The problem with gratefulness

Since I've started this new post, I have been kept in a constant supply of chocolate. All from grateful patients who have been under my care this year.

I usually open up the box and share the chocolates with the rest of the healthcare staff. A kilogram box of Cadbury's Heroes can be emptied in this manner in under fifteen minutes. I am usually able to save a couple of bite-sized pieces of Timeout at the risk of having my hand chewed off by the cocoa-maddened crowd. It's like throwing a fresh carcass into shark-infested waters.

Even so, I have put on 5 kg in the last 3 months. This is entirely due to the consumption of two or three chocolate pieces a day because nothing else in my lifestyle has changed. 5 kilos of chocolate weight! If this goes on any more, I shall be able to roll myself into work.

I am thinking of going swimming regularly at the local leisure centre. However, I have difficulty spending an hour in the pool just doing laps. I get bored and end up playing with water instead. Anyone have any suggestions on pool exercises I could try, just for a bit of variety?

Heard

Quotes from the consultant with the red bow tie:

On double glazing: "Nineteen thousand pounds for a pair of sash windows? Bollocks! I don't live in bloody Buckingham Palace."

On palpitations: "I knew a man who would stop his palpitations by jumping off the roof of his shed - and it worked every single time!"

On chest infections: "Antibiotics? Bollocks! Cough up the gunge, I say, that's the way to do it. Antibiotics are poison."

On teenagers complaining of chest pain: "Chest pain? Bollocks! Don't be a namby-pamby. Go home and play Nintendo or something."

On morning ward rounds: "Bollocks!"

On the 4th overnight shift

Name: TSCD
Age: 26

Difficult historian - slurred, incoherent speech.

Presenting complaint: Headache associated with photophobia

Examination:
Drowsy but rousable.
Appeared tired and pale.
Inappropriate affect eg giggles when discussing serious problems.
Disoriented in time and place.
Abbreviated mental test score: 6/10 (not able to give correct date/time, identify British Monarch or count backwards)

Diagnosis: Acute confusional state - ?stroke ?meningitis

Plan:
1. Continue overnight shifts (9pm to 10am) for another 3 days
2. Start morning ward round at 6am and continue until noon
3. Insist that patient arrive early to attend evening ward round at 8pm as well
4. Start up caffiene infusion as required
5. GPs to please send in as many agitated and aggressive patients as possible

Unacceptable

Dear General Practitioner,

If you are referring a patient to hospital out of hours who is confused or who has severe dementia, it would be really, really helpful if you sent a letter with the ambulance crew detailing why he or she needs hospital admission. Perhaps a copy of their current medications or past medical history would be useful as well.

If this is not done, then hospital doctors like myself will be forced to think that you are either lazy or stupid or both.

This evening, I have seen five confused patients who have been admitted to the hospital with no referral letter. This is unacceptable. How am I supposed to treat a patient when I don't know what the problem is?

Perhaps you think that I could call up your office and get all the details from you. However, your surgery is closed after 6pm. I will have to wait until 9am tomorrow morning to get information. If you felt that a patient could wait until tomorrow morning to get treatment, then perhaps you shouldn't send them into hospital as an 'emergency'.

Kindly wake up your ideas.

yours sincerely,
TSCD

Meh!!

It is 3am. An elderly lady is admitted.

TSCD: Hello. Why are you in hospital?
Elderly Lady: I don't know. Am I in hospital?
TSCD: Yes, you are in hospital. Do you have any pain?
Elderly Lady: No.
TSCD: Do you feel sick?
Elderly Lady: No.
TSCD: Do you feel well?
Elderly Lady: No.
TSCD: What is making you feel unwell?
Elderly Lady: I don't like to be in this room.

(pause as TSCD weeps silently.)

TSCD: Who looks after you at home?
Elderly Lady: Josh is my carer.
TSCD: Where is Josh?
Elderly Lady: I don't know. Why am I here? I don't like to be in this room.

(long pause as TSCD weeps silently.)

Elderly Lady: Maybe he is at home, because he lives at my house.
TSCD: Okay.

(TSCD calls Josh at home.)

TSCD: Hello, is that Josh?
Josh: Yes.
TSCD: I am the doctor. Are you the carer of Elderly Lady?
Josh: Yes.
TSCD: Can you tell me why she is in hospital?
Josh: Yes....

(silence.)

TSCD: Josh, could you tell me why she is in hospital?
Josh: She isn't well....

(silence.)

TSCD: What is wrong with her?
Josh: Well, normally she is brown but today she is grey.
TSCD: When did she go grey?
Josh: Today.
TSCD: I mean, what time did she go grey?
Josh: The whole time.
TSCD: I mean, what happened to her? Was she in pain?
Josh: Dunno. She was grey when she should be brown. So I called the ambulance.

(pause as TSCD weeps silently.)

Meh.

I'm on call.

The vending machines are broken.

The canteen is closed.

And I am very, very hungry.

*weeps*

Bring me sunshine

Spring Bulbs
Originally uploaded by Sunshine follows me.

MDH is a gardener at heart. He really is. Plants love him. He only needs to look at them just so, and they grow like mad.

We got all excited when we rented out this apartment because it has a sweet little juliet balcony - which is wide enough to hold two small balconnieres of plants.

This week, MDH went to the local Homebase and brought back a bag of dirt, some spring bulbs and a tray of pansies. He chose pansies, because he knows that I've always liked pansies - I love the way their little monkey faces always turn towards the sunlight.

Dirty hands
Originally uploaded by Sunshine follows me.

He also chose bulbs that would pop up and flower in the early-to-late spring. The pansies themselves are hardy and cold loving, so they will bloom all winter long.

This way, he reasoned, there will be flowers on the balcony everyday until the summer.

I helped him plant the troughs. That is, he got to mess about with the compost and bury the bulbs and pansies. I had the fun of ripping up old copies of the British Medical Association newsletters to line the floor, and cleaning up the mess afterwards.

Winters Pansies
Originally uploaded by Sunshine follows me.

So, I have two balconnieres of plants now. One with purple and white pansies, the other one topped with blue and purple violas. So far, so good.

I hope to see flowers next spring. Multicoloured crocuses peeking out under the elegant blue irises in March. Tall allums like giant strawberry chupa-chups in April. If this works, it will be absolutely gorgeous.

If it doesn't, we will end up with two mud troughs. Still gorgeous, but possibly not as decorative as a mass of crocuses and irises.

I'll let you know next spring.

Movie Night

The food:
Tomato and Basil soup with hot buttered rolls

The drink:
Cranberry and Raspberry juice with a splash of Bacardi

The movies:
Legally Blonde (I've always liked Reese Witherspoon)
Serenity
Howl's Moving Castle

Who turned off the sun?

Who turned off the sun?
Originally uploaded by Sunshine follows me.

This is what it looks like every morning when I drive to work.

Basil has got his fog lights on, by the way, but they don't seem to be doing much.

The first time I drove in fog, I kept using the windshield wipers because I thought my windscreen had gone misty from the cold weather.

Sometimes, it clears up by the afternoon - but it always returns in the evening when I'm driving home from work. Which is pretty scary, because I have to drive through a stretch of farmland which has no road lighting.

So...all of you in Southeast Asia who are experiencing the effects of the haze - I think of you all every day when I drive to and from work. Perhaps driving through fog is hazardous, but at least I can get out of the car, and all I'm breathing in is water vapour - not soot.

I actually did a project on the Singapore Haze for my module in Public Health and compared it to the London Fog. There's a pretty significant morbidity and mortality rate associated with bad air quality, which is why Singapore was always so keen on reducing air pollution and has pretty strict rules about particulate matter emissions from factories and vehicles.

My sympathies are with those who already have pre-existing lung conditions like asthma, and the poor kiddies who don't have air-conditioned classrooms. I had to do my A-level exams in an open air hall during the worst of the haze many moons ago, and it was horrible.

On another note, here's something else about the photo you see above: there's a gantry in the distance with flashing orange lights. You can't actually read what it says until you're almost under it but it actually says:

Stating the obvious
Originally uploaded by Sunshine follows me.

Well, thank you very much for the warning, folks.

Lessons in Singlish

MDH says:

"Aiyah! Stuck in traffic again! Like what, man!"
(translation: Aargh. I'm stuck in a traffic jam yet again. It's unspeakable.)

and says again:

"Aiyah! That cyclist, he ah...bak hu for brains!!"
(translation: Aargh, that cyclist has pork floss for brains.)

I think my work here is done.

Exhausted

Today, I feel like a dried up husk of a person. I just want to crawl into bed and lie quietly in a dark, silent room for a long, long time.

Unfortunately, I am still at work until 10pm.

I'm so glad I have a day off tomorrow.

Snippets

Pearls of wisdom from the consultant with the red bowtie:
"Membership exams are bollocks!"

*****

During a conversation with the staff nurse:
"Sympathy? Sympathy? Well, let me tell you something: sympathy lies between s**t and syphilis in the dictionary."

*****

Talking to an Elderly Gentleman:
"My wife? Yes, I loved her once. Haven't seen her for years."
"I'm right here, darling!"
"Oh, why, yes, so you are. Where have you been all this time?"

*****

Pearls of wisdom from the consultant with the red bowtie:
"Audits are bollocks!"

*****

Complaints from an elderly lady:
"I can't eat this biscuit. It's appalling!"
"Why not?"
"Well, it doesn't have any chocolate on it."

*****

Pearls of wisdom from the consultant with the red bowtie:
"Computers are bollocks!"

Interrupted

[8:30pm, it is a foggy evening. The hospital ward is quiet. A lone Doctor sits at the nursing station reading a referral letter. ]

Male Voiceover, with South Indian Accent: Dear Doctor, thank you for seeing this lovely elderly gentleman who is mildly confused...

[Elderly Gentleman enters stage left, screaming and running. Naked.]

Elderly Gentleman: YAARRRGHHH!!!! [exit stage right]

Male Voiceover: ...with a 'query' urinary tract infection. He is normally very well, but lately is more agitated than usual...

[Nursing Staff enters stage left, waving arms in air and screaming "stop him" "no" "hurry"etc. One of them slips, falls over, and curses.]

Nursing Staff: I just washed this! [exit stage right]

Male Voiceover:...and has been incontinent of urine. His wife has been having some difficulty looking after him at home...

[Elderly Gentleman enters stage right, screaming and running. Naked. He is followed by Nursing Staff.]

Elderly Gentleman: UP ARMS AND AT EM!!! YAAARGGHHH!!! [exit stage left]

Nursing staff: YAAARGHHHH!!! [exit stage left]

Male Voiceover: ...I wonder if you would be so kind as to arrange a full social workup and treatment for his 'query' urinary tract infection. Thank you for your kind attention...

Offstage, Elderly Gentleman: Hands off, you brigands! Hands off, I say!

Offstage, Nursing Staff: Get that umbrella away from him!

Offstage, Elderly Gentleman: Ha ha! En garde! Take that! And that!

Offstage, Nursing Staff: Argh! Ow! etc

[Doctor at nursing station looks up briefly, then carries on reading]

Male Voiceover:...Yours Sincerely, Dr Nothindu.

[Doctor sighs, picks up her stethescope, walks to stage front. ]

Female Voiceover, with Singaporean accent: I don't get paid enough for this.

[exeunt]

Grief reactions

It is surprising to find - in this day and age - mothers-in-law and husbands who believe that spontaneous miscarriages are the fault of the woman. These are educated people, mind you, who have studied biology and literature and who understand the twisted nature of the human psyche from TV soap operas.

As if a woman is not going through enough heartache and trauma to have lost her own baby; she also has to deal with with blame and isolation.

Why do people turn on each other in times of grief? Why don't families stand together and hold each other up?

Help me, matron!

I have just recovered from a really exhausting weekend. I was down in London at a friend's wedding where I was the 'matron of honour'.

("Matron" - ugh. Isn't there another title for a married bridesmaid? It made me feel like I should be wearing a large apron, for some reason.)

Anyway, I was up at all hours on Friday night making floral headpieces for the flower girls - had to prise the satin roses, organza ribbons and florist wirecutters away from the shaking hands of the exhausted mother-of-the-bride. She was so stressed that she kept bursting into tears at intervals. I had to use my Stern Doctor voice on her, and order her to sit quietly with a cup of tea.

Father-of-the-bride was torn between finishing up his wedding speech and comforting his tear-streaked wife. So I sent him into the next room to have some peace and quiet.

As for the bride-to-be, she was still trying desperately to tie up the loose ends - that is, she was calling everyone involved to double-triple-check-check-check all the details. At quarter-to-midnight, I confiscated her mobile phone. The Stern Doctor voice had no effect on her whatsoever (seeing as she usually works as a nurse) and she managed to sneak off with her mother's mobile phone. Fortunately, I caught her hiding in the closet with it, her finger poised over the dial button. She was made to lie down with icepacks over her face.

So, with everyone's mobile phones in my room, I had the worst night's sleep I've ever had in a long time. Ugh.

The wedding was beautiful, though, and I had a fabulous time.

Behold, the future of medicine

Scenario #1:

Gormless Medical Student: I'd like some X-ray teaching please.
TSCD: Okay. Have you seen any Chest X-rays before?
GMS: Yes.
TSCD: Okay, that's good. (puts up an Xray onto the light box) Do you know what this is?
GMS: No.
TSCD: Well, it's a Chest Xray.
GMS: Okay. Yes.
TSCD: Now, tell me what you can see.
GMS: It is abnormal. There is a big round...er...shadow...in the middle of the Xray.
TSCD: Actually, that's the heart. And it is normal.
GMS: To see the heart? On a Chest Xray?
TSCD:*facepalm* Yes. If there was no heart on the Chest Xray, I would be very worried, and I would maybe prepare some holy water.
GMS: Really? Why?
TSCD: *headwall headwall headwall*

*****

Scenario #2:

Witless Medical Student: I've just clerked a patient in. Can I run the clerking by you?
TSCD: Sure, go ahead.
WMS: Mrs X is a 30 year old lady. She came into hospital today because she was feeling sick.
(pause)
TSCD: And?
(long pause with some shuffling about)
WMS: And...that's all.
(even longer pause, whilst TSCD picks her jaw off the floor)
TSCD: How long did you spend with the patient?
WMS: One hour.
TSCD: One hour?! And that's all you could get out of her?!!
WMS: We talked about gardening, mostly.
TSCD: *facepalm* *headdesk*

Grand Rounds Vol 3 No 2

This week's Grand Round is hosted by Dr Kavokin at RDoctor Medical. Surf on over and check out the best of the medical blogosphere!

You know it's going to be a bad day when...

...you get to work and then realise that your stethescope is still at home.

Movie Night

The food:
Mexican style grilled chicken with carrotty rice

The drink:
Raspberry and cranberry juice

The movies:
'The Matrix'
'Pitch Black'
'The Usual Suspects'