Messiness

It's been a messy week... and TGIF is all that I can say.

image from here

The Bumtrinket developed an eye problem and even though some people went "nah, can't be!" I was antsy until it had been properly assessed. I mean, it's her vision for goodness sake, how can I risk being complacent? So anyway, that meant a lot of worry and substantial time on hospital and a few more tests we have to get done this weekend.

I then had to turn in a couple of assignments, and two more are due by the end of today.... gah! Having a lot of trouble concentrating and on again-off again headaches.

Worst, I have to go back to work today as my maternity leave is over! Can you believe four months have passed? I should be able to get my leave extended... I'm hoping and praying. It breaks my heart to have to leave her and go and it's been a mad rush to bathe her and express and store milk, worrying all the while. Darling has put leave so that went a long way towards allaying my anxiety.

Adding insult to injury, none of my saree jackets (which fit throughout the pregnancy) fit me any more! I'm just too frazzled to alter them. Thank goodness for ready made jackets!

Will be needing a lot of positive energy today!

I quit!!

Image stolen and mutilated from here

So yes. I quit.

My job.

I am no longer attached to the Ministry of Health. And no, it had nothing to do with the previous post.

I know this is not news to some of you guys, but I thought I'll come out of the er.... closet and make an announcement to the world in general. In fact, this whole quitting thing took place some time ago, catalysed by a number of events, and is to blame for the dearth of patient related posts on the bloggie. Also responsible, I think, for the reduced traffic. As one so-called fan put it, "I really liked your angst filled gut wrenching posts more than the twinkly happy ones". Hmmm....

So what does this mean? It means I'm no longer prowling the wards in high heels or lurking inside clinics. In fact, I won't be seeing many patients for the foreseeable future unless I want to (like volunteering at women's health clinics and in health camps). It means I joined a university as a lecturer, for a substantially lower pay, I might add. It means I'm doing a bit of teaching and a lot of research. It means I no longer work weekends, night shifts or casualty rotations. It means I don't have to be on-call and get the jitters every time the phone rings.

I hear you, gentle readers screech out "why???" in tones of outrage.

Like I said, there were a number of reasons. I saw the vacancy advertised in the paper and decided to go for it. It meant having more opportunity to go places and see things, like here and here and here and here. It meant not being stressed like I've described here or having moments of frustration and sadness like here and here.

It may be because I want to spend more time with Darling, just chillaxing, just the two of us. The ability to go pee whenever I want to (note cartoon) is also a great advantage, since I have had patients/relatives diss me when I get up to drink some water or go to the washroom instead of writing out their cards.

I'm really happy at my new job... I work in a nice office, in air conditioned comfort. I work with a great team of like minded people. I have research assistants and a secretary to ease some of the boring work. I don't have to wear saree everyday.

Will I ever go back? May be. It was something I negotiated when I went for the interview... so yes, I may do a clinical degree as well. It's nice to know I still have the choice.

So yes, I think it's all for the best.

Happy weekend all!

Shame on you!! (A tale of irony, failure and blatant discrimination)

And the star player is.... (wait for it ladies and gentlemen) the Ministry of Health!

Image from here

Of course, I need to add a disclaimer that I wasn't a witness to the sordid event, and that I heard it from a number of parties who were present.

Another sunny day in sunny Sri Lanka, a batch of young post-intern doctors, their SLMC registration cards all new and shiny, were attending an orientation programme organised by the Ministry. At one point, an official clambered on to the stage to deliver a lecture on "Communication, public relations and attitudes". Blinking owlishly at the audience, he has proceeded to deliver (very badly) a lecture in Sinhala.

After a short while, the Tamil speaking doctors have requested that he speak in English, as they were unable to follow what he was saying. A reasonable request, one would presume.

At this point, the official has snidely said "if you cannot understand, go outside and wait. You will be given a summary in English as a handout at the end of the lecture".

Stunned and horrified, yet maintaining their dignity, these doctors had walked out, followed by a few of their Sinhala speaking colleagues. Although the majority of the crowd had been outraged, few had the self assurance to join them. However, complaints were made to the organisers, followed by the assurance that this "official" will be pulled from the programme.

However, the drama continued on to the next day, lectures were still delivered in Sinhala, while the Tamil speaking doctors were taken (bussed?) to a different venue, where lectures were in Tamil.

In a time where we all speak of ethnic cohesion and reconciliation, I see this as an insult to all Tamil speaking persons and to all doctors. I see it as a personal insult to myself and my beliefs. I am shocked, disgusted and ashamed... but on further thought, I don't think I'm really surprised.

They talk the talk... but do they really walk the walk?

Snake in the grass!

Literally...!

Image from here

A few days ago, hopping out of the car and striding ahead to the house in front of Mum, I notice a black and yellow shoelace lying on the path. I stooped to pick it up and realised that

a) No one at home wears lace up shoes anymore

b) Shoelaces don't taper off towards one end

I shrieked and jumped back as my brain processed the triangular head with the wicked eyes and the familiar mottled markings of a baby Russel's viper, and my muscles worked on a survival instinct of their own. The fellow was tiny, compared to the monster in the picture above, actually looked more like this.

Panic and pandemonium reigned for a few moments and with the help of the neighbours, the offending critter was hacked to pieces... I didn't watch (too busy with a mini trembling fit inside my room), and although I am all for the sanctity of life and live and let live mindset, I was not in the mood to suggest catching it and sending it to the snake lab of the Colombo Medical Faculty (where the snake venom is milked for experiments).

Daboia russelli is one of the deadliest snakes in Sri Lanka... the venom wreaks havoc on a number of body systems, messes up the clotting, poisons the liver and kidneys, causes dangerous heart rhythms and can damage the nervous system, i.e. you're pretty much screwed. Antivenom is available, but it's a polyvalent antivenom (common remedy for several types of snake bites) that's is imported from India. Although quite effective, it causes unpleasant allergic reactions - fever, chills, rashes, itching, clogged throat, and in about 40%, anaphylaxis, which is life threatening. In fact, a patient once said to me "Doctor, I died and went to hell twice and crawled back. Once when the snake bit me, and once when you gave me the injection".

Dr. Asitha de Silva and his team recently published an article in PLoS Medicine, which will revolutionize how snakebite is treated in SL as their method can reduce adverse reactions by over 40%. Hurrah for the doctors who are doing something to take snakebites out of the "neglected disease" category!

According to the Annual Health Bulletin, 39,321 patients have been admitted in the year 2007 to Government hospitals following snakebite. Most are probably from non venomous snakes, but that's one of the biggest problems we face - difficulty in identifying as the snake is often not brought. Of course when they DO bring the snake, that can result in complications as well. I have my share of snaky stories... just like most of the other docs out there...

Once the patient was accompanied by a 3 foot long live cobra in a gunny sack, which was jumping around like crazy and obviously enraged. The relatives kept egging me to peer inside the sack and confirm the identity and I kept saying no effing way. Finally, they killed the fellow and put it in a glass jar and brought it back to the ward... gah!

On another day when I asked "did you see the snake?" the patient signaled to his friend, who promptly dropped the snake at my feet. I screamed and leaped on to my chair before you could say "fatal haematotoxicity"... and then realized that the snake was, thankfully, dead. That is of course no excuse and I swear that incident is responsible for my crop of grey hairs.

Yet another day a couple of teenage rasthi-types walk in holding a jar that had a coiled up krait. Apparently one of them had felt "something" and then noticed the snake. I was quite pleased since we had a suspect, and careful examination (I went over his skin with a magnifying glass) showed that the guy hadn't been bitten after all. I asked him to stay for 4 hours observation just in case (as he said he felt something), but next thing I know, they had disappeared, leaving the snake filled jar on the floor of the corridor, where to my horror, it was kicked by an unwary labourer and went rolling around the ward! Much frantic scrambling later, the snake (still in the jar) and I were eyeballing each other from opposite ends of the doctor's table. It took another 4 hours to find a labourer who was willing (read - not too scared) to hand the snake over to the Faculty.

So what do you do if, gods forbid, you or someone with you is bitten by a snake?

1. do not panic and run around (muscle activity = the venom will be absorbed faster)
2. remember that most snakebites turn out to be harmless
3. do not cut or suck at the wound, don't apply ice
4. wash with soap (if available) and clean water
5. remove anything that might constrict a swelling limb : bangles, rings, watches etc.
6. immobilise the limb, if possible at a level below the heart. If it's a leg, splint/tie it to the other leg, or use anything handy (e.g. an umbrella) as a splint. The victim would need to be carried, which is all the better since that minimises muscle activity.
7. don't tie tourniquets (reduces blood flow to the whole limb and may make things worse)
8. don't give aspirin or ibuprofen; paracetamol may be given if pain is severe
9. take the victim to the nearest government hospital - most are equipped to deal with snakebite
10. don't waste time searching for or killing the snake. Even dead snakes can give a "reflex bite" and you may become the second victim!

Stay safe, all!

Back...! And rushed off my feet*.....

So yes, back in sunny, warm, humid Sri Lanka, which is very similar to sunny, warm, humid Malaysia, except here I do not have the luxury of having air conditioned surroundings practically 24/7!

As you can imagine, being out of sight does not really translate to being out of mind, and I have come home to a *huge* pile of written (i.e. official) correspondence that needs to be followed up on and loads of other commitments, family, work, friends on my pending list.

To add to this, hours after I land, I learn my cousin has been diagnosed with typhoid, and also that my Mum has dense cataracts in both eyes, needing quick surgery. So, cousin was started on antibiotics, Mum goes in for surgery, and the next day Darling gets severe food poisoning and needs to be hospitalised. Thankfully, all are out of the hospital now but Mum will get her other eye operated next week and Darling is back on a "normal" diet and eating goodness knows what, so I'm feeling very gloomy when I think of the next few weeks.

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*Needless to say, posts will probably be few and far between... and shoe post will be delayed until i have a pedicure... I cannot model ze pweety shooze while having ugly feets! :)

Tired....

I am so utterly and chronically exhausted that even lifting a finger seems to be too much effort at the moment. This post is being fueled exclusively by my emergency stash of toblerone mini's.

I guess we all go through this sometimes... burnout, maybe... maybe just feeling out of sorts.

I've been wearing the same half a dozen sarees to work for the last month. Why? Because they are made of nylon, i.e. no need to iron, just rinse, drip dry and wear. Unlike the more fashionable Hyderabad cotton sarees that are a PAIN to starch and iron. Speaking of starch, does anyone else use the spray on type available at supermarkets? Darling swears they keep his shirts crispy all day. He doesn't trust me with his shirts because the last time I starched one, it was so stiff, it could have walked off and hung itself in the closet.

I have spent the last 5 days marking MCQs, on paper that has been designed to be marked by a machine and not by humans. Said machine broke sometime ago. After a couple of hours, the coloured dots start to swim in front of your eyes. I hallucinate about them even while at home. Life has become a binary black hole. Adding insult to injury, the payment is like 2 rupees per paper or something.

Not sure this post makes sense... need to sleep.

Travel log - sizzling Bali

Isn't it nice that I am starting my first post for 2011 on such a sizzling note? :)

So the Jakarta conference ended up with a bang because

a) My research won an award
b) I visited approximately 40 different shoe shops (yayyyyy!!!)

The conference was huge with close over 700 participants. The nice thing was that all us foreign delegates were allocated an "escort", either a final year medical student or a recent graduate who would help us change money, locate conference venues etc.

100's of participants!

I was really nervous while making my presentation because of the big audience, and because I tend to ramble and exceed the allocated time, but fortunately everything went well, including the Q/A session... phew!

The rest of the conference was very intensive, with workshops going on after dinner until 9.30pm, and then follow-up activities starting at 8.30am the next day. Somehow all the participants were oblivious to the bustling theme park around the hotel as they madly threw themselves into the academic activities.

Lovers at the beach, Anchol, Jakarta

By the final day, I was well primed for some fun, so I asked Gina, my lovely Indonesian assistant to take me shopping. Her reward? To be dressed in one of my sarees so she can take pics and post them on Facebook! So Gina and I, accompanied by her long suffering boyfriend hit Mangga Dua the shopping district of Jakarta...

Oh Em Gee.

The malls were massive, even when comparing with those of Malaysia and Singapore... and had everything from key tags to SUVs on sale. I was like a kid let loose in a candy store, running from one shop to the other squealing with delight at the offerings there. The only things that limited my spending were the consciousness of limited weight allowance by the airline, and strict instructions by Darling not to use my credit card in Indonesia.

SUVs for sale!!

Lame dude trying to sell me SUV

We shopped for more hours than I would like to confess, and I gorged myself on the yummy food available at every corner of the mall. They had sweets very similar to our kevum and banana pancakes which involved a sliced banana and a hefty dose of chocolate rolled up in a pancake, dipped in sweet batter and deep fried.... the chocolate melts and oozes out of the sides, getting caramalised and it's like a warm taste explosion when you bite into it... sigh...

Kevum, aggala, thalaguli, anyone?

Chocolate banana pancakes

Somehow, banana, cheese and chocolate seem to be the most popular flavours in Indonesia, since they were everywhere in all possible combinations. My foodie experiments also included a chocolate and banana bun, a chocolate and cheese doughnut and cheese and banana pastry. :)

Anyways, food experimented with, shoes and clothes bought... I headed back to the airport and boarded a truly terrible flight. For those of you who consider Garuda Indonesia as a potential carrier, don't.

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The sizzle continues...

Well, my next stop was the beautiful tropical paradise of Bali... where I was joined by Darling. The declared reason was so that I could attend another conference... the underlying reason was for us to celebrate our 3rd year as hubby-and-wifey. Sigh.... isn't that romantic?

Conference #2 was even bigger, with close to 1000 participants... it was hosted in the post resort area of Nusa Dua, and the sheer size of the conference hotel made us go all O_o. Darling and I stayed at less ostentatious but very comfortable digs in an area about 1/2 an hour away from Nusa Dua, and close to Kuta, which is like teh happening place in Bali, night club bombings and all.

Ohhhh Bali!

The beaches.... the sights... the sounds....

I think that warrants a separate post, don't you?

Till next time, gentle readers... stay tuned!

My bags are packed...

... and I am GONE!!

Yes folks, after a few weeks of heatbreak and nerve biting tension, my conference was relocated to Jakarta so I am on my way!!

Right now, this post is being typed in KL where I'm on transit for nearly half a day. This sorry state of affairs is due to the changes in flights, and the inability to change others, because of high penalty fees. Yeah, that's what happens when one flies on a limited budget.

I'm checked into the Tune Hotel, LCCT, Kuala Lumpur International Airport. The room is pocket sized (there is literally only 2 feet of walkingspace around the bed), BUT very clean, nice swiss parquet floors, tiny but fully functional tiled bathroom with shower and hair drier and well airconditioned. There is also a huge mirror over the headboard of the bed, which reflects the arty mural on the opposite wall. It's a huge improvement from the poky (albeit, much bigger) hotel room we stayed in the last time we were in KL... and costs about 2/3 of the price.

Ok, Jakarta tomorrow....

With any luck, I will continue to have cheap internet access so can keep you guys updated!

Night mares

Image from here

...or maybe they should be called night terrors. I have discovered that I am inexplicably prone to them. It got to a point where I would sit up in bed and start screaming... until Darling would manage to wake me up and quieten me down by reminding me that I was home in bed and not in the ward... and this has happened more than a dozen times.

There was the time I was with a patient in the ICU when the lights went out. I remember thinking, "thank goodness there is backup power and the machines still work" when the heart monitor started beeping and showed a flat trace... I rushed to the patient's side... and woke up. In front of me was a blank screen and beside me, a motionless body. I immediately reached for the carotid pulse and would have started CPR on Darling if he hadn't been woken up by my frantic checkings for signs of life. The blank screen turned out to be the laptop on powersaving mode.

Then there was the time I got out of bed and searched for the file of a patient who was desperately ill. I searched high and low, on my chest of drawers, on the dressing table and on the floor... muttering how treatment delays could kill. About 10 minutes of this and I realised that I was actually at home and not on call.

The there was the time where I was on call during a casualty. My ward at that time had no room for doctors. I didn't want to leave the ward at all, even to go to quarters. So the nurses screened off a tiny part of the corridor for me, I brought a folding bed from home and camped out*. And then my senior came to me, talked about an ill patient and outlined exactly how she was to be manged during the next 6 hours. I got out of my camp bed and went to the nurses station, inquiring about the patient. It was 2.40am.

Nurse : (blank look) there is no such patient...

Me : of course there is, I have to start specific treatment, which bed is she in?

Nurse : Dr. you have seen all the patients, there are no new admissions.

Me : (impatiently) look, Dr. R just told me about the patient, she is such and such a person, having this condition...

Nurse : Dr. are you ok? I promise you there is no one like that in the ward...

I spent the next 10 minutes or so, going to each and every one of the beds, looking at the patients, checking pulses and reading tickets before I satisfied myself that there was indeed no such patient and that I had been dreaming. By that time I had a splitting headache, and couldn't get back to sleep.

Then there was the time I was actually awake, and in a non-ward setting. A phone nearby was off the hook and started emiting a beeping noise. I swear, it was the same sound a cardiac monitor makes during ventricular fibrillation^#. I had a mini panic attack... my entire body tensing to the adrenaline rush as I looked around for a cardiac monitor hooked to a dying patient. it took me sometime to realise that I was in an office, and that people were looking at me strangely. At least I was lucid enough to figure out what had happened.

And these are just a few examples...

My seniors were getting most concerned. Apart from the fact that I was, possibly, clinically depressed... there was also a risk (however slight) that I would in a semi-dreaming state order wrong medication / treatment**. I was asked to speak to a counselor. I did, not that it helped much, but the depression lifted gradually and without resorting to pills. I guess I will never learn to leave work at work... possibly because these are people we are talking about here.

So yeah... I sometimes kick myself when I remember that I voluntarily joined this field.

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*During those few months I had my pillow case stolen twice, and bedsheets once.

^#Also known as the rhythm of the dying heart, v'fib usually precedes cardiac arrest.

** It never happened.

No time to be kind

a.k.a. one more reason I don't like my job

I used to be a good person. Kind. Considerate. Empathetic.

Then I became a doctor.

I traded many fun years of my twenties for mad studies inside the library. I worked a gruelling schedule, not wanting to compromise my training. I started working in crowded wards that sometimes had more patients on the floor than on the beds. (Has anyone ever considered how awkward it is to hop from one floor patient to another, one hand desperately clutching the sari pleats and the other clutching a clipboard?) I've worked crazy 30 hour shifts, not because it was part of my job description, but because there was no one else to take over. I've stayed up with patients who were certain to die, even when I could have gone to sleep, because I didn't want to miss anything that could be corrected. I've missed uncountable meals and managed to keep functioning thanks to the packeted milo and minute maid.... but that wasn't enough to keep away the bad gastritis.

Still, I've had patients yell at me for getting up to have a drink of water instead of writing their discharge card... even though they knew full well I hadn't had anything to eat or drink for 5 hours. I've had patients and relatives disrespect me because I'm female, even though I gave them the best I could, and never less than any male. I've spent hours educating patients, writing out instructions in their mother tongue and have them blatantly ignore me and come back to the ward, worse than ever. I've seen patients been smothered by their loved ones... twice, and there was nothing I could do (that's for another post). And I was getting sick and tired of the futile nature of many aspects of my working life.

So, I cultivated nastiness. I used biting sarcasm and a loud voice that can be heard all over the ward. It became my defence, my protective wall against daily frustrations. I no longer jumped up the moment I was called (anyway, chikungunya ensured that I wasn't jumping anywhere without pain). But I took my time. I would look patients in the eye and say that I was going to tell them once, that I was going to tell them twice... but after that, I would not accept them into my ward if they did not follow my instructions (even though I have never ever turned away a patient). I pointed out to demanding patients/relatives that I was not a machine. When they got demanding, I would announce my lunch break (I am entitled to 2 hours, although never in my life have I taken more than 15 min.) and walk off. When large hords of visitors flocked in, despite my advice against tiring the patient, I asked them to leave, and restricted to the immediate family. I rarely smiled.

I remember when Darling cottoned on to this change. It was a heavy nights casualty in the female ward and there were several young girls admitted - fever, attempted suicide, unknown pregnancy etc. The ward rule is that males are not allowed in... many of these girls are wearing only skimpy night dresses, or are tossing with such delirium that modesty is not quite achieved.

Yet there are a group of males who boldly walk in with their women folk, and cluster around the aisles, or stand at the door and look into the ward, or stand at the windows and peer in. Even though it is obvious, I ALWAYS explain that this is a female ward, other women are also here, it is not correct to peep in. It annoys me no end when they don't give a damn to what I say and continue to cluster at the door or windows. One night I lost it, and questioned the whole world in general and the offenders in particular if they had no shame, that although they make sure their own women are covered from head to toe, they obviously lose no opportunities to stare at other women in their night clothes, and if they didn't leave, I would be calling the hospital police post. I did not mince my words.

Because I had (unfortunately) forgotten to disconnect a previous call, Darling heard the whole blasting from the other end of the phone. It took him sometime to get over it.

Just before I changed wards, one of the nurses told me something that shocked me. She said that in all the months working with me, she had never once heard me sing or hum a song. The realisation hit me like a cold bucketful of water as I remembered the person I had been... always smiling, always chirpy, always with a tune on the lips.

And I realised... I was not a nice or likable person anymore.