Exhaustion Crisis!

OMG..things are never predictable. A shocking news to every MOs in A&E - one of our colleagues who went to KL attending a course, had a fall and sustained forearm fracture. So she's gonna be on leave for 4-6 weeks till recovery.

As we were already in a condition of acute-on-chronic exhaustion, now this basically has further worsened our shortage, leading to a condition called acute exhaustion crisis, with impending failure - if decompensation occurs!

And now everyday's work is awfully tiring. The "1-man-shift" can practically drain one in no time. If I were to make a wish now, I sincerely wish that, tomorrow when I open my eyes, a few MOs will drop from the sky and rescue the A&E department! PLS! We're really crying for help! ;(

My Article is in Newsletter!

Thanks to Tiffany, the Editor of the UCSI's newletter for the invitation, that I'd have the chance to share my article on her university's newsletter (issue Nov-Dec 08).

I've read through the newsletter and I think it's really a nicely done work. Good job to Tiffany and her team!=)

My article. Modified from my post "What exactly is Housemanship?".

Hope the students will like it ;)
Indeed I'm so glad to be able to share the article, and certainly will hope to contribute more in the future!=)

P/S: The article was modified a bit so that it sounds less "emotional" and I added a small paragraph at the end of it:

"Words from author:

Please take note that I did not mean long hours of working are good. Efforts are being made to cut down our working hours as it is really tiring. What I am trying to say is, before you're disappointed with the current working system, think first whether you can learn something from it, and also take the chance to train yourself physically and mentally, then you'll find it a good challenge rather than a torture!"

Why These were Missed?

I've seen a few cases over the last week and I really have some thoughts to share:

Case 1

A 70 year-old man complained of progressive abdominal distension and went to a hospital. He was told to have "angin" in the abdomen and was discharged with Syr MMT (antacid).

Case 2

A 8 year-old boy complained of "abdominal discomfort". He was told to have "gastritis" and was discharged with Syr MMT, too.

Case 3

A 50 year-old man complained of 2-month history of cough and generalized lethargy and reduced appetite. He went to several clinics, was given reassurance and multiple courses of multi-vitamins and cough mixtures.

Simple cases? Let me tell you what happened in the next half of the stories. I was really, really shocked to find out that:

Case 1

The abdomen is really distended and instead of "angin" inside, it's gross ascites! Baseline blood tests showed anemia with reversed alb:glob ratio - he was then admitted to check for the cause of paraproteinemia - and it then turned out to be multiple myeloma.

Case 2

8 year-old boy with "gastritis"? This is really not a good diagnosis that you give to a young boy. The abdominal discomfort was actually due to large hepatosplenomegaly, and also generalized lymphadenopathy was noted. The FBC showed pancytopenia. He's suspected to have hematological malignancy.

Case 3

Looking at the chest Xray, I don't think I have to say much:

A huge suspicious mass at the right upper zone. Need to rule out lung tumour.

What's happening?
Honestly, to pick up the gross ascites and the enlarged liver and spleen is nothing great. I think even a medical student can detect them. Maybe what they needed is, a person who REALLY examined them.

The moral of the stories is:
1. Eventhough the clinic/ outpatient is always busy, pls really spend some times to see the patients. Shorten the time by focal history and examination, but never "just symptomatic treatment".

2. Pick up the "alarm symptoms" - If an elderly complained of lethargy and poor appetite, "Multi-vitamin" is not the first-line treatment - Investigate properly!

3. If a patient tells you that his symptoms persist despite multiple courses of treatment, an alternative diagnosis should be strongly considered!

4. If you're not sure of something, consult the experts. You might get some unpleasant responses, but it benefits the patients!

At the end of the day, just ask yourself:

Are the patients happy with the diagnosis and the treatment?
Have you done sufficiently for the patients?

A Special On-call: Bodyguard Experience

I'm back from a special mission, sort of. Ha. I was on-call two days back, and it turned out to be an unsual one. Got an order from my department head that, a VVIP is coming to Taiping to visit and he requested a medical team to standby throughout his trip, and ya, I'm the MO who's going!

It's a rather new experience to me. In fact, it's less stressful than what I thought. Basically what I need to do is, carrying a stethoscope and following him around throughout his trip and of course, hopefully an uneventful trip - medically. Something like a personal doc for a day. ;)

And the good thing is, I get to stay in some nice places.

Water Chalet (Kampung Air). Staying in one of the executive suites. Pic taken during the afternoon lake cruise.


Interior view. Very comfortable. Remind me of some past good accommodation experience.

Oh and I have one cool thing to show..

This is something that I have to bring around. If you've seen enough of basic first-aid box, let me show you what's in this advanced one which is used in special occassions...

All the emergency medication and equipment. It even has a small oxygen tank inside!

It can be further opened up..a total of 3 layers. Almost everything that you need to attend a medical emergency, and it's just like a portable emergency trolley!

Then at night we went to the "Night hoot" in Ecopark. Something like Night Safari but I think this one is more exciting. Holding torchlight like walking into a jungle at night.


The da*n scary crocodile and the giant python.

So the trip ended the next day morning and it was an uneventful one. *thank god that I wasn't so Jonah hehe*

View from my room at 7am.

Think it was actually a quite fun experience. What a special "on-call" that I had! ;)

Acute-on-chronic Exhaustion!

Red alarm.
I'm (actually every MO in A&E) having some really tough times now. Currently Emergency department is having shortage of MOs and the condition is further worsened after one of my colleagues has got her transferring letter which is effective immediately, and one went into labour and subsequently maternal leave. So there are now only few MOs left, and the craziest thing is, now we even have to experience the extreme challenge: 1 MO per shift! Tell me, how to work with just one MO covering all 3 zones and the overwhelming number of patients?!! I mean if all patients with URTI are still ok, but what about critical ones? (If you wanna know how it's roughly like, pls read this, and it's my daily life now!)

According to my department head, we need at least FIVE more MOs and this has already been reflected to my legendary director. So hopefully she can do something, really.

And because of this madly bad situation, I most likely have to miss my good friend, JK's wedding in Dec. Sigh. Feel so sorry to him. So JK if you're reading this, hope you can understand..

So, *cough* Anyone's interested in joining A&E Department? You're most welcomed and pls let me know ASAP! ;)

Dance with Crutches?

I sorta came across this on Youtube and I was deeply captivated (make sure you watch till it finishes):



A long "Wooow"? I initially thought this is just so cool and the guy must be a genius. But I had one thing to ask, as most of the ppl would, that "Does he really need the crutches?" Then I read a little more about him at his website. Then I was stunned.

Bill Shannon, aka the "Crutch Master", has bilateral hip deformity due to Perthes disease. He then invented a unique technique for dancing on crutches - called Shannon technique that derived from his experience in their use as a mobility aid. For years, Bill has been a renowned dancer and choreographer and has motivated thousands of ppl around the world.

Take a look at his another clip:



Determination makes things possible.

How inspiring!

Just Another Jonah Call

Just finished my 3 consecutive night shifts..tiring! And one of the nights was particularly jonah. Well, let the pictures tell the stories.

A 66 year-old man with no known comorbids, with history of fever for a week, presented with severe SOB. The ABG showed severe metabolic acidosis - pH 7 with Bicarb of 4! The ECG:

The typical ECG of "Tall tented T waves, widened QRS, small P". What's in your mind?

The renal profile stat. Of course, a triple regime was given for the hyperkalemia before this result back. The ABG plus ECG gave a picture of nephropathy but I didn't expect it was this bad. Potassium of 8mmol/L! Patient could collapse just anytime. He's intubated and sent to ICU and for emergency dialysis.

Then the next SOB patient came. Known case of COAD, let's see his ABG:

Will you jump up from the chair when you see this ABG?
Ya you better do. Respiratory acidosis with PCO2 107mmHg, severe CO2 retention!
So the next thing? Intubation again what else...

So enough of medical cases. What about trauma case? A man with highway accident, pushed in for severe SOB. (It's a SOB night!)
He sustained traumatic amputation for his left arm, with massive hemothorax. Wanna know how massive?

I bet you don't come across such a massive one very often. It's 1500cc plus.
Another intubation for sure.

Beside the major ones, here are two patients with one similarity:

The above one was a young man post MVA with closed fracture right talus.
The below one was a young boy post fall while practising breakdance (in the middle of the night?!) with closed fracture mid radius & ulna.

You know what's the similarity?
Both of them refused treatment and wanted AOR (at own risk) discharge. Reason: Ubat Kampung - traditional medicine, despite counselling.

So I could almost foresee that both of them will come back few weeks later, complained of avascular necrosis, and malunion of the fractures, respectively. (I included these complications in the counseling but, I still lost to the Ubat Kampung.)

And lastly, my department head has come out with this folder (interesting title) for us to read during "free time". Too bad that on that night I didn't even have "free time" to correct my hypoglycemia.

Well, it's just another Jonah night for the poor doc...

p/s: ABG - Arterial blood gases, COAD - Chronic obstructive airway disease, SOB - shortness of breath

My New Magic Video!

Ya..finally! My new magic vid after the last one which was shot in 06..before my housemanship actually ha. Took this in the Starbucks at Gardens. This vid is a compilation of some of my new ideas in flourishy card revelations, plus two of my favourite card effects "Twisting the Aces" and "Bizarre twist". Very classical tricks, and have been included in my signature performance routine all these while!;)

So everyone, here's my 3rd magic vid:



Like it? ;)
And one thing I think I need to explain a bit here..the background song is not the original one that I put in. I had to replace it due to Youtube's restriction on song's use=(

Ya the pic in my vid. See you again in my next vid!=)

My previous vids:

Darren's card revelation 1

Darren's card revelation 2
My magic Portfolio