Taboo

Preamble

I've been saving this draft I wrote long ago towards the end of my fourth year of med school, uncertain if I should share it. Was worried that I'd get in trouble for sharing something like that. It's probably unlikely, given that I'm not sharing any identifiable information about the patient or the personnel taking care of the patient. Plus, it's been so long ago... I doubt anyone other than myself remembered this incident. I've considered deleting it and just move on, but some things are hard to let go, and this is one of them. Sharing it now because it was so hard to talk about it when it happened then. Perhaps sharing it here now will allow me to see it in a new light, and put it to rest. So... here goes.

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My Emergency Medicine rotation was a memorable one, one that gave me some of the best and worst experiences in my clinical years as a med student. One particular incident left a deep impression on me, and I had to pen it down while it's still fresh in my head. On one of our on-call nights, my friend and I returned to the ED (Emergency Department) from a quick dinner break, only to find the red zone to be almost empty save for this one patient with the attending and a house officer huddling around him. The ED was divided into 3 zones - red, yellow and green (like the traffic light) - and patients were triaged to a zone depending on the severity/urgency of their condition: red being the most urgent/severe and green the least like a cold or a minor cut, with yellow in between with the potential of escalating to the red zone. As most med students can attest to, we usually like to be where the 'action' is, if not actually making ourselves useful during such occasions, at least watching and observing to learn a thing or two. And on that fateful night, a thing or two we did learn, indeed, albeit not what we expected.

A 60 year-old pedestrian was hit by a motorcycle, and was found unconscious on the ground for an unknown period of time. Upon arrival, he was found to have GCS of 8, with an active bleeding somewhere in the oropharnygeal region. He had no external wounds, no broken bones. His condition warranted a tracheal intubation to secure his airway before being sent for a CT scan of the head to rule out an intracranial hemorrhage. Unfortunately, none of these happened and he was not intubated until two hours later. Meanwhile, this man was bleeding quite profusely and we were tasked to suction the blood out of the cavity, as they tried to intubate him. I watched helplessly, worrying about him bleeding out. At the rate that he was bleeding, I was almost certain the blood being transfused could not keep up. It took another two hours to send him for the CT scan, because while all this was happening, his abdomen became increasingly tensed and swollen. The consensus was that there might be internal hemorrhage, but they couldn't seem to agree with the next step. It was between sending him for head CT only, or whole body CT scan. At this point it was close to midnight, the red zone started to get busy, the surgical residents who were called for consultation were reluctant to bring the patient to the operating room for an exploratory laparotomy to potentially stop the hemorrhage in the abdomen. Deliberate discussion took place, and then some, and in the end they decided they wanted a whole body scan. As all those were happening, patient's BP kept going down, his pupils fixed and dilated, and all we did was keep giving fluids and blood products. Bad luck had it that the CT machine in the ED wasn't working, so he had to be brought to the radiology department at another site, which was a long way away. It took us at least another 30 minutes to gear up before we were finally on the move to the other side of the building. Alas, as soon as we got there, the man coded, test was aborted, CPR was started while we wheeled the patient back to where we were 10-15 minutes ago.

It was of no surprise that this man died after an unsuccessful resuscitation; and everyone carried on with other tasks and patients as if it was just another death. Everyone except me. I was bewildered, stupefied, but most of all I felt helpless. Perchance when he came in he was already a lost cause, perhaps death was inevitable with the severity of his injuries, but we didn't know that for sure. Even if we did, shouldn't our job be to do our best to save his life, the emphasis here being 'to do our best'? I was upset not just because a person died that night, but that in every step of the way I felt we as providers could've done so much better. I didn't (couldn't) understand why everyone acted as if it was just another green-zone case, why there was zero sense of urgency, why certain decisions were made (and took so long at that), and why everyone appeared to be emotionless and moved on so quickly. Throughout the entire time no one contacted his family members, no attempt was made, or at least none that I know of.

I tried to understand what happened, and what could've been done differently to prevent this from happening, but I was stumped. This to me should be a case to be brought up during Morbidity and Mortality meeting, but when I asked the attending about it at the end of our shift, her reply to me was this, and I paraphrased: "... you will see things that are done correctly, and things that are handled poorly. Good and bad decisions, and behaviors/attitudes. Just learn the good ones, and ignore the bad ones..." For the second time that shift, I was baffled. Sure, yes learn the good and leave the bad behind. But what about the patients?! By not doing anything, aren't we silently consenting to the wrongful actions or behaviors? Does that not make us complicit? That morning I had trouble sleeping. I felt I've failed the patient, and I couldn't get rid of the guilt. As I eventually dozed off, I think I died a little inside.

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Afterthought
I still think about this man once in a while. I wonder if it's just me being the med student who was 'young' and 'innocent' and this was some kind of rude awakening to 'how things are' in real life. An initiation of sorts. Because how else do you explain why everyone who was working there acted so nonchalantly and went about their business? Maybe they felt something too, but had to hide it to be able to function. If everyone dwelled, then no work could get done. Maybe it's the culture to act tough and move on. Maybe like me, initially it got to them, but after a while if this kept happening, they just had to wall their emotions off, toughen up and learn to shut up and move on. Maybe they all felt helpless at some point, but believed that nothing could be done to change this and so they just accepted the way things were and learned to live with it. I don't know. These are just my speculations, because we weren't allowed to talk about it. Because pointing out some behaviors, actions, or decisions that might be questionable is forbidden, I didn't get to understand the root cause in that context. I doubt they really understood it either. It's such a taboo that you just learn to sweep everything under the rug and do your thing. If you want to survive, that's the modus operandi. 

My writing this and sharing it here wasn't intended to criticise or to let known how bad things are back home. Situations like these happen everywhere. The point is, there is a need to talk about it, to discuss and address the issues so that we can improve. Pretending as if it didn't happen won't prevent it from happening in the future, and then it's just going to happen again, and again, and again... We owe it to our patients to do our best, and make sure we do not repeat mistakes that can potentially cost lives. Primum non nocere, in English, means 'first, do no harm'. To do that, we've got to set aside the ego, and be willing to take the first step to talk about things that went wrong. I do not know if things will ever change back home, but I sure hope it will. One can only hope. 

A Wrong Diagnosis

If you ever had that passing thought that "things couldn't go any worse than this right now", my advice to you is: please, stop. Stop that thought right now and switch it to something else, whatever that may be. Think of mockingbirds, ice-cream, the cute guy/girl you saw yesterday, your pet. Anything. Anything but that. Experiences prove, time and again, that every time that thought comes into mind, things will inevitably become worse. You may say, well maybe that's just my selective recall bias, an anecdotal fallacy, and not truth. Fine. Have it your way, but don't say I never warned you.

For the past few weeks I've been obsessed with rashes. Found every article I could and read about the differentials, examined for hours the images of each rash, read more than once about varicella, scabies, PLEVA, and a few others on the differentials. I'd wake up in the middle of the night from the itch, reached out to my phone and looked up other causes of rashes, or read up on one of the many skin diseases. I really shouldn't be going down the rabbit hole when I should be studying for boards, but I can't help it!! I can't stand not knowing what it is and why it's getting worse when it should be better! Arggghhhhhhwwarrrrghhhuuuurgggh!!! [That's me turning into Hulk, in my head.] 

So. As you can tell from the title of this post, turns out the rash wasn't chicken pox after all. Here's what happened. 

About two weeks after it started, when it didn't get better as expected for varicella, but in fact got worse, I started questioning the diagnosis. I would've got to the bottom of it all sooner if I wasn't so reluctant to see a doctor, or if I didn't hold on so tightly to the wishful thinking that it is the easier, simpler diagnosis. Because even though it's absurd that one could get varicella twice, it's still a shorter course of disease, self-limiting, and- I was banking on the probability of it being milder since it'd be a recurrent infection. I was really hoping it was "just" that, and be done with it. So when the rash started to spread, I convinced myself that I'm seeing things, that it's all in my head. Sigh. "For someone who studied so much, this type of reasoning was downright stupid," I can almost hear my dad say that to me. :(

And so it got to a point where I just couldn't lie to myself anymore and had to go to the university health center to get it looked at. The doctor being uncertain of what it was, referred me to dermatology. And with just two words, a huge portion of my anxiety melted away: pityriasis rosea. UGHHH. Really? I never thought bout it because there's no herald patch! And no christmas tree pattern as well! Here's another lesson learned, just because something is pathognomonic of a disease doesn't mean the absence of it precludes the diagnosis. I guess my frustration was noticeable, when I asked the dermatology resident: "How on earth did I get it?!" To which he calmly responded, as if trying to placate me, "It's nothing that you did or could've done to get this. It's a really common disease and a lot of people get it, but we still don't really know why it happens or what causes it." Great. Just great. Isn't this the majority of the case for almost 80% of the diseases out there?! That we don't know what the heck we're dealing with most of the time.  If I weren't in the medical field and could understand the unpleasantness of having to tell a patient that, I'd have rolled my eyes and stopped listening. But I get it, so I didn't pursue further.  Yes- I get it now, more so than ever, because now I don't only understand it from the physician's point of view, but also from the patient's. I know how it feels to be on the receiving end of that statement- and it sucked. 

Sure, I understand that a lot of medicine is still in the grey area, and that there are a lot that have yet to be discovered. But the simple truth is that logic never does make anyone feel better. It also makes me realise something about myself, which is probably also the nature of most human beings: that we always attempt to explain everything that happens to us (that's how the age-old adage of "everything happens for a reason" reasoning came along, isn't it? To make us feel better?), and we also try to do so in a way that attribute the cause upon something other than ourselves. In other words, we're always inclined to blame it on something else, anything but ourselves or our own deed. But when push comes to shove, we'd take the blame too, as long as there's a logical reason to it. We don't handle the "unknown" very well though. Indeed, it's the shrugged "I-don't-know-why-it-happened-it-just-does-and-I'm-sorry" explanation that makes us feel the worst. But why??? Why did it happen to me? What have I done to deserve this?!  Those are the thoughts that would plague one's mind, because one usually cannot fathom how a bad outcome could befall oneself when one has done everything by the books. Think of all the people who got lung cancer but never smoked a cigarette or anything in their entire lives. Or substitute it with any cancer that happened without a known risk factor in someone who had lived a perfect life up till that point. Think about the 30-something neurosurgeon who was about the complete his decade-long training only to find out he had terminal lung cancer. It's atrocious! How vile to have been sentenced to such fate when a 90-year old man a stone's throw away was probably happily puffing his cigarette celebrating his 70th-pack-year! But what can one do but throw up his hands and surrender to this thing called Life??! 

And when the initial emotions has passed and the dust settled, how does one cope with this kind of horrible outcome? Ironically, one tends to circle back to the "everything happens for a reason" argument to cope with it, or chose to accept and entrust one's faith to the higher beings. That, or one could go into self-destruction mode and start hating everything and everyone with the "fuck god, fuck the disease, fuck the world" mentality. 

Now I'm not being melodramatic, I don't have a terminal illness, I just have a skin condition that is also self-limiting, albeit one that will last 6-8 weeks. In the bigger scheme of things, I am thankful for being alive, for having "just" a skin disease. But being unwell is hard, especially for someone who's spent most of her adult life working towards being the person who provides care. Now that table has turned, it's a hard pill to swallow. I don't want or like to be reminded that I too am mortal, that I'm completely susceptible to any disease, and that the medical degree earned is not an immunity to any or all sickness at all. Alas, I, and all the other physicians who may share my sentiments, are just humans too. We too can die, can get heart attacks, dementias, stroke, or [insert your disease of choice here]. It's a silly, not-worth-mentioning known fact, but we don't really think about it until we have to. (One could argue that some deliberately avoid thinking about it, but that's a topic for another day.) The truth is, we all have to face mortality at some point, and we will all do so on our own terms. One way or another, eventually. (Unless you happened to be in a plane that miraculously disappear into thin air. Then sorry, no time for you to think about dying and death because your brain cells and every bit of you will be blown up into ashes before you could even conceive of what just happened.)

I write this before I had the chance to read Atul Gawande's Being Mortal, or Paul Kalanithi's When Breath Becomes Air (that's the neurosurgeon who had terminal lung cancer I mentioned above), even though those books are just sitting on the shelf two feet away from me. When I'm done with exam, I'll read them. Perhaps I will have additional thoughts on mortality then. But at this moment, as I'm writing this pondering upon mortality, grateful that I'm alive yet slightly (only slightly) resenting the cards I'm dealt with, I still think it's a good thing over all. I see some good coming from it, not because I'm a masochist, but because through this ordeal I had a taste of being a patient, of being unwell, without having to go through chemo or radiation (or worse- to die!).  Empathy and compassion often grow exponentially from first-hand experience. So hopefully this experience will help me be a better doctor. Then again- one could only hope, eh. :P 

Peace. xoxo.

Afterthoughts

"Welcome to the real world, where people only want answers -- correct, accurate answers. [...] In life, there is no partial credit for being half right. If you want to accomplish something important, you have to be totally right -- and be willing to face the consequences if you are not."  

Excerpt from When the Air Hits Your Brain, by Frank Vertosick Jr., M.D. 

It's funny how I'd always come across something that is so relevant to what I've been thinking about at that moment, as if the universe 'gets' what I'm thinking and is sending a message back at me. Those words from that excerpt pierced right into my heart, and mind. It's probably a gradual process, but at some point during my clerkship rotations, I realize this: every passing day I am inching towards that real world- a world where physicians are expected to be perfect all the time.

Some time last week, I was in the neurosurgery morning conference, and the head of department talked about how patients are increasingly demanding, and they would harp on the one mistake that you've done, and would not let it go. To some, it doesn't matter if you've done many things to help them or their family member; as long as there is one mistake, that's it. They will come after you. It's even more so in the field of neurosurgery than any other specialty - and for good reasons too, of course. But he brought it up to remind everyone that we are being watched - all the time. And so, pandai-pandai lah. 

Just finished neuro clerkship. Moving on to pediatrics. It feels like just yesterday that I did psych, but in actuality I've done psych, surgery, and neuro! Half-way point. 3 more rotations to go before year 3 ends. How time flies.

Untitled #2

Of late I count my days by whether it's headache-free or headache-filled days, and lemme tell you it's no fun at all to have the latter be the majority of them. Don't understand why this is happening; some says it's stress, but I really don't feel stressed at all- truth! Yet this past week the first thing I do as soon as I woke up is to pray hard that I won't have headache later during the day. It probably sounds like I'm whining about something petty, but if you've ever had tension headaches or migraine before, you'd know this kind of pain can be quite debilitating- in short it's nothing you'd wish for on anyone (unless you really hate them lol).

Apart from the headaches though, days have been filled with interesting (sometimes bizarre) conversations. Some people have delusions that are not that out of line from what we know as social norms, and I guess it's understandable- in most cases it's their coping mechanism, their way of handling what they considered as brutal reality, and they needed a way to deal with it. You hear views about life, about religions, about universality of all religions, about love, about 'the other world' etc.  Some of the things they said were quite mind-boggling, whilst some made me think (when I don't have headaches that impair my cognitive function, that is). Psychiatry is so much more about life and the real world out there for different kinds of people, most of them not the average people we surround ourselves with; it's becoming more interesting and less intimidating as the day goes by- it really just depends on how you choose to see things. Our professor told us, before we went out to the wards, "whatever it is, just take it easy," and I think that's the most apt advice to give. 

Today there's this guy who wasn't his usual self as the past few days. He made an analogy about him being a meek lion. "but just because I'm meek doesn't mean I'm weak," and he claims to be an empathic and simple person, but when pushed to a corner, "I'll ROARRRR!" And he also made a comment that's worth reflecting upon- "who do you think you are to want to help me? how can you help me? tell me, how are you helping me right now???" Indeed. Sometimes we doctors think we know better, and we prescribe meds intending to "help" them, but is that necessarily the best thing for the patient? Do we really know better than them about themselves and what they need? Do we? I have no answer to that, but I think that's a fair point that he made, and it's worth spending some time thinking bout it. Just a food for thought I guess. 

Movie Reflection: Something The Lord Made

Synopsis

The movie is about a white surgeon Alfred Blalock's partnership with his African American assistant, Vivien Thomas, in developing Blalock-Taussig shunt, a surgical procedure that saved the lives of babies who had blue baby syndrome. In essence, the shunt was made as an anastomosis of the subclavian and pulmonary artery, to provide oxygenated blood to cyanotic babies. (For those who are not medically inclined- it was a breakthrough surgical procedure done to provide oxygen to babies who couldn't survive long after their births due to the lack of oxygenated blood, and so it was kind of a big deal.) This movie tells an extraordinary story about an ordinary man whose role was pivotal to this invention. Vivien Thomas was an African American guy who had never gone to medical school and was previously a carpenter apprentice - and what's more, all this happened in a time when racial disparity was as deep as the Mariana Trench. The movie was a recount of the historical event, but took on more of Thomas' perspective, and it zoomed in on the complex relationship between the two men, how close they were when they were working together, yet how distant they were in social settings when they were out of the lab. 

Reflection

There are those movies that inspire you, and then there are those that inspire you. This is one such movie. Let me start by saying, if you haven't seen it, I highly recommend you to do so- it will be time well spent, I promise. It's a story worth telling mainly because it was a story about a man who worked hard and shone through even when the circumstances were not in his favor. A story about an underdog who won the day, except it's many times better- it was a significant milestone in the history of modern medicine; it saved millions of lives; and it marked the beginning of pediatric cardiosurgery. 

One of the things I loved about the movie was that I think it did a very good job depicting the era during which this relationship/partnership (between Blalock and Thomas) took place- the environment, the people, and the socio-cultural interactions between the races (and also amongst the people of the same race). There was a lot of subtleties, like how his own people who were working in the hospital were curious/suspicious/envious of Thomas when he got to wear the lab coat; like how Thomas saved up for his medical school only to find out it was all gone when Depression hit America. It must've been frustrating for him, no doubt. Yet in a way it was serendipity- if he had gone to medical school, he wouldn't have continued working for Blalock, and this great work of collaboration wouldn't have happened. Not saying that the invention wouldn't have happened, but it wouldn't have been the same. And then there was the conversation between Thomas and his brother, about the Brown vs. Board of Education - another significant event in the African American history in which it was deemed unconstitutional by the U.S. Supreme Court for public schools to separate the black and white students. It may be easy to dismiss it today, but it was really a huge feat back then, and it painted a clearer picture of the times that they were living in. Other things were like how there were separated washrooms for the blacks and whites, how they could only enter the hospital through a separate back door etc. People probably don't think about it now, but it was a great reminder of how things have changed so much since then, and for the better.

Thomas' diligence and creativity was inspiring; when he was in the lab you could tell that he was in his element. The lack of appreciation of his contribution did not sit well for him, and at some point he gave up and moved on to something else for a change, but then he went back to it after all. Was it because as frustrating as it was, he understood the circumstances, and made peace with it? Or was it more of a resilience to fight back in his own way, the way he knew how- by doing what he does best and show the world he will not be "defeated"? I don't know. Perhaps it's a little of both, and his passion for the work he was doing.

There is also another person I thought was worth mentioning- Dr. Helen Taussig, the other doctor who also worked on this shunt. In fact it was her who went to Blalock to ask for assistance. She was one of the first female doctors in a time when medicine was a male dominated field and females did not enjoy the socioeconomic status that we do today. It was tremendously tough for her to become a doctor; on top of that she was dyslexic to begin with, and became deaf in the later part of her life. But all these did not stop her from being an amazing physician who learned to lip-read to listen to her patients, and to listen to her patients' heartbeats with her fingers in lieu of a stethoscope. And even though her male colleagues sneered at her idea that something could be done for the blue babies, it did not discourage her to pursue it till the end. For all those reasons, I just think she's awesome. Hats off to her!

Anyway. Thought it was a great story told beautifully, and I probably didn't give it enough justice it deserves, so if you have the chance, do watch it. Peace. :) 

A Book Review

Such compelling words! I certainly don't want to be killed by the ignorance of my doctor, and more than that I don't want to be the doctor whose ignorance may kill others. The title kinda piqued my curiosity, but I should've known better- that such compelling words is part of the marketing strategy. And yet, I read on, because I was too curious to know what he had to offer. Why, indeed, are we taught in medical school that as long as we eat a balanced diet, we don't need nutritional supplements? Why is it generally frowned upon in the medical community?!

The book talked about how our body has its own natural healing power, and that the common threat of all diseases is the excessive oxidative stress that our body just can't handle anymore. It then went on to give anecdotes about how taking nutritional supplements helped the patients come around- some were healed by it, some saw dramatic improvements. The book gave a pretty detailed description of the various disease processes, in the simplest way that anyone can understand without needing a lot of medical knowledge. The author also stressed that nutritional supplements is only complementary to whatever treatment that the patients were receiving, and it is by no means the only thing that the patient should take in order to be well again - a very important point because some people might have misunderstood the author thinking that just taking multi-vitamins is enough and will heal them completely.

I can see how non-medical people can learn a great deal from this book. It was probably more than an eye-opener to them- it would've totally convinced them that nutritional supplements is the way to go. For medical students or medical professionals, it offered a perspective other than what we were taught or what we were accustomed to. I can't say I was enlightened by the book, but I give the author credit where credit is due. This book is primarily for general public to know their body a little better and to understand the disease processes that plague many of them, and ultimately it is a book written to encourage people to start taking care of their health- by taking nutritional supplements. For that, I think it's done a tremendous job convincing people.

So. Just for fun, I'd rate the book a 3 out of 5. The title of the book, in my opinion, is exaggerated. But it did its job- it made you read what he has to say! It also did its job convincing you to start searching for the most trustworthy nutritional supplements the market has to offer, at which point you'll come to realize that he was on the medical review board of the nutritional company called USANA (he's moved on to ARIIX last year). The fact that the entire book sounded like a marketing tool also irritated me a little. (OK fine, it is a marketing tool.) It got a 3 out of 5 from me only because my personal view isn't too far off from the author's, in that I do believe nutritional supplements is beneficial to a person's health, although there are many other factors at play too. In conclusion, unless you believe otherwise, I'd suggest reading something else that tells you things that you don't already know! Go read something more fun, like the discovery of insulin. or 1Q84. :)

While we're on the subject of transplantation...

… I thought this is cute. At least for nerds like me. :) 

Away from Mother Ship, Venturing Out

So, very early on in our medical training, we're taught communication and general history taking skills as well as physical examination skills with the help of simulated patients. Now after about 3 months of that, it's time to put them in actual use. Well, kind of. We'll be venturing out to the "real world" as we're posted to our designated clinics once a week for a 3-hour session, observing and learning from our preceptors. Hopefully it won't be all observing but that we'll also get to do stuff too. I personally want to work on my history-taking and interviewing skills, and all the other basics. Mmm can't wait. It should be fun!

As we prepare ourselves for the adventures and challenges in the next year or so that we can only imagine, one of our professors shared with us the following video from TED. It conveys a simple message, which is to stress the importance of a doctor's touch in a patient-doctor relationship. Couldn't be simple enough, yes, and perhaps it may seem like an ordinary, redundant point to make, but in reality it may be under-appreciated or under-practiced in this fast-paced technologically-driven world that we live in. And so, I just thought it's a good reminder for those of us who will be embarking on our new adventures soon. :)  Good luck everyone!

On Passion

It's great to be surrounded by people so passionate in what they're doing. They never tire in teaching or sharing their knowledge, they keep pursuing further knowledge, they love that you want to know more and they get excited about you asking questions. And the best part is that no matter what these people are passionate about, their love of the subject, their bursts of energy and enthusiasm never fails to seep out and affect the others around them. It's just wow. It's completely inspiring. I'm just grateful to be here, to know these people, to learn from them. 

A professor left us with this before he returned to the States: "You know, I always tell my students, whether it's clinical medicine, research or teaching, you should pick one and excel in it. It doesn't matter what. Just pick one and shine in it. If you wanna excel in all three, that's fine. But if you don't want to excel in anything, well. Then I don't know why we're here at all." 

Note: Picture above was taken in Singapore Art Museum. I loved it the moment I saw it. So vibrant, so full of life. :)

Back to School

It's not so much the idea of being back to school that excites me, but more of the fact that I finally get to learn all that I want to learn, and do what I want to do. Here's to another four years of late-night mugging, pots of coffee, exams, sleepless nights and interesting stories. Here's to 'a new beginning'! :) 

Nurses' Day

At least in Singapore it's around this time of the year. International Nurses' Day is sometime in May. Wonder who else celebrates nurses' day yesterday.

I wanna say they're a great bunch of people; taking care of patients day-in day-out. It's really a tough job you know, especially those who work in the chronic sick homes and the nursing homes. The fact that they have to change them at least 5 times a day, shower them at least once a day, transfer them etc. is back-breaking enough (I know I couldn't have lasted more than a month doing these); and on top of that they have to feed them, tend to their needs whenever necessary, talk to them cheer them up make them feel loved. Well. Ideally that's how they're supposed to be. I often wonder how they do it (then again- there's the economic incentive, the fact that they have to earn a living and fulfill their Maslow's basic needs).

Won't deny there are lots of good nurses out there, but I'm sure that, just as there are some nasty doctors out there who think they're all that, there are also nurses who can be abusive as well. That Nightingale Nursing Home incident was a good example. From what I gather, at times it can be quite hard to manage them too. They'd do things for their convenience's sake even though they know it's wrong. When caught, they'd still try to go about it their own way but improvise such that they won't get caught. But what I can't stand are those who're abusive to patients. For those, I lose all respect for them.

Not that I wanna badmouth nurses on this day, it's just that while I appreciate the good nurses' hard work, at the corner of my mind I wonder to myself, what are those 'bad' nurses thinking/feeling during this occasion? Are they really proud of their work as a nurse? Are they really compassionate people with just a few terrible episodes that could happen to just about everyone? Really, what are they thinking? If in the future I ever chance upon them, I'd be sure to interview them.

In any case, happy nurses' day! I hope everyone felt loved and appreciated. :)

Woah

saw this video, and i had to share this. being the geek that i am, i always find it fascinating that technology can do so much to enhance our learning experience.

Oh-What-A-Week!

thursday morning was chilly. the birds were still half asleep when i left the house. no chirping to greet me good morning. and due to working overtime the previous night, i got home at a quarter before midnight, reducing my sleep to about 4 hours since i need to wake up earlier than usual to get to the hospital for my 7am volunteering shift. but all of that was well worth it cuz i saw two surgeries while shadowing the veteran volunteer in the OR. i was enlivened just by being there, albeit only witnessing some minor surgeries. anyway. that's where i'll be posted for my next volunteering rotation. thank goodness i chose the OR, cuz i dont think i'll be quite as keen if i have to wake up to an empty ER for the next 3 months.

the first one was an arthroscopy, which is a knee procedure to remove extra fibrous tissues, torn meniscal cartilages or damaged joint tissues with the help of a small camera. was pretty cool, considering i'm not anywhere close to being a doc yet i got to stand next to the orthopaedic surgeon with him explaining to me as he operated on the patient's knee. :) the anesthesiologist was a pretty cool guy too.

the 2nd one was a femoral-popliteal bypass. the doc was originally gonna remove the clots in the femoral artery and insert a shunt in it; but because of some complications he couldn't do that, so they decided to do a bypass instead. this other anesthesiologist a burmese chinese doc (who speaks hokkien too!!) explained to me (and another volunteer) the procedures they were doing, and the big picture of general anesthesia, how it works etc. and then he went into this bioethical dilemma of whether the state should "waste" resources to help patients who don't help themselves. should patients who don't take care of their health deserve excellent health care only to be voiding all of the effort by smoking like a chimney and stuffing their faces with greasy high cholesterol food? wouldn't it make more sense to spend the limited budget (let's face it, there will never be enough resource to take care of everyone) on patients who deserve or really need it? then again, didn't all physicians took an oath of some sort that they should treat each and every patient regardless of their race, creed or religion - that said, personality and attitudes too? i'm just saying, i don't know much on this so i can't say for sure. but quite frankly, i do agree with the doc to a certain extent. i mean, if you wanna inhale beef burgers right after your surgery, then what's the point of the surgery?! so that's the interesting stuff in OR on thursday.

at work, its been terribly busy, so much so that i woke up from sleep thinking that i had to get back to work cuz there's just overflowing samples that i have to test. -.- that same morning i was told i need an evidence of continuous employment eligibility to work in the US to be offered this job that i've been praying for. after 2 interviews, 2 written tests, i got it, only to be taken away from me because i don't have the appropriate documents. damnit.

later that morning my hair got tangled in the hair dryer and i had to chop them off or else i'll have the hair dryer connected to my head forever. it was quite a comical sight, if you will. XD

saturday - gotta work. chean flew back to malaysia for cny. lucky her. i hope she brings me back some milo and cny cookies. :)))) ok back to studies. toodles~

In Between Those Cheeks!

"ni neng bang wo ma?" that's what he said to me when i was listening to one of the EMTs (who happened to be a braggart) telling me how he'd have done it if it were him drawing blood from this lady patient. to be polite, i replied "ke yi ah!" and so i excused myself and strutted off to the other treatment room, thinking there might be some exciting stuff for me to see while helping.

true enough, it sure was exciting. guess what i was asked to do?! i were to pull apart the cheeks (and uhh.. it's not the cheeks on your face. yeah - the other... cheeks. geddit?) because there was an abscess in the perineal area and he had to make an incision, press out (and scrape out) all the pus *OUCHHH x a gazillion times* and then stuff in the gauze cloth with meds into that hole. i can't explain how painful the whole procedure was, partly because i haven't experienced it (god forbid that i do), but also partly the cringing and screaming and crying from that guy was quite reserved imho. reckoned he's a brave man, and he even cracked jokes bout it. i respect that man, i really do, but whilst pulling apart the cheeks i didn't have a mask on, so i could smell the stench from the pus, and it smelled like someone who hadn't showered for 2 months.

so that was it. the little exciting piece of story i had to share. there were more stuff that happened that night, but i figured i shouldn't disclose them here all in one go. so, till the next time! adios :)