….?
R : Sorry to hear that. But if you still interested….
X: Err….. I am just a resident. Don’t think I qualify yet to sit for FRACP yet.
R : Oh! I thought you passed your exam…..
X : I was an intern last year, while at Franga.
R : You are so good! You were so good then!
X : *kembang till letup KABOOM!*

That was probably the highest compliment I received for my hard work. Despite that, the day went bad enough to sour my mood later.

My housemate would be away for the next 2 weeks starting tomorrow. The house is going to quiet again.

Arrivederci.