Last Day!!!

7th of July 2009

In exactly 24 hours, I complete my internship...

I will no longer be obliged to work 36 hour (or longer) shifts...

Even if I do work nights, it will be at my own convenience (mostly) and better yet, I'll be paid for all those extra hours...

I will be able to welcome Darling home after work, instead of talking to him from the ward at 9pm, saying sorry honey, I'll take a good couple of hours longer. I'll be able to make healthy meals for him and not feel a pang at the sight of the bulls-eye and bread dinner he ate alone the previous night. (To be honest though, most of the pang is at the unwashed plate, but whatever).

I can actually take time to be nice to patients instead of snapping at their questions because I'm overworked...

I can get a haircut, pedicure and maybe go on a trip with some friends...

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It's my LAST DAY folks.... wish me luck!

Tagged again! - and late, dammit!

Okie... I typed this post about a month back and stupid silly me forgot to hit "publish". And since I only get one Sunday a month off, I didn't see it until now... oh well.... better late than never, I guess!

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Aww... I love all you lovely people who tag me!

Big grin... (I'm such an attention whore)

So I was asked 5 words about what I feel and to tag five more bloggers (I understand that RD is responsible for this latest one... cool!)

So

1. Relieved : fewer casualties and hopefully no more coffins coming home
2. Nauseated : seeing bodies of VP and others being flashed over the TV, have you no respect for the dead?
3. Inspired : by friends and fellow bloggers who are taking a really active role in helping IDPs
4. Hopeful : that health, hope and happiness will be soon achieved by all who have been crushed by both sides (intentionally or otherwise) during the conflict
5. Slightly stunned : as this is something I didn't think to see happening in my lifetime.

Ah, now the tagging part... since I'm usually late in getting involved with happenings at Blog-world, looks like everyone is tagged already... so it's open... TAG! You're it!

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On a different note... it's good to be home and on broadband again. Honestly, my job truly sucks. I get one day off every 3 weeks. I work late on 6 days of the week, and can go home by about 5.30 pm once a week. I am chronically exhausted. I hate my job. Oh well, just about 5 more weeks to go! :)

I was actually quite annoyed during the whole we have won the war, VP is dead, all hail the free kiribath attitude prevailing last week. The TV was blaring full blast in the ward while I was clerking patients and since every one who could hobble out of bed was clustered around it I couldn't exactly ask for it to be turned off. The plus was that it helped weed out the malingerers... if you are well enough to dance in front of the TV, you are well enough to go home.

The OPD decided to have a kiribath party, thrusting plates into the hands of all and sundry walking by the hospital. Of course this meant that not a single minor staffer could be found in the ward and NONE of the referals got done, blood transfusions were delayed and the nurses and doctors were generally annoyed. I came across three of my ward staff, traces of lunumiris around their mouths, one dancing insanely while waving the National flag. The grinned sheepishly when they saw me and were so embarrassed it was impossible not to grin back.

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I graduated last week too! Bit of an anticlimax seeing that I actually passed out of college a good 18 months back. So there I was all cloaked and gowned and on stage with the parents and Darling looking proudly on... I also went home with a nice shiny medal! Not bad eh?




So anyways, this is it for this month... with any luck, I'll be back soon! :)

No words to describe...

The feeling...

When the alarms start to scream...

When the monitor shows a flat trace...

When you yell for the emergency trolley and launch into CPR...

When you pound on a chest, and pump air into resisting lungs...

Sweat dripping down your forehead...

Ignoring the stares of the other patients and bystanders who have clustered around...

Trying to ignore... typical Sri Lankan morbid curiosity...

When your arms ache and you think, damn, another one...

Keeping time, injecting cycle after cycle of life-giving drugs...

And then you feel it under your hand, a vague bump...

And then you lay your palm across the left side of the chest...

bump, bump, bump...

blip, blip, blip... on the monitor

And you look up... tired smile fluttering across your face...

We've got the heart!

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Doesn't happen often...

But when it does... no words...

Peace

Yapa was an old guy who was transferred in from Mathara somewhere in December last year. He had spent so much time in the ward that he used to joke that he had been added to the ward inventory. Always greeting me with a sweet smile, he would say, every morning without fail, "no need to check my blood pressure Nona, there's nothing wrong there... see if you can fix my lung".

And that was precisely what was bothering us. His left lung was virtually non existent as the left side of his thoracic cavity was filled with fluid. This had been drained 5 times in Mathara, only to fill back up again. We were reluctant to stick a needle in again - this type of collection usually meant either cancer or TB, both which need specific treatment but no matter how many tests we did, no diagnosis was reached. So poor Yapa was bounced around, from our ward, to the Medical Investigation Unit, to Chest Clinic Borella, to Chest Hospital Welisara and back to our ward and no one had a clue what was going on. X-rays, bronchoscopy, bronchial washout, CT scans etc. etc. Even Dr. House, MD would have been impressed by the thickness of this guy's file.

And every day he'd get a little more breathless. Each night, he'd have more difficulty in breathing. And each day I'd get more concerned at how little he was eating. Finally the decision was made to put in a tube and drain the fluid... and for a couple of weeks he was walking around carrying the tube and bottle as if it were a special kind of handbag and looking absurdly happy about it.

Then one day, he just deteriorated. Hands were cold and clammy, blood pressure was low and breathing was irregular. We pumped in saline and plasma, nebulised him with everything we vould think of, gave high dose oxygen and he pulled through. That evening as I did the round he told me, "Nona, I'm going to die in the night... the forms I have filled to donate my eyes (coreal transplant) are in this little bag under my pillow, don't forget". I pooh poohed at his statement, patting his arm and reassuring him that he was now on the mend.

Yapa survived the night... but he died at 8 am the following morning. His last words to me were once again, not to forget the forms. He sank into a stupor and then died peacefully a few minutes later. He died not screaming and begging to be saved, but convinced that his time on this earthly plane was over and his last wish to help someone in his death.

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May he attain Nibbana

What's with these women...?

Hi, y'all!

OK... it's been a very long time. Needless to say, I've overworked, underslept and been in a generally foul mood for the last two months. Many thanks to all of you who dropped by to see if the blog was updated... and to those who sent kind wishes during the Avurudu season, which alas, I spent in hospital.

Ah well, 41 weeks down... 11 more weeks to go...

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I work these days in a female ward... the one and only house officer. The complaint rate is generally higher than in a male ward, but then, when males are sick, they are really really sick. Most of my patients are wheeled in on trolleys and chairs, looking like death warmed over... A bottle of saline and a night in an uncomfortable bed later, they're just begging to go home. They remember the kids, the washing and the shopping. Sometimes all they need is a break... one sweet old aachchi actually admitted that she came to hospital for a nice rest away from her chaotic household and I didn't have the heart to boot her out until the following morning.

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A recent admission to my was was a 19 year old girl who worked in a small shop at Pettah. She complained of fever for 6 months (mind you, 6 months of feeling unwell and she turns up at 12.45am - go figure). This is what we call "fever of unknown origin" a clinical mystery to which both myself and my registrar delved into with great interest. Blood tests, ECGs, x-rays - and then we find she has very high blood pressure and that her kidney function is miserably poor. Is the high pressure the cause or the effect, we mused, and ordered more x-rays and gave several different types of drugs in order to control the BP. Finally, a scan was done and what that report said freaked me out like nothing else... 16 week single live fetus seen in the uterine cavity.

Holy shit! That little idiot was pregnant!! And she lied to me about her period!! And the pregnancy test was negative because it was an advanced pregnancy!! AND I had taken 3 x-rays and given her a bunch of drugs that are virtually guaranteed to harm the baby!!! I was so mad that I actually slapped her across the arm and and yelled at her, asking whom she was trying to fool!!! Turns out that the guy who was responsible is married to someone else and has two kids from that marriage and all he wanted was an abortion. She wanted the kid - more I think because she couldn't contemplate the thought of abortion.

Cue Angel calling up her sister (both parents had passed away) breaking the news, stopping the sister from committing physical assault, arranging for counselling and finally transferring her to a specialist maternity unit that would take care of both the kidney problem and the baby. Sigh... I swear that whole episode took years off my life!

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A friend of mine works in the adjoining ward and she has a far more suspicious nature and more experience, having worked in a maternity unit on her first 6 months. The very next day she points out a new patient to her side, a rather chubby young girl, and said "Angel, she's complaining of body swelling for 6 months... can you make a spot diagnosis?" The girl is 22, unmarried and looks thoroughly bemused. I hazard guesses of hormonal problems and connective tissue disorders. My friends shakes her head... "can't you see the pigmentation on her face?? She's definitely pregnant." Examination of the tummy shows a wriggling baby, scan confirms a baby and girl continues to deny that she has had sexual contract, or a boyfriend or has even seen a man before... Her parents are equally skeptical. "No no, our daughter is a good girl. there's no way she can be pregnant, she never even talks to boys, you are educated people, why do you lie to us??" etc. etc.

She delivered a bouncing baby girl 2 days later.

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Such incidents never fail to surprise the continuously naive Angel, but my friend says that 6 months in a maternity ward and nothing would make her so much as raise an eyebrow. She told me of how she was called to the ward one night to see a heavily made up young woman who was complaining of abdominal pain. A closer look confirmed that the said young lady was in her bridal outfit and - you guessed it - in labour. Apparently it was some shiny puffy garment that was swathed around to hide the bulging belly and she had come straight from the reception when the pains had got too hard to bear.

So the blushing bride was rushed into the labour room and gave birth within two hours. By dawn the next morning, she had signed herself out of hospital, saying that she needed to be on her honeymoon, and that anyway the homecoming outfit would now need adjustment. Her mother was left in charge of the kid and later took the kid home once all the vaccines were given. It was all my friend could do to stop tearing her hair out - and since nothing was actually illegal (only very fishy) there was nothing much she could do about it.

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Now, I too have cultivated a suspicious nature. All women are sharply questioned about their period... a stock of pregnancy tests are kept on the emergency trolley (easy access, heh!) and tummies are poked more often than ever. And I recall with great fondness the words of wisdom quoted by an old Prof. 4 years ago "every woman between 5-75 years is pregnant until proven otherwise".

Grin!

Randoms

So did I tell you guys that I got chikungunya fever? You know, the really nasty one where your joints hurt like crazy? Last month. Unrelenting fever at 104F. 2 days in hospital - ironically, my own ward. And now my joints feel as if I've fast forwarded to 80! Aiyoo... a cocktail of painkillers and as of late, methylprednisolone (a fairly funky steroid) is what I use to dull the pain.

The worst off are my hands... the small joints. And my hands are my livelihood. Every time I check blood pressure, it hurts, when I tap at a lump or feel for a liver or percuss a lung, it hurts. Giving CPR hurts like hell. Walking and climbing stairs present less of a challenge. Went to a wedding recently and had to come of the dance floor after about half a song because de ol' joints, dey be acting up. Duka, duka...

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One month and a bit done... a wee bit less than five months of this nose to grindstoning left. We did a little mortality count - 16 deaths during the first month. Last Sunday I was freaking out... 3 deaths between 10.30 pm and 2 am... and just 2 nurses and me in the ward (and Darling dozing in a corner, trying to shut out the chaos).

Bummer

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I turned 29 last week - big deal. Was working and then had a long emo-moment with Darling. Sigh. There is a very material girl in me that just loves pressies and (this is the important part) can't get enough. Dinner was at the Sizzle... life seems much more bearable when one is well fed and watered...

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Watched Slumdog Millionaire and was totally wowed. Was slightly disturbed to discover that MIA sings most of the songs but hey, just because I think she has had a deluded upbringing and should be seriously re-educated doesn't mean I can't like her songs, right?

Watched Madagascar 2 and was less wowed. Funny movie though... love the penguins.

Am also becoming addicted to House, MD. It's a slow excruciating week until Sunday dawns and I can watch the latest downloaded episode. I can actually guess some of the diagnoses too... although it's a little demoralizing how 10 minutes into the episode they say "do a whole body scan" or something like that.... yeah, if I could scan my patients bodies at the drop of a hat, I'd be a brilliant diagnostician too. I guessed yesterdays one fairly accurately... Darling is most impressed with me (grin!)

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Am constantly hungry... I think it's a side effect of the drugs... the prednisolone to be exact.... am also looking slightly moon-faced with all the water retention. Mood seems to have improved marginally though... do steroids have a "Happy Pill" effect? Must tail myself off the meds but seriously what's so bad about eating all the time and being free of joint pain and stiffness?

Okay Angel, focus, focus - you are not, repeat, not getting addicted to steroids, ok?

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Okie... I got to go now... have a lovely, lazy half day off left to spend in peace. I slept till 11am today....aaaaahhh.... bliss! I think I'll catch some more soon.

Batter fried mushrooms for lunch.... yummy, scrummy...

I'm off! :)

Days of January, evilness and other randoms

Ok... I realize with a shock that this is only my 2nd post for January.

Life sucks...

Life, in fact, is one big suckfest...

I'm doing General Medicine at the moment, am over and done with surgery and being stressed out more than I've ever been in my life. People just come to medical wards and die... they just die like flies and I'm having a hard time getting over it. There have been more deaths in my new ward in 3 weeks than in my old ward in 3 months. It's nothing to do with the ward, admissions to the medical wards are - in a word - buckets (waiting to be kicked). Heart attacks, strokes, alcoholic liver disease and chronic kidney disease. I keep cringing daily at the ominous rattle of the hospital coffins as they carry their cargo towards the mortuary.

I don't finish work until 10 or 11 in the night sometimes. I start my ward round at 5am on some days simply because otherwise there just isn't enough time. After working in a ward with 30 patients, I'm now in one with 65 patients. Ack!

6 months and 3 weeks down... only 5 and a bit to go...

I pray they go fast...

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I have also found a gauge to my evilness....

You Are 34% Evil

A bit of evil lurks in your heart, but you hide it well. In some ways, you are the most dangerous kind of evil.

How Evil Are You?

Hmmmm.... I suppose 34% is not that bad...

Found this on Scrumpy's blog and couldn't resist!

I guess this is where the pitchfork factors in...

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Have realized that all my petty fights and arguments and rants at Darling have centered around food. How pathetic is that? I yell at him when dinner is not ready or breakfast is not what I wanted or when he falls asleep instead of boiling pasta. Darling now claims that I love him only after being fed and watered. Maslow's hierarchy in practice? Maybe...

Dammit, I can't balance being an intern and being a wife... :(

Poor Darling... :(

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I'll be hitting yet another birthday soon... in a couple of weeks, actually. Close to thirty, ovaries ticking away...

Did you know that women who have kids after thirty are more at risk of breast cancer and ovarian cancer? Is it selfish to want kids partly because it reduces ones risk of a nasty illness?

I want to have a family... but I want the two of us to have a decent married life as a couple first. This year just doesn't count...

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Anyway, have to go now... am on-call for the next 3 days... won't be home for a good couple of weeks.

Wish me luck folks...