Ash Cash

Hospital slaves' wages are only peanuts compared to other professionals. I earn in a year what a certain galatico Señor Beckham earns in 2 days.

Every bit helps. And one source of extra income is from the ash cash.
For those deceased who will be cremated, a cremation form will need to be filled in prior to the trip down the crematorium chamber.

There are 2 parts to this form. Part A is filled in by the doc who has looked after the deceased prior to death, usually a junior hospital slave like me; Part B by a senior doc with at least 5 years of clinical experience who has never seen the deceased. Both docs will be paid a handsome £55.50 each for their less-than-5 min effort.

Different people feel differently about what to do with the ash cash. Some say the money is sacred, and will willingly donate the monies to charity. Some see the monies as extra pocket money, and will happily spend it.

I fall somewhere between the two groups. Received my dues yesterday, quite a bit of them I must say. And I've decided to donate part of the cash to the Tsunami Appeal Fund. The rest goes to the wifey. Me, still leave with nothing!

Brief Unprofessionalism

I was doing my routine morning ward round this morning in a 6 bedded room, when I saw this very familiar scene on the ward TV. I didn't believe it at first, but 5 sec later, I'd no doubt about the place. It's my home country: MALAYSIA!!

I failed to control my emotion, and shouted to my patients (3 of which were demented!!): 'It's where I come from! It's where I come from!'

It was only then that I realised it was a bit unprofessional to have shouted like that in the middle of a ward round.

Anyway, I was thrilled to see a British travel documentary TV programme about Malaysia. Just like the title of the programme: "Wished You Were Here!"

Real Life Medicine

Some many months ago, I was doing an on-call with my senior, Dr B. I was then called to the Casualty urgently to see a middle-aged man with acute chest pain. Myocardial infarction (medical jargon for heart attack) was one of my several differential diagnoses. His ECG was borderline for MI. After discussion with Dr B, we decided not to thrombolyse the patient.

A bit lost now?

Just to give you a crash course on MI. When someone has a coronary, one or more arteries in his/her heart get blocked by a blood clot. As a result, the heart muscle supplied by this artery becomes starved of nutrients and oxygen, and dies. If an ECG is performed during the attack, it will show a certain change called ST elevation. The treatment for MI is a powerful clot-busting drug to dissolve the clot. This procedure is termed thrombolysis. Basically the sooner the drug is being administered, the more healthy heart muscles can be salvaged.

Back to my story. As it transpired, the man did have a heart attack. One of the cardiac nurses (rather unhelpfully) put in a risk management form against the both of us. I was requested to submit a formal report regarding my (lack of) action. Fortunately I was vindicated.

Unfortunately history repeated itself last Friday. I was once again doing on-call with Dr B. A middle-aged lady with yet another borderline ECG. The only difference this time was she strongly and repeatedly denied ever having any chest pain. She was brought in after fainted on a bus. We didn't thrombolyse her because the evidence for MI was rather weak. Subsequent investigations however showed she has had a MI.

I'm sure someone somewhere will very soon put in a risk managment form against me and Dr B.

The problem is: Medicine is never as straightforward as it seems to be! Not every patient, every case would comply with textbook medicine. In fact we hardly ever see such a patient. Working on the shopfloor, seeing real patients with their ever unique presentation of disease, is different from learning a particular medical condition in the textbook. At the end of the day, I am the one who has to make an assessment of the situation, and then initiate a treatment plan which I think is most appropriate. Not the nurses, not the consultant, and DEFINITELY not the fatcat managers.

Hindsight is always a more superior tool. But when I'm seeing a patient there and then, I can only do what I believe is best for my patients.

Weekend On-call Report

As it turned out, the weekend on-call had not been too bad. 19 new admissions on Friday, of which I saw 10; then 9 on each of Saturday and Sunday (me 5 each).

As usual, the caseloads were predominantly chest pains and SOBs (shortness of breath, that is). It also appeared that there's an outbreak of D+V within the hospital cathcment area. Too much dodgy Chinese or Indian takeaways perhaps??

Apart from a brief argument with one of the A&E Sisters, which in retrospective was totally unnecessary and indeed childish, it was uneventful from the diplomatic front.

Things are starting to look bright again.

All calm before storm

Today has been reasonably quiet and easy. But things will be very different tommorow as I'll be on-call for the weekend, starting from tommorrow. This means I'll be the clerking machine, seeing the vast majority of the new acute medical patients. I'll be working non-stop (most probably) from 0830 till 2130. I would not have time to rest or to eat. In fact base don my previous experience, taking a 2 min toilet break would be equally impossible.

Friday is always a mayhem in the hospital, with GPs referring every single patient they see to us, and then go on a weekend break. We,on the other hand, will have to sort out their mess from the community. If the GPs detect any hint that the patients might give them problems over the w/end, he or she will have absolutely no hesitation to chuck them to us. They hate to have their w/end interrupted by patients. They don't want to be called out to see patients at home. Weekdays fine, weekend NO!!

So we will most likely end up having 30-40 patients being sent to us in a 12 hours shift. That's an awful lot for a district general hospital. Worse still, there will only be 3 doctors on-call tommorrow. Even worse still, is that because I'm the SHO, I will be seeing 60% of them. The JHO, being a newly qualified doc, is understandably slower then me; the Registrar, being more senior than me, will only troubleshoot here and there. It would be lucky if he can help me to clerk a few patients.

Nonetheless I think the experience would be most rewarding and gratifying. Only if I don't end up arguing with the Management (again!!) tommorrow regarding the A&E 4 hour waiting time target.

X-Ray Update

At last we have the knee X-ray for Mrs B. NO fractures, NO evidence of osteoarthritis, NO calcification. Good for her. Let start mobilising her a bit more with physio.

Patient knows best

One of my patients was admitted with knee pain last Thursday via the Casualty Dept. According to the hospital computer system, she had a knee x-ray in the department. When I fisrt saw her on Friday, she was adamant that all she had in Casualty was a chest X-ray. No knee.

She suffers from Parkinson's, and looked a bit confused then. I promised her I would find her knee film, thinking that she might be forgetful. Meanwhile we should treat her pain symptomatically.

Days came and gone. Still no knee x-ray found today, and more crucially patient is still in much pain. I finally decided to place an urgent call to the X-ray Dept.

"Sorry doc. The knee was requested, but the form wasn't signed by the Casualty Officer. So it wasn't done", said the radiographer.

DUHHH!!! No wonder no one could find the knee film.

Mrs B has Parkinson's, but obviously she isn't demented. I wonder, I wonder why didn't I believe her last Friday? Surely the patient knows best??!! I just hope there isn't any thing serious (eg a big fracture) on her knee X-ray (to be done in the next 1/2 hr). Will keep you update!

One step closer..

Received my MRCP Part 2 written paper result yesterday. Believe it or not: I PASSED!!
Didn't think I would pass this time. In fact I felt awful coming out of the exam hall 1 month ago.

Have been receiving words of congratulations from bosses and colleagues all day. Needless to say, both the wifey and myself are thrilled with the result.

2 down, 1 more to go. Shall sit for the next part of the exam in July. Hopefully it will turn out alright too. With a bit of luck, I would be able to add the magical 4 letters M-R-C-P behind my name come this August. Can't wait!

A dying patient

Mr KB was a very pleasant man. Diagnosed of advanced lung cancer few months back, but never gave up on hope nor himself.

I was asked to see him 2 days before his demise. He was breathless, but in my opinion no worse than usual. His daughter asked if Mr B could be placed in a single room, instead in his current 6-bedded room. They would like a bit more privacy, she pleaded.

I told her this was not possible, because the room was occupied by a patient troubled by D+V. In actual fact, this patient had not have any more D+V for at least 48hrs (ie not contagious anymore). This would mean, in theory, their beds could be easily swapped. I turned down their request for a single room, partly because I didn't think Mr B was terminally ill, but mainly because I thought it would be too much of a trouble for the nursing staff to swap patients all over the ward.

Mr B then went downhill rather rapidly and unexpectedly. Later that night (after I went off duty), he was moved into the sideroom. I saw him again 2 days later, at this point, he appeared moribund and was really struggling for his breaths.

I asked him if he would like to have a small dose of morphine to keep him calm and comfy. He duly accepted my offer. 2 hours later, he passed away peacefully in the presence of his entire family.

I'm glad I managed to provide him some comfort shortly before his death. But I can't forgive myself for turning down their request for some privacy during Mr B's final days, on the basis of 'not wanting to trouble the nurses'.

Afterall, that's what we, as the healthcare providers, are paid to do.

R.I.P, Mr B.

RISK MANAGEMENT

Attended a talk on 'Risk Management' late last week. The speaker was the Head of Risk Management Dept of the hospital I'm currently serving with. To me, he's just another $50000-a-year fatcat who is draining the resource-depleted NHS. In another word, someone who is employed to do nothing so that no more monies are made available to better staff the medical and nursing departments.

He said most adverse incindents could be avoided if the risk-takers(ie doctors) could be a wee bit more careful. He went on to show us graphs after graphs of meaningless statistics. This was followed by an explanation of the incident reporting system and the way his department (staffed by more fatcats) deal with problems.

I must have dozed off half way through his talk, becoz I didn't seem to recall him mentioning anything about his ridiculous wages and the lack of doctors on the shopfloor.

I woke up just in time to hear a member of the audience asking him if the shortage of doctors in the hospital constitutes a risk, and what is his department going to do about it.

To this end, he answered: 'Well, my department only collates data. We then submit them to the Board. They are the one who make decisions about the hospital.'

I left the talk no wiser than when I first arrived. One can only wonder why the department wasn't called Risk Data Collation Department. In what exact way does it actually MANAGE risk??

Prawn attack!!!

The wifey cooked me some very delicious prawns in tomato sauce last night. Thoroughly enjoyed it.

Then bammmm!! My head started to itch suddenly. Then my ear canals. Better get a quick hairwash I thought. It was after the wash that my wife asked, 'Hey! What happened to your skin?'

I was covered in weals, spots and rashes, all over my body. My face started to burn. My non-medic wife cleverly suggested that it could be an allergic reaction to the prawns.(Hey smartie! Wanna be my medical assistant?)

The itch became a bit too much to bear. Double-quick stepped to the local A&E, and was told I needed to register first. Worse still, there were loads of people already there waiting to be seen. God knows the waiting time. By this time my face was like a furnace. I cheekily slipped into the treatment area, and found a colleague of mine on duty. She immediately gave me some strong antihistamines.

I'm not sure if it was a placebo effect or not, but I certainly felt a lot better itch-wise after ingesting the antihistamine.

Wifey then asked if we should sue the supermarket where we bought the prawns. Nah! Itch or no itch, I have had a nice meal. Let them off this time, I say.

EASY LIFE

Best day of my medical career life so far! As a hospital slave (who is underpaid and definitely overworked), I usually have 35-40 patients directly under my care. I see them every morning during my ward round, and depending on the caseload and the severity of their medical problems, each round last between 3.5 to 6 hours.

Today, for the 1st time ever, I had only 8. Never have I ever finished my ward round in 1.5 hours. Which means after 1030hrs, I just hung around doing nothing. And still got paid for that.

Starting to sound like a typical Malaysian civil servant, huh??!

Good to be back

Thank God! The festive period is finally over. Believe it or not! I dread Xmas and New Year every year. Shops don't open when you need them most, public transport not providing frequent enough services, and damn!! hospital came to a standstill with only few (unlucky)doctors working. Yours truly was one of the unlucky ones.

We had a full strength of doctors today. Great! It means things get done, patients are seen and treated. Everybody is happy. I think the biggest winners are undoubtedly the patients.

Put it boldly: I would not wish to be admitted to a hospital during the Xmas/New Year period. How on earth am I going to get the best treatment when there are so few doctors around?? What's the point of spending millions of pounds investing in high-tech medical gadgets, when you can't even finance more doctors to work??

I suspect if the media (tabloids especially) get the wind about the way hospitals were run during this period, they will absolutely have a big field day.

At the end of the day, we are here to serve. Patients' interest should always be the top priority in the operation of any hospital.

Have we all failed our solemn duty to the patients??

My beloved wife outside London Tower 

HAPPY NEW YEAR

Not a very good start to the new year, with the rapidly rising number of deads in the Indian Ocean region. I'm contended with what I have: a wonderful wife and a seemingly good career. I should consider myself very lucky indeed.

Nonetheless, a new year would be less meaningful without naming a few new year's resolutions. I wish:
1. to pass my MRCP exams
2. to attend more outpatient clinics (time & workload allow)
3. to perform my first cardiac pacing procedure
4. to have less run-ins with the hospital management,
and most importantly,
5. to spend more time with my family

Have a good one everybody!!