Monday, December 29, 2008

Last Days in A&E

It's year end and I'm leaving the Emergency Department. Informed by my hosp director that I'll be transferred to Medical department starting Jan 09.

If you remember my story, I initially applied for medical while finishing my JMOship and due to medical was full, I was put in A&E "temporarily" till there is vacancy (for details you can read this).

And this wait has been 6 months! Much more than I expected, but I found it a very rewarding experience. I like the environment, though busy, but it is never boring! It certainly exposed me to a greater ranges of problems of all disciplines and making diagnoses have never been so difficult but yet challenging. I've really, really learnt a lot.

And not to mention the great staffs that I worked with. To all medical assistants, staff nurses and community nurses, a big thanks to you all!

I'll always remember that every morning there'll be one Nasi Lemak for me (they know I'm very prone to hypoglycemia), and with some cute wordings =)

And now I'm moving on to the next stage. The bigger challenge I think.

Which I need to be more well-equipped.

Here I come, Medical!

Monday, December 22, 2008

No Room for Ignorance!

I'm sure most of you read the article on The Star - "No room for ignorance in hospital wards" by a Seremban doc, I think he/she has made a few good points. Just to extract a few,

"How do you call yourself a doctor when you do not even know how to perform CPR? Most importantly, one must work with a conscience. Yes, they are allowed to make mistakes, but never at the expense of the patient’s life due to their lousy attitude or severe deficiency in knowledge.

To the parents of these young doctors, have you heard the other side of the story before defending your children? Did they tell you why they got scolded at work?

And if you find out that your child caused a patient’s death, simply due to his poor knowledge and lousy working attitude, will you be able to sleep well at night?

To the house officers who complain a lot, if you can’t even handle negative comments from your senior colleagues, how can you survive when you face demanding patients and family members?
It’s disheartening to see that the public is trying to sensationalise this issue without hearing the other side of the story."

I pretty much agree with what he said, and I think these are what most of the MOs thinking of the current batches of HOs now. After I read also Yew's & CCC's stories, I think hospitals are more like horror places to public now, at least the images will be altered, not sure whether to the extent that affecting public's confidence towards us. But as what fibrate said, "If you care enough, you reprimand them, so that they’ll become better doctors." I guess that's what we eventually want!

So to all HO-to-be, hope you all hear what we're saying!

Sunday, December 21, 2008

Interesting ECG (3)

Since some of the students were kinda confused about how WPW (Wolff-Parkinson-White) syndrome ECG looks like - so coincidentally I just came across one last night!

Looking at the above ECG, delta waves (the slurred upstroke) can be seen in every beats, broadening the ventricular complex as well as shortening the PR interval. Very typical!

Also read:
Interesting ECG (2)
Interesting ECG (1)

Thursday, December 18, 2008

Bad Assumptions

Bad assumption #1

A Bangladeshi man walked in accompanied by a Malay woman.
After the consultation,
Dr spoke to the woman, "Alright you can settle the bill over the counter there. Are you his employer?"
Woman: "I'm his WIFE."
Dr: "(oops..)"

Really Bad assumption #2

A middle-aged uncle walked in with a baby, accompanied by a 20+ young lady.
Dr greets the man, "Hello uncle, this must be your grandson? So cute..."
Man: "I'm his FATHER. Can't you see that's my wife?"
Dr: "(Oooops...)"

Extremely Bad assumption #3

Consultant doing ward round with all the MOs/ HOs.
Reached a bed of patient with coronary heart disease.
Consultant: "Uncle you really have to control your cholesterol la. Do you exercise?"
Patient: "Not really. I have to work..."
Consultant: "That's just an excuse la. What do you work as? Selling Nasi Lemak?"
Patient: "......I'm a LAWYER."
MOs & HOs: "(Ooooooooops...)"

Moral of the stories: Be very careful when making assumptions! These are real stories and you certainly do not want them to happen to you!=)

Wednesday, December 17, 2008

"Floating Elbow"

Fracture above and below the elbow joint - making it like a "floating" joint.

The feeling that you get while examining it can be quite scary!

Tuesday, December 16, 2008

Bomoh's Sorrow

Saw this 60 year-old man in ER early morning, who alleged was knocked by a cow's horn at left sided chest.
On examination by doing a gentle chest spring, the crepitus can be clearly felt. So I told the man that he's likely to have sustained rib fracture.

His response was of kinda dramatic one.
He actually turned angry, "Doc, how sure are you that I'm having fracture? *pats on his chest a few times* If my ribs are broken, how come I don't feel much pain?"

Then the story gets interesting.
"I tell you, I'm actually a Bomoh (traditional healer in village). I used to treat fractures! This morning I was "demonstrating" how I could be knocked by a cow without getting injured (now I get to know the true history), now you're telling me that I've broken my ribs? This is ridiculous!"

In view of his hyper-emotion, I told him that why not we look at the Xray.

It shows fractured left 3rd & 4th ribs.

Then he really got into deep denial, "This is not my Xray! I DON'T BELIEVE IT! Doc, I'm a Bomoh! (he mentioned this not less than 5 times) You don't try to cheat me OK! I have no fracture! I will not get injured!"

Then the next thing is he refused all treatment including painkillers, then took an AOR (at own risk) discharge.

Think it's the end of the story? I thought so but apparently it's not. Since I was on call that day, so I got to see the 2nd half of the story at night.
Around 10pm, a man was pushed in for complain of dyspnea. I had a glance on the patient, OH MY GOD it's the Bomoh again! The first thing that came into my mind was he must have massaged himself at home and self-induced some pneumothorax or lung injury.

But luckily it's not. He came because he really couldn't stand the pain.
And the first thing he said when he saw me was, "Doc, I'M SO SORRY. I shouldn't act so rude this morning. Pls forgive me. Pls admit me to the ward for treatment. Thank you."

A 180-degree change.
But I'm glad that he came back for treatment though.
And what a special experience on my encounter with a Bomoh! ;)

Monday, December 15, 2008

Interesting ECG (2)

Saw this ECG in ER.
It belongs to a lady who has underlying bronchial asthma, presented with palpitation.

Took me reaaaally some times to figure it out.
Irregular rhythm with variable PR interval, tachycardia...what do you think it is?

*The leads are well connected for the ECG so there's no cunning magic here^^

Related post:
Interesting ECG (1)

Saturday, December 13, 2008

Magician's Getting Tricked?

Saw this young man in ER. Suspected to have Dengue fever due to the abnormal FBC result.

Me: "Hi, how many days have you been having the fever?"
Pt: "Day 3 of fever."
Me: "Ok...did you notice any bleeding from gum?"
Pt: "No, no bleeding tendency. Actually, you can ask me in medical terms. I'm a medical student."
Me: "Oh great! Sure. You having any SOB?"
Pt: "Pardon? S.O. what?"
Me: "Oh sorry...I mean any shortness of breath."
Pt: "No no...I don't."
Me: "How are you feeling actually?"
Pt: "I only have a bit of dyspnea."
Me: "......(suddenly dunno how to continue)"

No shortness of breath but has a bit of dyspnea?
Oh maybe he's trying to trick me whether I know the meaning of dyspnea! Hehe.

(Shinyin, you have a cute junior!^^)

Friday, December 12, 2008

Interesting Case! (2)

Saw this patient in ER. Think it's interesting to share.

A 84 year-old man was pushed in for progressively worsening dyspnea. According to his daughter, he only has history of gastritis. The dyspnea has been there for 1 week, but he denies any chest pain. There is history of reduced effort tolerance but not much of orthopnea or any ankle swelling. Upon further questioning, the daughter told that he has been feeling lethargic and having poor appetite for the past 2 months.

On examination, he looks mildly tachypneic with SPO2 94% on room air. Lungs were generalized crepitations on auscultation. Abdomen has a spleen palpable with shifting dullness positive. No pedal edema. Multiple cervical and axillary painless lymph nodes palpable.

Then the daughter showed some blood results that he just took in a private lab few days ago.
Hemoglobin: 8.4 g/dL
Total protein: 118 g/L
Albumin: 19 g/L
ALT: 40 IU/L
ALP: 120 IU/L
Se Calcium: 2.4 mmol/L (2.1-2.6)
Se Mg: 0.8
BUSE - within normal limits

ECG shows ST depression over I, aVL, V4 to V6.
Trop T stat: Negative

Your colleague thinks that he should be treated as Acute Coronary Syndrome with left ventricular failure, based on the ECG and chest findings.

Do you agree? And if not, why?

(Answer's in comment)

Related post:
Interesting case! (1)

Thursday, December 11, 2008

A Beautiful Mind (2)

Ya. The unlucky me again.
Saw this patient who came in the midnight.

"Hello uncle, any problem?"

"Hmm. My problem is, I don't even know what's my problem!"

(*swallowed saliva* I know I'm in trouble, deep one)

"You see, I always feel like I have fever but actually I don't."

"I like to put one hot towel on my forehead, but if you ask me whether I have headache, actually not really. Why is it like that ah doc?"

(HOW am I supposed to know why you like to put hot towel on your head?)

"Then on and off my right hand will shiver. It happens more when the weather is cold, but sometimes when it's not so cold, it shivers a bit also."

"Then I also feel discomfort over my abdomen. No if you ask me whether it's pain, actually not really. Endoscopy? Ya I've done it. Even colonoscopy also. All normal."

"Sometimes I feel anxious. My job? Oh I work as a teacher. Stressful at times but strictly speaking, not to a level to cause me anxiety. Thyroid problem? Oh I just went for a complete health screening, all blood tests are normal!"

"My appetite is fine. Not much of weight changes recently also. But I on and off will feel tired know? Like not interested to do things..."

"My symptoms sound like neurological symptoms? Ya one of my doc friends told me also. I've already gone for a brain scan and it's normal too."

"So doc, actually what's my problem?"

The whole consultation took me 30 min. And I think I sweated. The problem is not about the diagnosis, but difficulty in getting even the symptoms! Can you get a distinct symptom from his history? All also quite vague...and when you think of something and he'll tell you, "Oh I went for checking already and it's normal."

Tough isn't it? Any brilliant diagnosis other than "A beautiful mind"? ;)

Read also:
A Beautiful Mind (1)

Wednesday, December 10, 2008

Goodbye, Old Friend

He's gone.

My good old friend who has accompanied me since my first year as a medical student...a good 7 years of friendship.

He has never failed to be my best working partner...and I've always tried my best to maintain it at good condition. I dare to say that its function is still as good as new!

But I was shocked that he gave up yesterday. After a while of thinking, I think I found out the precipitating factor. It's all due to the stupid missing tendon hammer in the casualty la! It has been missing for the past few weeks and made me having to use my stethoscope to elicit the reflexes! See now what happened to the diaphragm! Gosh...I can't believe that I indirectly (or maybe directly) caused harm to it...sigh. But it's just too late.

Nevertheless, probably it's a sign to me for system upgrading.

Hey Yew, I think I'm definitely joining the club already la! ;)

Tuesday, December 09, 2008

Picture Quiz (2)

Ya time for picture quiz again! Let's look at the following ECG:

Ques: Please give a spot diagnosis.

Hint: It might not be an ordinary diagnosis!^^

(Answer's in comment)

Related post:
Picture Quiz (1)

Sunday, December 07, 2008

Couple Jokes (4)


GF: "Dear, after we're married, will you quit smoking?"
BF: "Yes..."
GF: "Will you quit alcohol?"
BF: "Yes..."
GF: "Will you quit clubbing too?"
BF: "Yes.."
GF: "So good..anything else that you'll quit?"

BF: "I think I'm quitting the thought of getting married..."


Wife: "Dear, pls tell me honestly that do I look pretty?"

Husband: "Yes you surely do."

Wife gets satisfied and walked away happily.

After 10 min, wife asked again, "Dear, actually, were you telling me that just because you didn't want me to get hurt?"

Husband: "No...I didn't want myself to get hurt."

Wife: "......"

Related posts:
Couple Jokes (3)
Couple Jokes (2)
Couple Jokes (1)

Saturday, December 06, 2008

Smoke & Mirrors 2nd Edition

"Illustrated by renowned artist Si Scott, the Smoke & Mirrors playing cards were developed by Dan and Dave Buck. Dan and Dave spent over eight months working with Si on the design, with the goal being to create a deck that is elegant, refined, and modern.

Interest in the decks has been unrivaled since word first emerged of their existence. All of the artwork was illustrated by hand in pen and ink. Smoke decks are white; Mirrors are black. Both decks feature a custom designed Ace of Spades, Joker, and tuck case.

From the intricacy of the design to the feel, finish, and quality, Smoke & Mirrors are a case study in attention to detail. The feel and finish is flawless - printed on premium Aristocrat quality stock.

The result is an artistic expression of royalty: a true luxury deck."

- Theory 11

Let's have a look at the preview:

Truly a masterpiece. I'm just so gonna get this!! ;)

Monday, December 01, 2008

Couple Jokes (3)

Saw these from a mail that dear forwarded to me. Found it really funny so just thought of sharing it;)

A woman worries about the future until she gets a husband.
A man never worries about the future until he gets a wife.
A successful man is one who makes more money than his wife can spend.
A successful woman is one who can find such a man.

To be happy with a man, you must understand him a lot and love him a little.
To be happy with a woman, you must love her a lot and not try to understand her at all.

Married men live longer than single men do, but married men are a lot more willing to die.

A woman marries a man expecting he will change, but he doesn't.
A man marries a woman expecting that she won't change, and she does.

A woman has the last word in any argument.
Anything a man says after that is the beginning of a new argument.

I'd say..these theories are quite true! =p
What do you think?^^

Also read:
Couple Jokes (2)
Couple Jokes (1)

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