Work Rules

After the "My boss & I" article, i saw this at another corner in SCN. Very funny as well! It's called the "Work Rules":

1. Sickness
This is not allowed under any circumstances. We will no longer accept your MC as proof of illness. If you can walk to your doctor, you can certainly come to work.

2. Death, other than your own
You must arrange to attend all funerals very late in the day after your work is done. This is provided we approved your leave.

3. Death, your own
This is acceptable as an excuse, but we would like at least 2 weeks notice as we feel it is your duty to teach someone else your job.

4. Personal hygiene
Entirely too much time is spent in the loo. In the future you will follow appointed time to go, according to alphabetical order of names. If you miss it, you must wait till the next day when your time comes around again.

5. Quantity of work
No matter how much you do, you'll never do enough. Please do not have doubt on this matter.

6. Quality of work
The minimum acceptable level is perfection at all times.

7. Advice from owner
Eat a live frog the first thing in the morning and you will be hopping around all day without feeling tired.

8. The boss is ALWAYS right.

9. When the boss is wrong, please refer to rule 8.

Darn funny work rules..but in fact, my department is currently super short of JMO/HOs..3 are leaving by next week and there'll be only 5 left..sigh calls every other day are gonna be inevitable. By then, these work rules are probably becoming reality? Hope NOT..!!

Thinking of being an Obstetrician?

I just realized that one of my posts: A Perfect Surgery HO was used in efenem's blog, without me knowing it. Then I saw one interesting post of him, so I suppose i can just do the same. HA. (efenem, i'm just kiddin. But i really quite like your this post=D)

So You want to be an Obstetrician? Here's his thoughts on O&G:

1. The most tensed medical specialty everywhere in the world; it involves antenatal care, medical and surgical natal care, and postnatal care of the mother and the baby. And then there’s clinic! That seems to be a lot of work more than a sane person can handle! (Ya it's whole lots of care, from preconception to antepartum/intrapartum and postpartum care..)

2. It is the most sued medical specialty. In the US, 76% OBs have been sued at least once, 57% twice, 42% three times or more. The family expects you to make no mistake; even a little defect beyond your control can come with lawsuit. Many obstetricians have high malpractice insurance premium, differing in different countries. (Yup i couldn't agree more on this)

3. Most bloody, nauseating and complicated specialty, making those in surgical specialties look very mild and tame. That’s what I heard when an obstetrician came to MRSM Taiping to give medical career talk. And I confirmed that myself when I first time watched the delivery of a reluctant-to-push mother. Birth is beautiful? Think again! [Hmm it can be complicated, but can't be the most bloody & nauseating la..after all, Obstetric department is the only dept where you see new lives..it can be very, very gratifying=)]

4. Most obstetricians are men since most of them are very strong (physically and mentally) to handle bloody surgeries, abortions, miscarriages and other stuffs. But so far that I asked from my peers, only women want to be OBs, no man so far. Maybe I wasn’t asking enough. (There's saying that man who joins O&G will get somewhat "womanized"..as in fact they are the men who know women the most..)

5. Myths and Superstitions; there are things like when an OB is trying to do God’s job such as taking away life of a baby (abortion), he/she is cursed and doomed forever. Some OBs have reported to have failed conceiving child of their own. Maybe there’s a psychosomatic correlation I couldn’t fathom. Maybe that’s never true at all. (Hmm no comment..)

6. According to a survey, OB is one of the specialties with the least likelihood of physician’s satisfaction. As in previous points, the work is always stressful and demands perfection; for the mother and the baby. (Hence it comes with the sky-high pay! But with equivalent pay-back price..)

(Credits to efenem)

Mad Referrals

No the referrals are not mad, but they are highly likely to cause instant madness.

Referrals are very common in medical practice, and I would say that the case referring itself is definitely an art, same goes for accepting a referral, but the latter can sometimes be a pain. As turning down a referral is a showing of disrespect, but having to see those unnecessary ones, especially during a busy call, is somehow really a torment.

Mad referral #1:
When I was in Orthopedic posting, I once got a referral from medical that one patient complained of leg pain and refer Ortho for "to rule out fracture". Wait, the best part is, no Xray was done yet. How could you refer Ortho without having done a Xray? You mean you're..only suspecting it? What about one day i'll refer back a case "to rule out diabetes, pls kindly check his sugar"? They'll sure come and burn my department, right?

Mad referral #2:
My good friend a medical MO, once told me about similar problems. He was referred a case from O&G: Sinus arrhythmia. My friend nearly developed instant arrhythmia after hearing that. Sinus arrhythmnia, a perfectly normal condition, what do you have to refer medical for?!

Mad referral #3:
I think this is the best. When I was in medical, one man was admitted from some klinik kesihatan. I read the referral letter:
"Dear doctor, thank you for seeing this 53 yr-old man, complained of loss of appetite and weight loss...Impression: Failure to thrive.

Oh god, a 53 yr-old man was referred for failure to thrive, what has this world become?!


P/s: "Failure to thrive" basically refers to a baby/child whose physical growth is significantly less than that of peers!=)

Doctor & Patient 2

Continue from the previous post..

An obese patient came to clinic.
Patient: "Doc, i think i'm seriously overweight. What should i do?"
Doc: "Oh you just simply need to exercise more."
Patient: "Then what kinda exercise should i do?"
Doc: " Very easy, it's mainly neck exercise. You turn your head to left, then to right. That's all."
Patient: "Huh? Then how many times should i do it in a day?"
Doc: "Hmm..it depends. Whenever someone invites you for meals or pass you something to eat, you have to do this exercise until he walks away.."
Patient: "......"

My Love with Cards

Yes this is Me. The magic doc who's always with a deck of card in his hands.

Even since i was bitten by the magic bug, cards have become something indispensable in my life. Though I know that magic is not entirely about cards, well I can perform other things too, but cards have been most of my interest, kinda like my "specialty" in magic.

Card collection is definitely one of the best things in life.

And there's something I came to understand only after learning magic. Do you that there are some mysterious and captivating knowledge in cards? Thousands of years ago the symbols in our common deck of 52 playing cards, plus the jokers, were created as a calendar and lifetime guide for the earth. The 52 cards represent the 52 weeks of the year. The 13 cards in each suit represent the 13 annual cycles of the moon, and the 12 face cards represent the 12 signs of the zodiac. The numbers on all of the cards added together from each of the four suits, equals 364? The days of the year less one. The joker represents the 365th day of the year, and the 2nd joker represents the extra day in leap year. The four suits represent the four seasons of the year, and the seasons of our lives. The two colours, red and black, represents day and night. Interesting isn't it?=)

And cards have brought me to know so many interesting people and friends. Brendan is one of them. Oh ya, and there's a term to describe ppl like us, the "cardician", meaning the card magician. I used to thought there's another quite good one - cardiologist, the specialist of cards! Hehe..i think one day when i become a cardiologist, the double meaning can be applied to me dy. Ha.


My 2nd flourish video posted on youtube. I've long prepared to film the 3rd one, but time is really a limiting factor! Hopefully can do it pretty soon. Enjoy the vid, and feel free to give comments!=)

Interesting Chest Xray

First, let's see how a normal chest Xray looks like:

Then look at this boy's:

Spot diagnosis:
a. Something's definitely abnormal but dunno where.
b. He might have swallowed a ball.
c. Why-heart-so-big-one syndrome
d. None of the above=p

This is a 10 year-old boy presented with chest pain, associated with worsening severe breathlessness for 2 days, with history of URTI symptoms about 2 weeks ago. He was in respiratory distress and was nearly intubated. ECHO showed dilated 4 chambers, severe MR/TR with pericardial effusion. (Btw, hence the CXR features- globular heart shape)

I guess you're having something in your mind? Ya he's treated as Rheumatic carditis.
End of story? No it's not. I had a feeling that there's somethin more.

If you do notice, there's associating pulmonary congestion, and dilated all chambers shouldn't occur so fast, if it's just a first onset acute rheumatic fever.

So I did some further questioning. I asked the child and his parents that whether he had any similar febrile illness before. They took some times to recall, and finally gave a history that, at his age of 4, he had an episode of high grade fever, associated with joint pain which was "migratory", but he did not seek any treatment. He was well for a period of time, then started to have intermittent chest pain, fatigue and exertional dyspnea, but he thought he's just being "weak" and did not pay much attention to it.

Bingo.
And that matches the whole picture. A massively dilated heart with pulmonary congestion points more to a chronic condition, and this child was actually having rheumatic carditis, but it was an acute on chronic condition.
He responded well to treatment and currently awaiting to see the paeds cardiologist in IJN soon=)

UTI Prevention

That day I saw one female patient who presented with first episode of UTI (Urinary tract infection), and she asked me about how to actually prevent the recurrence. While giving her the usual advice, some really, really funny memory struck my mind.

I can still vividly remember one incident that happened during my med student days.

During a presentation about UTI, my lecturer mentioned under the UTI prevention, that 500ml of cranberry juice a day, can reduce the risk of symptomatic recurrent infection in women by 10-20%. And he showed a picture of cranberry juice.

One of my batchmates, yes he's a smart fella, but he's the "sees what ppl don't see, but doesn't see what ppl see" type of person, popped out a question:

"Sir, hmm I just wanna clarify..the cranberry juice is to..hmm..(hesitating)..drink isit?"

My lecturer was baffled for a few secs as the question sounds kinda weird, then he asked him back,

"Hmm, i thought it's obviously to drink it. Pls don't tell me you're thinking of using it to wash down there?"

I tell you, that class we had the most non-stop laughing till nearly suffocated. Coz from his expression we knew he really thought so.

And till today, if someone asks me about UTI prevention, the first thing that comes into my mind will be a glass of cranberry juice, and the question on how to use it. HA.

Light Moment

I was covering my friend in the casualty during weekends..in the morning there was this Bangladeshi construction worker wheel-chaired in, accompanied by his employer, alleged left foot hit by a heavy metal piece. The foot was pretty swollen, so an Xray was ordered.
X-ray came back normal, the employer asked, "How?" and i said,"No fracture seen."
He gave a brief smile of relief, then turned to the Bangladeshi and said, "kesian! kaki kena potong lo!" (poor thing, foot need to be cut off)
I was shocked, thinking he misunderstood what I said, then I saw him showing the Xray, "Wah tengok, (pointing at all the interphalangeal joints), sini, sini, sini, semua patah! hancur betul!" (Wah look, here, here all fractured! really shattered!)
He shook his head and ask the patient, "Macam mana? kena potong la.." (How? have to cut already..)
The patient looking at his employer, skeptically, but kinda worried as the Xray appeared somewhat "convincing" to him. The employer paused for a few secs, finally couldn't help and started laughing, so did I and the nurses, then only he knew he's being kidded, and started laughing out.

What a joker employer.
But I think their interaction was kinda fun, unlike the others that i've seen. This incident has indeed brought some light moments to the clinic=)

Semi-mad Call

Post-on call today..super exhausted as usual, guess i'm gonna write somethin on "Post-call syndrome" someday hehe. Yesterday's call was indeed a mad one..because of Hosp Ipoh was out of ventilators, they sent one ventilated baby to us plus bonus a set of 30 weeker twins in-utero transfer. So of corz, they became ventilated twins post-delivery. Just when we were busy handling the three, labour room called for a walked-in unbooked 29-weeker in labour. Not to mention the admissions for yellow babies..including few severe neonatal jaundice almost ended up exchange transfusion but luckily not..otherwise you'll see me & another MO resuscitating each other.

Now just woke up, no just regained consciousness from a collapse. I think not many ppl can experience the post-call feeling (i mean the non-medical ppl) as we did..36 hours or longer of non-stop working, it's still alright for the overnight but the next day morning is when the awful time comes. You'll have subtly dropping GCS, with episodes of LOC (loss of consciousness) and apneas, as if you're ready to collapse anytime. The LOC can happen anytime while clerking patients, talking to colleagues, or half way eating, like a absence seizure kinda thing. Hard to describe, one has to really experience it and he'll know=)

But one good thing is I just realized that i'm in the bloground today.."Darren has been very inspired to blog recently and came up with some interesting posts on a New Syndrome called Hypo-money-ism, some Slow learners who were brought for assessment and what makes a Perfect Surgery HO.."-MMR
And my good brother has written something back to my healing hearts..i'm glad reading it!=)

The Healing Hearts

"Hospitals are like the Museum of Human Life. One can find birth, aging, illness, death, and all walks of life...During the process of serving the patients, a feeling of peace and of being needed emerges. The most valuable reward that I obtain is the beauty from the smiling faces of the patients. Thence, I learn and learn and learn to be grateful, appreciate and be satisfied with what I have and continue to serve them and to learn from our greatest teachers"...Jing

I counldn't agree more with what Jing has said. Jing, one of my best frens since high school, has been such an inspiring person to be with. We graduated from the same batch in yr 2000 from Chong Hwa, I got into IMU whereas he went to Aus for software programming; however 3 yrs later he brought me a good surprise: he's joining me in medicine! I guess this is what he meant, to heed the calling=)

We share a lot of commons and thoughts in medicine, patient care and life. And thanks to him, i got to know about TzuChi, and had opportunities to contribute to the public. But Jing has made it further, he spent his elective in Taiwan, to visit the TzuChi General Hospital (which i spent mine for magic course=p), and came back with a more matured mind, that i called him a much "TzuChi-nised" person=)
I'm really proud of him. Jing, can't wait for you to join me in the service soon!

Words from Master Cheng Yen. The most beautiful sentence i've ever seen.

Believe it (or not)

Some random things i came across recently which i find quite hard to believe but..well, they happened.

1. The American "pregnant man", who was born a woman, but underwent transgender surgery and been on long term testosterone therapy, is currently expecting. The news has spawned much controversies socially and ethically. Looking at his classic pic, a bearded man with gravid uterus, what you think?

2. Do not have your haircut before asking the price. A news from China that a girl went for a haircut, instead of paying a normal price around RMB 35, was charged RMB 12,000. she has to gather money from 30 over of her friends to pay for the amount. 12 k for a haircut, hmm.

3. Have you ever checked when you see some drinks labelled "enriched with X"? That day i did, for a sport drink that was "enriched" with Vit C, you know how much Vit C it actually contained? Hold your jaw, it's THREE mg, no not per ml, it's per bottle. It's like a few drops of orange juice la..so enriched huh.

4. Ok the last one only docs can feel the impact. That day during the colorectal conference, i met some docs from HK and we had some nice chats. When talking about the pay, you wouldn't believe how much is theirs. A fresh graduate starting housemanship, the starting.basic.salary is 40k, equivalent to RM20,000, PER MONTH. Err go figure about their expression after i told them mine. It's a two-way culture shock. Ha.

Well life goes on..

A Perfect Surgery HO

I finished my surgical posting 2 weeks ago..and i must say that it's the best posting ever. I've heard much of how nice it is and till I got there, it's still better than i expected. There, all MOs, specialists or even the head of dept will treat you like a friend! They respect your thoughts, concern about you/your life/family & everything..basically a very warm, supportive and motivating posting. I'm just gonna miss it a lot. (and esp wanna say big thanks to mohan, thinesh, calvin, mark & all other MOs, for guiding and helping me so much!)

And when i did some revisions about surgery, I came across this in the "Surgical Recall" book..gosh how could i not notice it before..it's so funny! It's about what makes a "perfect" HO:

A Perfect Surgery intern/(house officer)

1. Never whines/ complains
2. Is never hungry, thirsty or tired
3. Is always enthusiastic
4. Is never late
5. Makes the intern/resident/chief look good at all times
6. Knows more about his patients than anyone else
7. Loves operation theatres, never wants to leave the hospital
8. Is the first one to arrive at clinic and the last one to leave
9. Reads from a surgery text everyday
10. Is confident but not cocky
11. RUNS for materials, lab values, test results etc before rounds
12. Smiles a lot and has a good sense of humour
13. Always writes the op note without question
14. Loves to do op and can never get enough

And this is the best..
15. Has a steel bladder, a cast-iron stomach, and a heart of gold!

Does such super HO ever exist?=)

My Boss & I

I'm in charge of SCN now and Elaine has reminded me a few time that in the Sister's room, there's an interesting article. I finally saw it and found it REALLy funny, so just to share it here. It's called "My Boss & I":

When I take a long time,
I am slow;

When my boss takes a long time,
he's thorough.

When I don't do it,
I am lazy;

When my boss doesn't do it,
he's too busy.

When I do something without being told,
I am trying to be smart;

When my boss does the same,
that is initiative.

When I please my boss,
that is apple polishing;

When my boss pleases his bosses,
he's co-operating.

When I do good,
My boss never remembers;

When I do wrong,
He never forgets.


It's just soo bitterly true!!=)