guilty

my baby has finally knocked his lil knuckle on heaven's gate. well, he is not biologically my baby. since i started my paediatrics rotation, i had been calling my lil patients 'my babies'. i talked to them. i cuddled them and sometimes its so nice to have them in your arms. they are tiny, warm, cute, rosy pink and active. Unfortunately, this baby was an exception. he was never active. Since he was tachypnoiec at birth, he was put on nasal CPAP for 14 days. He was perfectly fine until i was in charged of the ventilatory section of NICU. Blamed it on the death angle who has never failed to be my best friend. he was then intubated and requiring triple inotropic support. soon, he developed all the complications of prematurity - intraventricular haemorrhage, necrotising enterocolitis, jaundice and septicaemia. his septicaemia was so bad that it had led to panophthalmitis. we had no choice but to suture his eyelids to prevent exposure keratitis. when my specialist broke the bad news to the baby's parents, i felt like weeping. that was when i saw the never ending love that parents have for their newborn. Seeing their critically ill child brought tears to the mother's eyes. Being a strong devotee of buddhism, i believed that every sufferings will come to an end. God must have loved this tiny baby more than any of us. He was then gone, being supported only by ventilators and inotropes. His mother did not want us to off the ventilatory support. For goodness sake, that was her only child and soon i learnt that his father had an extramarital affair. How pitiful..... she lost her son and her husband. she has nothing left.

All in all, I hate cheaters and false hopes. I hate people who don't even know how to treasure me as a friend. For those who think that i am even worst than those unwanted people in your life, please stay away. I just want to be your friend. is it so difficult? I don't think i need you at all because i have a bunch of awesome girlfriends.

i guessed its time for me to pay more attention to the people around me. i just realized that even CCU staff nurses are taking good care of me. they changed the bedsheets for me and gave me a new blanket to sleep whenever i am postcall. Some of them are just like my mother. they made me feel so at home in SP. i felt so ashamed of myself for not knowing their names. i am so sorry if i had neglected anybody. i will grow up and be a better person. muacks!!

where has the sunshine gone?

it has been exactly 2 months since i stepped my lil feet into internal medicine. All the senior HOs gave bad remarks about this department. Obviously i was scared to be a medical HO. Did not apply for medicine as my 2nd posting but i guessed i was given medicine for some reasons. I don't believe in God but i should just clasped my hands and thank him for putting me in medicine. Otherwise, i won't get the chance to meet some of the nicest people on earth. most of them left and i am feeling a lil bit bored.

i guessed i have to learn how to be responsible for all the silly things that i had done. I posted a comment in facebook and my big boss got to know about it. I was merely dictating what she scolded me and for that, i am being punished. I tried to be strong but its not easy to be one. Promised myself that i will still stay cheerful in medicine but i failed. somebody once commented that i brought sunshine to the department. I wonder where the sunshine had gone.

now that i am being punished, i have to work extra hard

1) i have to do all the discharges on my own without help

2) i have to clerk all the cases that came into the ward on my own. nobody is supposed to even take blood for me. i can manage 9 cases in 4 hours. that is another record

3) i am not allowed to go to the clinic

4) i have to do morning rounds alone with my MO when all the other HOs were sent to the clinic. it was not a tough job cos i know all the cases in the ward.

5) whenever boss is on call, i have to be on call

6) whichever ward she is posted to next month, i have to follow her to her ward

7) all the simple procedures in the ward would be done by me

8) all the scans will have to be spoken by me to the radiologists

9) all the NIA forms is to be filled up by me

10) i have 9 on calls this month. the others got 6 calls to do

all in all, i guessed that i am doing one man show in the ward

i am taking this punishment as a challenge

will prove to her that i am capable although i am a slow learner

i shall survive

everybody is talking bout my facebook story in the entire hosp

i hope they will stop doing so

the other specialists can't stop laughing at me whenever they see me around

one of them wanted to refer me to psy

for goodness sick, i am not depressed yet

lesson of the day : miss annie is not going to be active in facebook for the next two months

tears of guilt

69/ chinese/ uncle

was admitted for sepsis secondary to infected sacral sore, acute on chronic renal failure secondary to dehydration, infected left lateral malleolus DM foot ulcer, hypochromic microcytic anemia - post transfused 2 pints of packed cells, diabetic and hypertension

his wife noted that he was staring blankly at home, not responding to call and gave a history of poor oral intake for the past one week.

we did a plain CT brain for him and noted to have hypodensities over the right caudate nucleus and right external capsule. this is his 3rd admission for recurrent stroke.

started him on ryle's tube feeding and he was tolerating orally for the past 6 days

we had to maintain his low BP with inotropes.

his GCS was always 11/15. he had always wanted to tell me something but there was no voice

his non hemiplegic hands were always grabbing mine

somehow, i knew he was begging me to release him - we had to restraint him for he was strong enough to pull out his ryle's tube

that day, i weaned him off from his NPO2 as he had an oxygen saturation of 99 %
unfortunately, he started to desaturate that night itself and stopped breathing at 5.30am
pupils were fixed and dilated, unresponsive to light

his 'so called' filial sons came
i had to break the bad news to them that their papa was no longer around
they were then sobbing, squeezing out tears of guilt


they had never been to the ward, unless i called them over
i wanted them to learn how to feed the old man by ryle's tube and how to take care of the bed sores
i was at the verge of scolding them through the phone
what is the point of crying when it is too late to do so?


this is the first uncle who passed away under my care
i had blamed myself for weaning him off from his nasal prong oxygen
but then, medical patients are just so unpredictable
they just choose to desaturate and knock on heaven's door

my first proposal

i was attending to a 3 year boy who had degloving injury over the right arm when the uncle over the next bed had a severe bad, productive cough. he was breathing harshly with polyphonic wheeze. he was still able to speak in full sentence. there was sputum on the anterior aspect of his chest. i attended to him stat, put my stetoscope deligently over his chest, straining my ears to listen to his breath sounds. he had prolonged respiratory phase with ronchi. he must be having an acute asthma attack. i put him in propped up position, ordered the nurse to nebulised him stat with ventolin.

Then, he was pretty much comfortable. i probed for more history and found out that he has LOW of 1.5kg, LOA and had TB contact. we did a mantoux test for him.

out of a sudden, he called me..........

patient : Dr, u sudah kahwin ke?

me : tak tau...................i don't want my patient to know anything about my personal life

patient : mari lah... Dr... kalau you belum kahwin, jom kahwin dengan saya

me : tak mau

patient : kenapa??????????????????????????

I ran out from the cubicle, stunned. when i read his social history. he is a 61 years old / malay / male who is unemployed, married, stays in an old folks home and has 4 children

how is he going to take care of me?

i am not that stupid to become a stepmother of 4 ok?

learning how to protect myself

I had never met anybody so mean before in my 3 months of working life. AL is just another lazy young doctor in the ward. To make matters worst, he is a 6th poster. All he knows is to order me to do something.

INCIDENT A

there was a patient who suddenly deconsented for operation due to depression. So AL went to pacify the patient for op. He must have been a sweet talker because patient agreed for op after that. i should have given him a pat on the back. so AL came to me..............

AL : Ann, can you call the anaesthetist now to inform them that the patient has agreed for op?

i was speechless. Hello!!!! do you know that anaesthetists are the scariest people in the whole hospital? they had no common sense. they devoid of feelings. all they do is to scream at HOs and make HOs look like fools. I don't blame them for their extreme craziness for they had no HOs under them to torture.

AND AL wanted me to call them?? I am not that naive to dial that number. First, i will be scolded and he will escaped. No way am i going to become his scapegoat. Only MOs and nurses are allowed to call those ferocious anaesthetists. Then, i came to my senses. why can't AL call the anaesthetists himself? Why must he specifically choose me? just because i am a first poster?

I have learnt to protect myself. I don't want to make AL angry because he is going to become my MO soon. i gave him that fake beaming smile and i told him this......

ANN : oh AL, i have things to do now. why not you try to call our MO instead? don't call the anaesthetists. let our MO inform the anaesthetists ok?

INCIDENT B

48 years old chinese uncle complaints of acute onset of right knee swelling for the past 4 days. there was suprapatella bulge, patella tap was positive, warm, ROM limited due to effusion. After the rounds, i pushed patient to the procedure room. did a knee joint aspiration for the first time to rule out septic arthritis. i knew that i have to send the synovial fluid FEME urgently because septic arthritis is an emergency. i ran the the lab myself and i saved one bottle of synovial fluid for the MO on call to inspect the fluid. I have learnt well. Dr L was once very unhappy with me when i told him septic arthritis is not an emergency. I kept calling the lab to trace the urgent FEME when AL sat at the counter gossiping with the nurses. It was his patient afterall.

then he saw me busy tracing the results. He came to me and asked me to inform the MO on call that i had saved a bottle of fluid for inspection. and... how he doesn't mind running to the OT just to show the bottle of turbid synovial fluid!!!!

Hello!!!!! why do i have to do the calling again? Dr K was the MO on call that day and he will be extremely mad if we call him for no reason. i don't understand why can't we wait for the synovial fluid FEME to confirm that there is pus cells / numerous leukocytes / increasing trend of ESR before informing the MO. i bet the MO on call was busy in the OT. i guessed that he wants to show the MO that he is hardworking.... he has been doing all the job, when he actually did NOTHING.... he just wants to get the credit

so, i gave AL that fake smile again

ANN : oh AL, why not we wait for another 30 minutes for the lab to release the FEME result? then you can run to the OT if you want to inform the MO?

i was complaining to cafu about how mean this 6th poster is.... he had always wanted me to become the scape goat..... Cafu said these are the kind of people who will survive.... I maybe gullible and tiny, but i am not going to let any 6th posters bully me....

home sickness

it was an acute onset of extreme homesickness. suddenly i had the urge of curling up like a ball and allowing a few drops of tears to be squeezed out from my myopic eyes. i longed to feel the soft, bushy fur of my forever faithful nicky boy. I can't wait to have a decent dinner with my parents and my silly lil baby bro. to make matters worst, cafu is always on call. i had no calls... that forced me into a state of poverty. I am craving for mommy's soup so much now that i swear that i can feel it trickling down my throat.

I will going home next week but i hate it when everybody is so concerned with my marriage. The problem is i am not at all ready to be somebody's wife. I still feel so young. There are so many things that i want to do. I can't imagine me wearing that white gown in the next 5 years.

please stop asking me when i am getting married!!!!!!!!!!!!!!!!!!

can i just have some peaceful time at home? without STRESS?

thank you

tomato red banana

the night is as quiet as it used to be and i just can't force my eyes to shut. A sense of embarrassment kept hovering me like dark clouds which were about to pour torrentiously. i am invariably ashamed of myself for not being able to speak proper mandarin + hokkien.

i was sitting with Dr K in the clinic this morning. A malay girl came to seek consultation for osteochondroma and she told me ..... 'Dr, i can speak mandarin'..... i ended up speechless, practically hunting for the right words to defend myself that i am not a banana afterall. Then, my lovely cornea caught the sight of Dr K laughing at me sarcastically. he was nice enough to explain to the patient about her condition in mandarin. i thought that he was nice. how innocent!!! he was then desribing how verbal constipated i was to the other MOs. of course, there was a burst of laughter which seemed to be contagious, enough to stir a commotion in the OPD. i stood there, warm blood gushing proximally to paint my cheeks tomato red. if i were an ostrich, i would have dug a hole and buried my blushed face!!!

So, i am a chinese who looked like a chinese but can't speak chinese!!

my first month in sp

wee!!! looking forward for my very first salary!!

i have been posted to the orthopedic ward in K5 for exactly one month now

i have learnt a lot including on how to order drugs through the computerized system

of course, there were a lot of ups and downs

3 of my MOs are kind enough to me

my brannula skills have improved a lil bit.

i can now withdraw blood from old uncles. i could still remember how terrible i was back in med school. the vein was protruding and i couldn't get that blood into the syringe

Dr A said that my skills and knowledge were inadequate when i assisted him in OT. he said i was holding the scissors badly.

Dr K hit my hand with the bone cutter when i held the scissors wrongly. we did Incision and drainage for a right shin abscess in the OT 2 days back. i had fun sucking the thick yummy pus. i was then warned by him to stop playing with the pus

i presented my first CME today. surprisingly my specialists love my presentation

hoho...so delighted and proud of myself.

i can now treat high BP cases, hypokalemic cases and uncontrolled DM

i have done 2 ray's amputation too

guess that i have achieved quite a lot in this one month

can't wait to go to medicine. the HOD is worst than the combination of manomani and mv. since all my colleagues are appealing for medical after ortho postings, i guess i will go to hell together with them

starting my active call tomorrow. i hope i will be able to set at least 3 brannulas...