I didn't do it

Mrs Crumbles is very, very ill. Her persistant cough and 'touch of the rheumatism' has turn out to be a very aggressive lung cancer spread all over the body and into her bones. She moans in pain, and covering her face in her hands, she weeps. She begins to talk about planes and fires and being in Cambodia. She doesn't have much longer.

The consultant on the ward round says to us, quietly, "Start the Liverpool pathway today, and get me the Yellow Form."

This is doctor-speak for "This patient is dying. Make sure she is comfortable in her last few days. If she dies, do not resuscitate."

I take the drug chart from him, and get out the Liverpool protocol. On the 'as required' side, I write in morphine tablets for pain, haloperidol injections for nausea, midazolam injections for agitation and anxiety.

The nurses are somber.

They wheel Mrs Crumbles into a sideroom where she can have peace and quiet. Mrs Crumbles begins to scream they do this. She retches loudly, vomits, then screams again.

The nurses grab the drug chart out of my hands. "She's agitated!", they cry out in unison. They begin drawing up the midazolam.

Fifteen minutes later, as I'm tending to another patient, Staff Nurse Blue walks up to me and whispers in my ear, "Mrs Crumbles has gone a little bit 'flat' and sleepy. Please have a look at her."

I walk into Mrs Crumbles room. Her eyes are shut and her face is serene. There is no sound in the room but the hissing of the oxygen mask. She takes in a big, heaving breath that is not a breath, but more like a gag. I put my hand on her wrist. No pulse. I put my hand on her neck. No pulse. She makes another last ditch effort to breathe. Then, there is nothing.

My mind collapses in a muddle.

Midazolam!
Injection!
Death!
No!
I've killed her!
No!
No!
Gotta do something!

My throat is suddenly very dry.

I croak at the nurses, "The midazolam! The midazolam!" and wave my arms in a windmill fashion. The nurses look at me with sad eyes. They've seen this many times before, the dying patient becoming the deceased patient, the junior doctor freaking out over the prescription charts, the junior doctor who hadn't realised that the patient had been knocking on death's door for a long time.

Nurse Blue puts her hand on my shoulder and says, "She was dying and it was her time."

And then I realise that she is right, and we couldn't have killed her with a subcutaneous injection of a meagre amount of sedating midazolam.

But for 30 seconds, I thought it was my fault.

I cried - mostly in relief.

Then I wiped my eyes, and steeled myself. There was doctor's work to be done. Her husband had arrived, and not in time to say goodbye.

Shipman?!

I think I killed my patient.

Unacceptable

It is not acceptable to call the ward at 4:30pm to say that you are going to do an impromptu 3 hour ward round "hopefully before five". Especially when your junior doctors are only supposed working until 5pm.

It is not acceptable to expect a newly qualified doctor on his first day at work to know the innermost secrets of all the patients on the ward. And it is not acceptable to shout at him. And it is not acceptable to shout at the nurses either.

It is not acceptable to approach a doctor who is dealing with patients who are acutely ill and ask her to do "urgent paperwork" for somebody who has already gone home. And it is not acceptable to grumble about her behind her back when she asks you to wait until she has finished stabilising the ill patient.

It is not acceptable to ignore the senior's advice on how to be more efficient - especially if what you are doing now could lead to serious errors in patient management or delay treatment.

It is not acceptable to discharge a patient when, clearly, the patient is still sick.

It is just not acceptable.

And yet, I can do nothing, but just take it all in.

Painting the town

They wheeled him in, covered in scratches, screaming. His pupils were dilated, eyes bloodshot. He flailed his arms wildly to ward off the demons. He screamed when we approached him, and he screamed even more when he saw our gloves - bright blue and leaving trails of blue fire behind them whenever we moved.

His hair was matted together with emulsion paint, and his clothes were bespattered with it. He had fallen off the window ledge of his apartment into the construction area below.

Five minutes later, they wheeled in a small girl, 2 or maybe 3 years old. She was crying. There was paint in her eyes, her ears, her nose. Her clothes were a solid, hard shell of emulsion. As we washed the emulsion off her face, she opened her eyes and saw Mr Scream next door and started to cry, arms reaching out for him.

He did not even remember holding her in his lap.

All in moderation

I have received a couple of spammy comments with random contents like 'Play Bingo' and 'My Naughty Pictures'. Hence, I have turned on the comment moderation thingy. All comments will go through except the advertising ones. This will save me having to trawl through my own site to find out where the random spam comments are posted. Grrr.

Chaos

The more boxes I unpack, the more cluttered the place seems to look. The boxes never seem to empty, but the rooms get more and more full. Maybe I'm a magician at heart.

Soon, there will not be enough space for anything!

And I can't find the new cushion covers I bought from Forestprints. *weeps* I'm sure I've opened up all the boxes already. They must be here somewhere. They better be!

Pruning time

MDH did all the packing for this latest move with the help of the Outlaws, whilst I recuperated from my night shifts. After the last box was closed and doubly reinforced with duct tape, MDH cornered me (I was getting ready for work at the time) and fixed me with a piercing glare.

"Your clothes take up three entire suitcases. Three! My clothes take up one suitcase. You have to do something about it."

"But I need all my clothes!"

"You don't need all those clothes. You don't even wear half of them!"

"Sentimental value, sentimental value!"

"Listen, you get rid of the stuff you haven't worn for the last year, or no more new clothes!"

So in the face of such an ultimatum, what could I do?

I've been in charge of the unpacking at our new location, which gives me the opportunity to be ruthless with my wardrobe.

Absolutely ruthless.

Goodbye ratty P.E. kit from Junior College.
Goodbye 15 year old stripey shirt that I always save for plane rides because it's so soft.
Goodbye oversized birthday present from ex-boyfriend.
Goodbye souvenir sundresses from Cancun, Hawaii and Barcelona.
Goodbye Benetton sweater that I haven't worn for 5 years.
Goodbye assortment of university logo tees from various friends.
Goodbye thai silk shawl from the flea market in Bangkok.
Goodbye long denim skirt that no longer fits.
Goodbye discoloured Gap drainpipes.
Goodbye Victoria's Secret jammies.

Sniff.

Happy National Day, Singapore

It's the 9th of August.

So I says to MDH, I says, "Today is National Day."

MDH is in the shower, and he gets all excited and starts making up a National Day Song, because I have told him that every year there is a new National Day Song for Singapore.

"Hooray for Singapore! We will all work hard," he warbles, "We will work hard and live in a tiny flat and the cars are very expensive and the lifts don't stop on our floor, but we don't complain, because it's Singapore and we love it here because it's so clean. It's so clean and the roads are good and our taxes are so low compared to 40% in Englishland and Singapore is so great. Let's sign on the line with the pen with the rubber band string...!"

(MDH has been listening to the mr brown podcasts. I have been trying to educate him on Singapore and all it's lovable quirks, you see. MDH's singlish has improved drastically. There's nothing like immersion therapy.)

This year, I am not going to miss the National Day Parade again! There is a live webcast of the NDP celebrations and I am looking forward to it, yes I am. I miss National Day and all it entails - the flags, the bunting, the fireworks, the heckling of the people watching the parade's live broadcast on TV...

Yes, every Singaporean I know mocks National Day, but at least they still acknowledge its existence and they know all the words to 'Majulah Singapura'.

Here in the UK, there is no equivalant day for celebrating 'UK-ness' and I don't actually know anyone who is able to sing the entire 'God save the Queen'. I think the closest thing they've got to National Day over here is the Queen's Birthday, and who knows when that is. I think it has a parade of some description, and perhaps some fireworks, but it's not a public holiday. What is the use of a National Day which isn't a public holiday? I ask you.

Tupperware party

So a warning to all of you new doctors starting in the Emergency Department: whenever a patient brings in his or her own tupperware, beware - never volunteer to see the patient. Beware, I say, because I (as you know by now) have learned this valuable lesson and I have learned it the hard way. And because I am particularly stupid, I had to learn it three times over.

Learn from me, people.

Tupperware #1 -
description by patient: This tupperware contains the spider that bit me in the supermarket. I now have a small rash on my hand.

action: Stupid doctor (i.e. myself) opens up tupperware to have a look, as if she knows anything about identifying arachnids. Serves me right for trying to be a smarty pants.

result: Large spider scuttles out of tupperware onto my hand, then drops on the floor and terrorises the rest of the A&E staff. And when I say large, I mean, large. This eight-legged freak was probably living quietly amongst the bananas in the fruit section for several years before renovations work disturbed it. It was probably about 5 cm in diameter. I spent 20 minutes trying to coax it back into the tupperware, the nurses and myself screaming loudly the entire time - we couldn't kill it otherwise it might be too mangled to identify. Then we sent the tupperware to the local zoo to get the spider identified.

Tupperware #2 -
description by patient: This tupperware contains a dead snake. I killed it after it bit me in the ankle.

action: Stupid doctor (i.e. myself) opens up tupperware to have a look, as if she knows anything about identifying snakes.

result: Small adder is definitely not dead, not even remotely. Patient probably stunned it long enough to carry it into the house on a stick and ram it into a box. The snake hisses at me, but I manage to shut the tupperware before it slithers out. I managed to identify snake by looking at pictures on the internet and confirming it with the local zoo - definitely an adder, definitely mildly poisonous, definitely should have worn gloves before opening the tupperware.

Tupperware #3-
description by patient: This tupperware contains some worms that wiggled out of me when I was moving my bowels.

action: Stupid doctor (i.e. myself) puts on gloves this time and gets the patient to open the tupperware.

result: An enormous mass of writhing white tapeworms almost spills out onto the floor. The smallest of these is about 15cm long. I am suddenly aware that my face is way too close to the opening of the container. I have to send them to pathology to be identified so I spend 15 minutes trying to stuff one of these creatures into a pot normally used for storing dentures. It does not cooperate. Afterwards, I vomit copiously and then the rest of the day I scrub my hands obsessively. I will never be clean again!

Beware the icecream tubs

Note to self: If a patient pitches up with an icecream tub, do not do not do not pick it up or open it. And do not pick it up and open it without wearing gloves. Ever.

AARGH!!

*runs screaming to the toilet and vomits copiously*

Away with the fairies

TSCD: Hello there, I'm the doctor come to see you. How are you feeling?
Mr Doolalie: Yes...well...the atmosphere here is quite pleasant.
TSCD: Okay, can you open your eyes please?
Mr Doolalie: No, I like to keep them closed if you don't mind, to enjoy the atmosphere.
TSCD: Do you know where you are?
Mr Doolalie: Oh yes.
TSCD: Where are we now then?
Mr Doolalie: That's right. Absolutely. And what are we? Hmmm...
TSCD: No, where are we now?
Mr Doolalie: It...is...the present day. A good day for brick laying.
TSCD: Okay. Have you any pain anywhere?
Mr Doolalie: It is...a grand day for brick laying.
TSCD: Ummm...okay. We will need to do some blood tests and Xrays.
Mr Doolalie: Oh yes...the blood is thick and so is the mortar. That's why it sticks to the bricks.
TSCD: Do you have any questions for me?
Mr Doolalie: Yes...I do have a question.
TSCD: What is it?
Mr Doolalie: Are you...German?

Wandering summer

Sheep in the vale
Originally uploaded by Sunshine follows me.

I have just realised that I haven't shared the pictures of our trip to the Lake District (let alone our anniversary weekend getaway). There is a distinct lack of photos on my blog as of late (I totally blame BT broadband!), just reams of boring text. It's all about multimedia nowadays, and I must keep up with the times.

I must say that I was dreadfully poorly during my trip to the Lakes. I had envisioned myself sauntering along the decking in a breezy cotton skirt and roman sandals, holding my floppy hat in my hands as my hair streams behind me in the warm summer wind. Certainly, MDH had filled my head with grand ideas of dining daintily on strawberries and cream whilst floating along in a rowboat, splashing around in the cool river waters in bathing suits, picnicking on the dry grass.

Bracken lace
Originally uploaded by Sunshine follows me.

Needless to say, the clothes I had packed were totally inappropriate for the climate. Nevermind that it was sweltering along the South Coast and my hospital was admitting dozens of heatstroke patients. The lakes are always cold and always rainy. I should have known this from experience, having grown up in a flat near the water catchment reservoirs in Singapore.

I had one set of 'wet weather' gear with me (corduroys , sneakers and a denim jacket), but I had to borrow one of MDH's jumpers to wear, over several sleeveless and spaghetti strapped tops. Never believe anyone who claims that layering is everything. I looked like a walking portmanteau.

Lake Thislemere

The Lakes were pretty much deserted at this time of year, as school holidays had not yet begun. So no one witnessed how ridiculous I looked. I only have photos now, and everyone knows that photographs tell lies.

(My mother takes one look at the photos afterwards, mumbles something to the effect of "Aiyoh, you have nothing to wear ah?". Then, she goes out and immediately purchases three new coats for me to wear.

Mother emails me pictures of the coats and I spend half an hour convincing her that I do wrap up warmly in the cold english weather, honest, mum, I do, I really do.

I had to make her return two of the coats. I kept the third one because, after all, my mother does have impeccable taste when it comes to clothes, and it was a beautiful piece of crochet, just perfect for autumn. But I digress.)

Burning pine cones
Originally uploaded by Sunshine follows me.

The cold weather meant that we could retire to our cottage after a bracing walk and cuddle in front of a crackling fireplace. The cottage would soon be filled with scent of burning pinecones.

Pinecones, by the way, make a very satisfying fizzing and popping sound when they are burning. Sparks fly everywhere when they start crackling, so I now understand the purpose of fire screens.

I've never actually had a real coal fire before, so I spent every evening getting in touch with my inner pyromaniac. Of course, MDH was in charge of the Prometheus side of things. He would light the fire and then pound his chest in a manly fashion. I would excitedly potter round the cottage doing my duty as the gatherer, picking up garbage (sodden tissues, empty cardboard cartons and the like) that we could use as firestarters.

Occasionally, the sun deigned to make an appearance (on the last day of our trip, of course), and this meant that MDH and I would be seated outside on the slate steps, drinking tea and teasing the local cat.

Calico cat on the slate steps
Originally uploaded by Sunshine follows me.

This Thomas kitty was obviously the pet of the whole town, sleek and fat with glossy calico fur. He would stare at us with his golden eyes, before rolling onto his back and his paws batting the air in supplication. How could anyone resist such a plea from pink paw pads? Besides, there were plenty of roast chicken scraps to spare.

Once our feline friend had scoffed down his fill, he would pad off to the next house for seconds. In his absence, the tiny garden would slowly come alive with birds - the tiny warbling wrens, the acrobatic blue tits, the curious and territorial robin, the greedy chaffinches.

We'd watch them flit amongst the hedges, as the setting sun cast a red glow over the dry stone walls.

When night fell, the crickets would start to sing and we drifted slowly off to sleep, snug under the fluffy duvet, listening to the sound of frogs chirruping and the faraway chime of bells, as the cows from the nearby fields made their way home.

Back in the game

One year of A&E is over, and I've secured a post in general medicine up along the northern coast.

MDH and I moved into our new apartment yesterday - a cosy little place that has a 'Juliet' balcony overlooking the bronze waters of the estuary. It's all kitted out with brand new furniture and has nice wood laminate flooring. The hospital we work at is about 15 minutes away in bad traffic, and we're only a stone's throw away from the city centre.

And, the best part is that our broadband service has been activated! Huzzah! BROADBAND RULES!!

The last 2 weeks have been horrific without the internet. MDH and I would come home, and we would be unable to check our email. We don't have a TV, so we had to listen to the radio in order to keep up to date with world news. Yes, it was back to the 1940s for us. In the evenings, we would sit on the sofa and listen to the wireless reporting on the war in Lebanon. Good times.

It is my first day on the job today, and I start on overnight duty until the end of the week, manning the acute admissions unit. This is why I am updating the blog at 4am.

I met up with my consultant this morning. The first thing he said to me was:

"You are a doctor. University graduates have an average IQ of 135 in the UK. Doctors are considered to be the top 5% of university graduates in terms of intelligence. As such, you are considered to be brighter than the vast bulk of the populace. Therefore, I expect you to know how to write."

Point taken.