future

I think I need to start thinking about my future.

I need to know what I want to specialize in. I need to know (first) what I like. Which is not easy. Cause somehow, medicine isn't as simple as just being a doctor. You are either a heart doctor, mental doctor, kidney doctor, family doctor... (layman's language larrr)

Maybe, gastro would be nice. But there's a hell lot of gastro specialist in Msia. Cardio, resp, and geriatric is definitely a no-no. Neither are dermato, infectious disease (if there is any!), onco or haemato! Surgery? 50-50. So, I'm down to either gastroenterology or nephrology. Or just general medicine...ahahaha!

And I have to think about having my own family...hmmm.....cause nowadays, I cant stop smiling looking at other people kids! ARGH!!! Well...better than looking at other women's husband..eheheh!

Peace

hero

I saved my patient's life.

Around 1830 yesterday, macam biasa, I checked all the blood results. One of my patient's troponin came back as 0.6!!! (The first troponin was negative) DAMN! Cepat2 aku pegi jumpa patient tu, and asked him does he has any chest pain etc etc. Dia basically OK jek, except for dull, mild pain over the epigastrium area. He had USS Abd few hours before and it was fine. So, I did an ECG on him. Guess what?! Acute changes -> ST elevation 2mm in lead II, III and AvF. As well as TWI in lead III.

MI beb!!!!

So I spoke to the MROC (the nice and soft spoken Dr Khalid), and he asked me to start the patient on aspirin, clopidogrel, enoxaparin and metoprolol. And try to get a telemetry on that patient.

When he reviewed the ECG (2 hours later), he came to the ICU to see me, and with a big sigh he said, "Marisa, that ECG showed acute changes. Definitely MI. Will you repeat another ECG for me, because I may want to thrombolyse him". Okie doc!!

So, I did another ECG on the patient. Same ST elevation in inferior leads, no changes except I think the TWI has resolved. So, that patient (which is Dr Clarke's patient), transferred to ICU last night and was thrombolysed. Hooray!

Rasa cam hero penyelamat dunia seantero plak :)

carcinoma

Terasa malas nak keje.

Suprisingly, this week on take, we've lots of patients with newly diagnosed carcinoma. 62 years old lady, came in with obstructive jaundice with mass in portal/gall bladder fossa. Diagnose? Query pancreatic head ca. Need laparoscopy and biopsy. Coincidently, next bed to her, is another lady, already diagnosed of pancreatic ca and is currently on chemo. Good news though, as her repeat CT abd showed shrinkage of pancreatic mass and no sign if mets. Green light for resection.

Another patient, 72 years old lady, came in with pleuritic chest pain. CTPA showed pulmonary embolism and is currently treated for it. At the same time, she has mutliple vertebral fracture and on examination (missed by the SHO oncall) by my Reg, revealed a left breast lump, tethering to skin. Require referral to UCHG under Prof Kerin for breast ca assessment.

One gentleman, has tracheal deviation and hoarseness on examination. Highly suspicious of thyroid ca. CT thorax reported massive retrosternal goitre, slightly obstructing the oesophagus. Hmm...

Point I'm making is....THE IMPORTANCE OF GOOD CLINICAL EXAMINATION.

Peace.

Ciao

sakit

Doctors get sick too.

I was down with terrible flu on Wednesday. Must be due to exposure to a mixture of pneumonia and TB cough (query TB, nasib baik patient tu negative AFB x 3). And I was on call on Wednesday.

On Thursday, I got really bad. I dunno what my temperature was at that time, tapi boleh la nak rebus telur bawah ketiak. Eheh.

On Friday, after the ward round, I asked Colin, whether I can go home or not. He said, what time, and why do I wanna go home. I just said, I'm sick. Really2 sick. Cant think, cant walk, cant breath sume la. Sakit sangat. Dia pun cakap, "Marisa, kalo dah sakit tu, jangan malu2. Cakap jek. Aku kasik hang balik punye la" Yang pastinya, dia cakap dalam English daa.

So, aku balik awal Jumaat tu. 11.30 aku dah cabut. Weekend aku kene oncall. Seksa woo Sabtu tu. Tapi, selepas 4 botol yogurt 3 papan panadol, 1 kotak besar jus oren dan 2 hari kantoi puasa...hari ni (Ahad) aku mampu la nak oncall...

Eheks...

NB apa dah jadik dgn Dr Clarke. 3 patient post ERCP dia sakit teruk this week. Sorang dapat post-ERCP pancreatitis, sorang turns out ada liver abscess, yang sorang lagi..just plain low pain threshold..ahaha.
Anyway, since aku tak pernah tulis something berilmiah, meh la aku kasi tau apa risk factor for post-ERCP pancreatitis.
1. Patient-dependent: obesity, previous pancreatitis, female, young
2. Procedure-dependent: more than 5 attempts of cannulation, injection of contrast into pancreatic duct, extravasation of contrast into pancreatic duct, difficult anatomy

Peace.

My apology

I knew something wasnt right when Colin said ,"Marisa, I need to talk to you about something. About Mary's transfer letter."

Turns out, my letter, which was at first addressed to Dr Fleming, read by Mr Kelly (plastic surgeon yang paling membencikan). And he wasnt happy with the letter...

My patient, Mary, has spastic quadriplegia secondary to MS. On admission, she has staph aureus septicaemia, faecal n urinary incontinence n extensive decubitus ulcer. In that letter, I mentioned that, she was seen by a plastic surgeon in UCHG, but there is no documented details on this. I was verbally told by the patient that they cant do skin graft on her ulcers at that time becaouse it was too deep. I supposed, this were the words that pissed Mr Kelly off.

So, he called Dr Clarke yesterday. He was angry that Dr Clarke's intern somehow wrote something which mencabar kredibiliti la kununnya. Although no name mentioned! So, Colin said, Dr Clarke called him, and wanted me to write an apology letter to Mr Kelly. Dr Clarke was angry as well..ehehe...mati aku. Nasib baik, hari Khamis Dr Clarke slalu takde.

So, yesterday, Colin helped me to type the apology letter. And he said before I send the letter, let Dr Clarke to see it first. He also said, he's partly to blame coz he did checked the transfer letter before it went through (3,4 kali la dia baca hari tu), but he didnt expect those words would flipped someone off.

Hari ni, Dr Clarke seems to be in good mood. Siap cakap beday dia Sabtu ni, dan takpela kalo tak kasik hadiah. Siap buat lawak jenaka ngan me personally. So, aku pun ingat, dia dah lupa kot kes Mr Kelly tu. Tak pasal2, jam 2.30pm, after aku wat EST for my patient, sampai jek kat St Joseph ward station tu, nampak la Carol borak2 ngan Colin. Dr Clarke plak dok depan kompuetr...TAIP MY APOLOGY LETTER!!!! FUIYO!!!!

Smart ah intisari surat tu. Aku siap cakap kat bos, memang bahasa cantik giler, nampak sangat bukan aku yang tulis. Dr Clarke cakap, dia memang tak puas hati ngan Mr Kelly. Sebab kecik nak marah. Dia cakap, it's OK, we write the letter, macam la kita sorry, tapi kita tak. Sebab kalo baca surat yang Clarke tulis, ada unsur2 sarcastic gak le. Its up to Mr Kelly to figure it out. Kalau dia tak puas hati, berdepan la ngan Clarke sendiri. Dia tanya aku, Ok ke surat tu? Ada yang tak puas hati ke tak? Nak tambah apa2? Sebab dia cakap jugak, aku semacam dibuli oleh Mr Kelly..dan cakap, kalau aku under MPS or MDU, mintak la advice diorang..hehehe. Ok dad..eh bos!

Lepas Dr Clarke blah, aku cakap ah kat Colin (ooo...aku dah bonding rapat ngan Colin skrg nih..abang ensem la katakan), "I thought Dr Clarke is going to be very mad at me.". Pastu dia senyum. Dia cakap "When Mr Kelly called him yesterday, he was very angry. He thought you might had written something that's so bad that Mr Kelly got so angry. But then, I printed out the transfer letter, and called him (Dr Clarke) back and told him what you wrote in the letter. It turned out, it was just a little thing. And his anger just simply cooled off. He's not happy with Mr Kelly as well. It's not entirely your fault, because you just said what the patient told you." HEEEEEEEEEEEEEE...

So kanak2, pengajaran nyer ialah...

1. before you say something, check the information.

2. before you send a referral, check it with your senior colleagues.

3. if in doubt, ask your SHO or Reg.

Oh, be nice to your consultant. Whatever person they may be, at times like this, they're good help.

Oh ya, Dr Clarke, Colin dan Carol juge bertanya, adakah aku akan bekerja dengan Mr Kelly di UCHG nanti....nasib baik tak...hehe. Concern la diorang nih. Sayang korang!

real love

Heh.

He gave me a sweet with 'real love' written on it. Ces. Dont blame me if I fell for you.

Anyway, he's gone to St James's. Lalala. Dah takde motivation nak pi keje pagi2. tsk tsk. Rabu ni Pei Seey buat makan2 kat umah dia. Ajak ramai docs. Nak mintak tolong aku masak...on jek! Bley amik gambar ramai2! Tapi John takde :(

...aiseh, mana la the next patient for stress test nih!!?? Siot tol Boon ngan Minesh, aku kene cover stress test utk team Barton plak!

Oh, aku pass ACLS semalam. Best giler! Tak sabar nak ada cardiac arrest!

stressed

pagi rabu tu, mood aku ok datang keje. tapi yang siotnya, datang2 tengok oisin tak siap keja. tak amik consent patient aku yang datang for ercp. kata aku lupa kasi tau. hek eleh. kalau aku lupa pun, takkan la bodoh bendul sangat. seperti la patient yang datang untuk angio atau MRI atau colonoscopy...semua kena consent. aku bengang sebab turned out patient tu confused, kene la relative dia yang consent. nurse kata masa patient datang malam day before, relatives dia ada sekali. tapi time tu oisin tak ambik.

aku pun sound la oisin. dia kata silap aku yang lupa kasi tau. aku cakap common sense amik consent takkan tak tau. dia cakap takde, takde..tu patient aku, bukan tanggungjawab dia. mak oi! bukan main terasa baran aku time dia cakap macam tu. macam dia tak ingat, sebab dua patient dia la aku terpaksa cover stress test sampai 4.30 the day before...tu bukan patient aku, tapi aku buat jugak, kan???

aku bengang, marah sampai hari ni. tak tegur oisin, eka n aini. naper tak tegur aini ngan eka? sebab aku rasa diorang tau oisin salah, tapi tanak back-up aku. instead gelak2 suruh aku jangan carik gaduh ngan oisin. bengang.

tak pasal2 aku bengang ngan safwat masa klinik sebab stress banyak patient. ye ah, aku jumpa 4 new patient dan 3 review. satu new patient dah 30mins at least. colin away. safwat oncall. tinggal aku, carol ngan clarke cover klinik. klinik habis kol 1.45pm hari tu. aku koma nak mampus tak makan lunch.

habis klinik, kene setel hal kat ward. tengok2 team durkan lepak2 discuss2. aku paling bengang kalau hari selasa, aku kejar stress test ngan phlebotomy ngan cover patient kat ward...kalau nampak team durkan lepak2. oh, hari selasa (the day before) yang aku kene cover patient durkan sampai 4.30 tu, mahir ada hati nak kasik lagi sorang patient dia. naseb baik sally keras hati tanak amik, kalau tak, kene jugak aku cover sampai pukul 5. ingat aku suka sangat buat stress test ni? keja kat ward sapa nak cover?????

macam ni la. lain kali hari selasa, aku tanak cover patient durkan for stress test. korang jangan main2. aku dengan minah2 ECG kamceng ketat. kalau aku nak boikot, bila2 masa aku boleh. after all...bukan patient aku kan???????

peace.

bak kata korang2 la kan, jangan gaduh2. ciao.