The House Of God

The House of God by Samuel Shem.

4th year medical student. The year was 2007. The place was the operating room. It was a laparoscopic hemicolectomy case. The anaesthetist was in his 50s or maybe 60s. Sorry i could not recall his name. He had this unique way of setting cannula. He used a ‘butterfly’. The nurse pointed out he is the only doctor in Manchester Royal Infirmary who would use a ‘butterfly’ to set an IV cannula before surgery. The one and only. He is eccentric, intriguing, a joker as well. While we were in the middle of surgery, he suddenly asked “so Lydia, have you read The House Of God?”. And I said “no”. Suddenly a roar in the operating room. The surgeon, the registrar and the old anaesthetist looked at each other and laughed and talked about the book. He then said to me “You must read it!”.

It took me 4 years to find the book. It’s simply amazing, hilarious and i find some of it real and true. I’m glad i read it now, not 4 years ago. Having work as a doctor and appreciate what the job is all about make me understand what Samuel Shem is trying to convey…. Did i mention the book is first published in 1978? But reading it in 2011 and comparing my HO days with those interns in 1978 (intern in US = House Officer in UK/ Malaysia), i chuckled a bit. Nothing has changed.

Got it from Kino!

LAWS OF THE HOUSE OF GOD

1. Gomers don’t die

2. Gomers go to the ground

3. At cardiac arrest, the first procedure is to take your own pulse

4. The patient is the one with the disease

5. Placement come first

6. There is no body cavity that cannot be reached with a 14G needle and a strong arm

7. Age + BUN = Lasix dose

8. They can always hurt you more

9. The only good admission is a dead admission

10. If you don’t take a temperature, you can’t find a fever

11. Show me a BMS who only triples my work and i will kill his feet

12. If a radiology resident and the BMS both see a lesion on the chest X-ray, there can be no lesion there

13. The delivery of medical care is to do as much nothing as possible

Lost? Read the book. You won’t regret it. Especially if you’re a HOUSE OFFICER. This book is meant for us. Doctors.

P/s: Ever since i started reading the book, i secretly call my patient gomer and gomere whenever i saw them in the ward.. hahahahaha… and i luvvvv ‘Fat Man’

Happy Reading~

Adjustment Disorder..

I’m diagnosing myself to have an adjustment disorder.

It’s a term Psyc loves to used when they can’t figure out what is wrong. I donno what is wrong with me anymore huhuhu..

I haven’t brag about my MO life right? I enjoy it at first, later struggle with it, then love it, then hate it, regret it, grateful of it.. owh A MIX FEELINGS! For your info, I started my MOship last Disember. Almost 1/2 year, time sure flies. Remember those things i said before on how i hate my MOs when i was a HO and pledge not be like them? Ironically, i found myself more n more like them! I do hate myself for it

That day i scolded a HO for not doing her morning round, for not updating the investigation charts, for not carried out my plans, for not sending the cultures..bla..bla.. endless. I got angry for her ‘slow reaction’ and tortoise like attitude. I keep comparing her to myself “if i can get it done why couldn’t you?”. When i share my misery with a good friend she just said these 4 words “They are NOT YOU” which I agree. I admit different people react and do things differently. And I happen to have a HO who is completely opposite of me who likes to make my life miserable! I already give up the word ‘perfect’. I now lower my expectation to ‘just get it done’. Even that simple wish cannot be fulfilled. Now i know why my MOs dulu-dulu hate their HOs. Coz now I hate them all !!

Attitude is the essence of medical practice. If you got a right attitude, you will survive. General medicine is scary. We got the highest admission rate per day, the highest ICU/HDU occupants, the highest of everything. From mistakes to complaints to negligence. You have to have an attitude that can withhold those pressures. Willing to work long hours, finish all the clerkings, discharges, prescriptions etc..etc.. (it’s never finish you know), develop soft skills, getting angry at, being shouted at (i mean by patients and the relatives), and most importantly to try to be as thorough as possible on the job to avoid mistakes that could possibly take someone’s life. General medicine covers >80% of what we learn in medical school. The only time for us, to put our knowledge into practice esp HOs are during the 4 months Housemanship rotation in medical department. I remember what my previous boss Dr. Chua said, “as a doctor your knowledge and medical management must be good. Because no matter how high you go, even if you become a surgeon, oncologist, neurologist etc.. at the end you’re a doctor and as a doctor you are expected to know how to manage a simple case like hypertension and diabetes”. I am so frustrated when those young doctors taking the jobs for granted. I’d been there. I was a HO before. Don’t tell me that the workloads are too much to bear. Get out of my ward if you thought of saying that! My apologies to those who have broken down emotionally, mentally, spiritually and need a few weeks off, see a shrink, on anxiolytics, anti depressants…… oh how medicine must be cruel to you guys. But when you see ‘it’ from where i stand.. from my small eyes … general medicine is fun, challenging and 100% rewarding if you have the right attitude. I mean it. I am here am I?

I am trying my best to be a good medical officer. Giving advice and guidance to the young ones. But if they keep irritate me with their blank ‘i donno what to do’ stares, annoying giggles after serious warning from specialists, mistakes here and there…..

the answer is : Get out of my ward. As simple as that. HO mistakes = MO responsibilty.

Acute “roundworms” intestinal obstruction

I watch this on Youtube a few days back after a friend of mine suggested it on her facebook. It’s damn cooooolllllllllllllllllll!!! A 3 year old with acute intestinal obstruction. Guess what is causing th obstruction?? hehehehe yum..yum.. WORMS!!!!.

Enjoy the spaghetti!

Today’s lessons:

1. Wash and wash and wash your hands ALWAYS

2. Don’t walk bare-footed

3. Don’t eat uncooked meat

4. Have your pets dewormed

;D

“thrown to the district”

Here I am serving the country.

For the next 2 months (maybe) i’ll be here in Segamat Hospital. Orthopaedic posting in HPSF is divided into two. For those lucky ones we’ll be “thrown” to Hospital Segamat to complete half of our posting. Others will stays in HPSF for the whole 4 months. There is no particular reason for being sent to district hospital. And guess what, this time, I’m the lucky one!

I’ve been here for almost 30 hours now. When you got nothing to do and half dead, the hands of the clock move too slow in your eyes. *sigh*.. donno what shall i do for the next 60 days!!! So my 1st impression of this hospital?? —> BEST . How about the town itself ? —-> SO-SO. Hostel ? –> yucks i HATE it!!. After 2 years being pampered at home, going back to hostel life is not something  that i like to do ok..

Anyway, to my surprise, the hospital layout ( i mean the ward) really looks like those in the UK. It looks exactly the same like one of the district hospital i’d been attached to during my student years. It feels like home hehehehehe… The specialist and MO are super duper nice and ‘chill’.. the nurses ARE GREAT!!! they set the branula, they take the blood, they even fill in the form!!! “doctor, you just sign here and here and here…” How cool is that??? I thought i will only enjoying this luxury when i become a MO later. Who knows you are treated like a ‘real’ doctor here! hehehehe, now i love those ladies in white uniform

Now I am looking forward to working in this hospital. It’s hard to say what will happen in the future (finger cross nothing will change while i’m here ;D).  In the mean time, i need to find something to fill the time. And writing my blog again is definitely one of it. It’s sad to see that i’ve been neglecting this blog for the last 1 year.. Now I’m back. Back for good. Hail MangoAndJojoba cause you are the saviour of my soul right now!

H1N1

aigoooo…here and there people keep talking about H1N1 aje. I think the media is exaggerating the issues. I need new topic and new gossips please.

To the public,

Calm down. Don’t worry too much. Yes H1N1 is everywhere. If you are healthy there is nothing to worry. H1N1 is a virus that cause ‘flu’ like symptoms (ie: cough, runny nose, muscle ache, fever or in some cases diarrhoea, vomiting or abdominal cramps).  Generally people would get 2 or 3 episode of flu a year. Usually in “normal” viral flu/cold , paracetamol a.k.a panadol, bed rest and drinking a lot of water is enough. In most viral infections, the symptoms last for about 5-7 days. No antibiotic is needed (antibiotic is for bacterial infection only).

So what make H1N1 different? nothing much really. It’s a new strain of virus. It gives same symptoms as in ‘normal’ flu infection. In healthy human being, it lasts for 5-7 days. Your own body a.k.a immune system will fight the viral itself. So, if you are a healthy adult with no other medical disease, just treat it as a flu. Nothing to worry. Take paracetamol/ panadol, bed rest, drinks a lot of water. H1N1 only gives BIG problems to those who are immunocompromised a.k.a mereka2 yg x sihat dan kurang daya tahan or antibodi. For example old people, people with chronic diseases (sakit jantung, asthma, kencing manis, sakit buah pinggang bla2…, cancer patients, AIDS patients, kids, small babies…) In these immunocompromised patients, they have very weak immune system. Therefore their body is not strong enough to fight the infection. So, from simple H1N1 flu it will melarat jadi penumonia (radang paru2 la dlm bahasa melayunya). In severe peumonia, you have problem breathing. If you can’t breath, you die. And of course, we as doctor will try to help you. We give oxygen, control the infection and if necessary we would put you under mechanical ventilation (in worst case scenario lah).

Currently in suspected or confirmed H1N1 cases, only those who requires hospital admission will be admitted (yg teruk2 aje). For those yg ader selsema, batuk2, we just give you MC to stay at home atau dlm bahasa glamernyer QUARANTINE for couple of days. Medication wise, we can give you antiviral. But usually, your body will fight the infection themselves. So take a good care of your body. We give paracetamol/panadol for your fever, muscle ache or headache and we advice for good hydration. Take a good rest. And please don’t spread your disease. If you are sick, don’t give your love ones free kisses hehehe… Kalau ader baby, jgnlah pegi cium baby tu. Kalau nak batuk, cover2 la sikit mulut/hidung. Practise good hand hygiene. Stay in bed and watch DVD!

I think there are few private clinics/hospitals yg provide H1N1 vaccine. By having the vaccine, you’re exposed to virus earlier. It will stimulate your body to produce antibodies and memory cells. So in the future if you’re contacted with the real H1N1, your body will say “hmm..this virus looks familiar, i fight them before. i already have some memory cells to produce antibodies in mass production and destroy it right away!”.. So, your flu episode would be shorter Having H1N1 vaccine does NOT mean you are protected from H1N1. Don’t forget you can have flu like symptoms as well with the vaccine! Plus, the efficacy and the side effects of the vaccine is still not fully established (still under research)

My advice:

1) Prevention is better than cure. So stay away from sick people. If people next to you is coughing, run away!

2) Stay healthy. exercise + eat healthy food with lots of fruit. Vitamin C will boost ur immune system. So a glass of fresh orange juice at lunch would be great

3) Don’t spread the disease. if you are having flu, stay at home. Take panadol/paracetamol, drinks a lot of water, bed rest. if your fever or symptoms worsen,  seek appropriate medical treatment.

4) practise good hand hygiene (exp: Mr X a H1N1 victim is coughing. He wipes his nose with a tissue. Then he continue writing. Mr B come to Mr X desk and say “May i borrow ur pen?”. Mr X says “okay” and gives Mr B the pen that he is holding. Mr B starts writing. Suddenly Mr B rasa nak korek hidung. And he did! Guess what?? all the H1N1 virus from the pen is now in Mr B nose. Mr B got flu 3 days later hehe..) So, wash hands before korek hidung, wash hands after wipe ur nose, wash hands before eating, wash hands after going to toilet. wash hands, wash hands, wash hands!!!

5) stop smoking. don’t damage your lungs. nanti bile dpt infection or pneumonia, your lungs have to work double or triple harder to compensate the damaged lung tissues as the result of chronic smoking. Smoking –> damage lung –> + infection –> breathing would be MORE difficult –> you DIE easily!

So, don’t panic.

Again i say, don’t PANIC.

Relax la babe..

It’s just a flu outbreak.

P/s: the chances of me getting H1N1 is higher than yours coz i work in the hospital. Tapi semua org yg keje kat hospital tu relax je. So you guys yg kat luar tu patutnyer lagi la x payah nak panic2. relax aje.. stay cool :8

SMOKING KILLS!

I’m cheering for the govt decision to raise the cigarette price to RM6 per pack. That is still cheap though, 30 sen sebatang? I wish the price exceed RM10 per pack! Even school kids are smoking nowadays.. mana dpt duit nih?

Since I have nothing to do at home, I have decided to play my role in promoting anti-smoking campaign. My first target, of course YOU, my readers!!! hahahaha… Here are some of amazing anti-smoking ads I manage to find in the net. And trust me, these ads are COOL!!!

Smoking kills!

..like killers travel in packs..NICE!

yeah it's a time bomb!

impotance, premature ejaculation, poor sperm counts, sperm cacat and MANY MORE!!

hebat gak Indon nyer advert ngeri seh..

And the winner of them all.. hehe check this out! scroll down people!!!

NHS rocks! what an art.. hahahaha

Death..

Life was not a valuable gift, but death was. Life was a fever-dream made up of joys embittered by sorrows, pleasure poisoned by pain; a dream that was a nightmare-confusion of spasmodic and fleeting delights, ecstasies, exultations, happinesses, interspersed with long-drawn miseries, griefs, perils, horrors, disappointments, defeats,humiliations, and despairs–the heaviest curse devisable by divine ingenuity; but death was sweet, death was gentle, death was kind; death healed the bruised spirit and the broken heart, and gave them rest and forgetfulness; death was man’s best friend; when man could endure life no longer, death came and set him free.

- Letters from the Earth

To confirm death…. you must elicit that..

1) response to pain – absent

2) pupil reflex – absent and pupil appear fixed and dilated

3) pulse (carotid) over 1 minute – absent

4) heart sound over 1 minute – absent

5) breathing movement and sound over 1 minute – absent

*4 & 5 using a stethoscope of course….

Now, selamat meng’confirm’ death..