emed in sgh is usually spent waiting around to clerk non-chest pain/giddiness patients for case write ups, finding cool physical examination findings and setting IV plugs etc. i have to say ive been rather detached with the patients ive met so far. im actually far more talkative than most, and i take time to talk crap with my patients, and help them bide time while they wait for the doctors to see them.
today's call began different from any other, as the only reason why i was doing call, was cos my grand uncle had parked in front of my car, and i couldn't drive out lol. he was also at a medical appointment, and since i was leeching off the parking at the shophouse he owns (my mum's siblings and her own an apartment in that block), i decided to not bother him with my schedule and hang around for call.
let me just re-iterate, that the "medical students curse" is very very true. the more medical students hang around, the less happens. and the more chest pains are brought into critical care, and clerking becomes uninteresting. that's probably why i talk a lot of rubbish with my patients.
i met an uncle, who is a contractor by trade, and a very devout buddhist. he shared with me his philosophy in life, which i think, despite the different religious beliefs between us, is a very good one. he believes that he should make everyone around him smile and be happy. he doesnt believe in discord and anger, and instead advocates peace and harmony. (a very buddhist kind of belief i must add.) very applicable in my trade, since patients are always unwell and irritable, sometimes i think its essential to treat the patients as human beings, and not as cases, as a lot of us do. sometimes, talking about recent political events or lifestyle beliefs makes them smile and them feel a bit better. the uncle was telling me about how i should find a boyfriend at least 6 years older than me, as the rates of divorce in couples with very close ages is very very very high. so random!
i also talked to the son of this lady who was complaining about lower abdominal pain and vomiting. he was telling me about how his mother, who has had so many operations in the past, despite her age, takes great pains to look after her husband, who is bed-ridden after a stroke. she is a small woman, but she always does the transferring of her 95 kg husband. she is an incredibly strong woman, with bilateral mastectomies and her ovaries removed due to cancer - possibly BrCa gene related. and yet, still going strong. she was dx to have constipation, prob secondary to colonic adhesions due to the multiple operations in the past. thank goodness it was nothing serious.
well carrying on to the more interesting and "good stuff" for the night.
1.totally diagnosed pleural effusion and felt stony dullness thru a respi exam.
2.clerked a copious hemoptysis case, who went into hypovolemic shock and had to be fluid resuscitated and sent to MICU. also detected consolidations and creps in both bases.
3.i did a T&S (toilet and suture) for this gentleman who had been beaten up by mysterious strangers. wooo. exciting! the MO was so nice! letting me do the T&S.
4.saw a plausible aortic dissection, central chest pain going suddenly to the back, with a patient doubling over in pain and curling up on the bed - turned out to be unstable angina cos there were no signs of aortic dissection, BP on both arms were similar, no difference in pulse pressures radial-radial, and radial-femoral, and no CXR changes expected of dissection.
5. saw a very very sick patient, on the dangerously ill list, and how he deteriorated and passed on. we were just listening to his lungs to detect a massive consolidation (aspiration pneumonia) and in half an hour, he deteriorated. his vitals dropped drastically, with his BP around 50+ systolic, and SaO2 being 51%. he just passed on quietly, his stridor just went away, and he seemed at peace. i dont know if it was the time or i was just feeling a bit tired, but his passing felt rather surreal. i didnt really believe that he was gone, until his family came in and they started wailing. then i thought about how i would deal with my parents passing away, and i knew that if that happened, i probably wouldnt know what to do, and feel so helpless, and so sad that they are really gone. what would i do then? how would i mourn? i dont know. the only comfort was perhaps they would head to a world without pain or disease, and would live by Jesus' side in the glory of heaven. i think the most difficult thing in medicine is breaking bad news, and ensuring psychological care for the family of the deceased.
6. dengue hemorrhagic shock. scary. confusing. high tension. got saboed by jaryl into doing a catheterization. despite not having done one since surg, and forgetting most of the steps. i was so worried i perfed his urethra, cos he started getting hematuria, but it was dx as secondary to his low platelet count and DIVC state. doing a catheterization on a hemodynamically unstable patient (seesawing BP at 70mmHg systolic despite litres of IV saline and gelafusine) is so mega stressful. i kinda detached my emotive state from body and things went pretty okay, its crazy trying to keep composure and hold the patient's penis up and perform a procedure that you did so long ago, i cant really remember what happened, adrenaline rushing and i think retrograde amnesia due to the fear, but everything went okay thanks to all the help from the 3 brains around me - abhi, chinnie and jaryl. again i declare - scary. at least it went in, and i didnt complicate things. also, translating the doctor's words for his mom wasn't easy. she was so scared and shocked at the seriousness of his condition, he was fluid resuscitated and had tubes hanging out of most orifices. challenging, considering i didnt know how to say dengue fever in chinese. its hard to break bad news. hard.
home.
had 4 cups of tea today. tired. drove home, along some roads which had no street lamps as they short-circuited from the rain. dangerously scary. wet roads too. reached home at 5:08 am.
its 5:47 am and im not sleeping yet. had a nice hot bath and am snuggled up in bed. shall catch some shut eye and fall asleep before the sun comes up. yay. at least tmr is saturday and i can sleep in.
a totally worth it call. if only more calls were like that.
-cheryl~*
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