Showing posts with label Intern Diaries. Show all posts
Showing posts with label Intern Diaries. Show all posts

Monday, August 23, 2010

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.

Sunday, June 27, 2010

First death

Somehow, I think that is something that really affects all doctors... the first time someone dies on your watch.

Mine was a few years ago and I still get flashbacks... still remember locking my self up in the teaching room of our ward and retching over and over again until there was nothing left to throw up. Still remember sliding against the cool wall until I was seated on the floor, alone in the darkness, hot tears burning my cheeks and whispering "I'm sorry" over and over again. Still remember it taking the best part of an hour to stop shaking... and then walking out, completing the night round, calmly writing out the death certificate. Still remember going home in a daze, walking into the shower, clothes and all. I threw away those clothes - they were so soaked in blood I don't think anything short of a blade would have gotten the stains out.

Since then, I have watched scores of people breathe their last, closed their sightless eyes, talked to hysterical relatives and filled out the forms over and over again. Death no longer has the power to shock... but the awe still remains. And so do the memories. I remember every. single. one.

That fateful night was a Saturday, and the patient was Rupasinghe* a transfer from Dambulla, who had a couple of episodes of blood stained vomiting. We had scoped him the day before and found an ugly ulcer in his stomach, probably cancer. I had explained about the surgery to him, told him about eating well and getting his strength up and informed the anesthetist to do the pre-op prep.

Sometime during the ward round I heard a hoarse shout from the toilets... and I remember running into the patients' toilets and finding Rupasinghe lying on the ground... he mumbled about passing blood with his stools, and started to moan. I'm not sure how, but I had him out of there and almost onto a trolley by the time the attendants heard what I'm sure were my semi-hysterical shrieks and came running.

One look at his eyes and tongue was enough to confirm what I feared - he was as pale as a sheet of paper and that meant the ulcer had eaten into a blood vessel and he was bleeding into his stomach, so fast that fresh blood was coming from the other end. Rupasinghe clutched my hand, and asked me if he was going to die... and I said something soothing, and told him we'll be taking care of everything.

My senior was there in minutes, and we started pushing in pint after pint of blood, saline, and starch - me on one side, a nurse on the other, squeezing the blood packs to push the fluid in faster. Suddenly R started gasping and before any of us realised what was happening, a gush of blood fountained out of his mouth, drenching my white blouse. The cold hard realisation that this man was going to drown in his own blood terrified me. We pushed a tube into his mouth, and fixed it to the suction machine, removing the blood as it welled up. More doctors were called in, more blood and more fluid, all of us working with silent, grim determination.

And then he improved... blood pressure started climbing up, and he opened his eyes, staring semi comprehendingly at the drenched sheets. I told him not to worry... that everything was under control... and we kept on with fluids. I remember smiling at my senior, and wondering why the relief wasn't showing in his face. Then Rupasinghe clutched my hand again and said, "I'm going to die doctor". I shook my head and managed a smile and said no, that's not going to happen, things will be ok.

He looked straight into my eyes and gasped out "you doctors are such liars".

Those were the last words he spoke. Less than a minute later, he started vomiting blood again, and this time, we couldn't stem the flow. Deprived of its lifeblood, his heart stopped, and CPR was just a futile exercise.

And looking into his sightless eyes, all I could hear were those final words, clanging over and over again inside my head, each syllable a skewer through my consciousness.

Thursday, June 24, 2010

Little Johnny Batta

Image taken from here

Whenever I pass through the accident service, I get flashbacks to the times when screaming ambulances brought in casualties airlifted to Colombo, human beings mangled and torn apart by gunfire, batta mines, claymores, RPGs etc. Our hospital would sometimes get as many as 100 casualties in a single night... and this was after the "less" injured had been sent to Homagama, Jayawardenepura etc. Often the accident service theaters and staff will be overwhelmed and the general surgical units (such as the one I worked in) would be called in, and every theater would have teams working into the small hours of the morning.

One of the Consultant Surgeons I worked with once gave us the history of batta injuries. Once upon a time the blast only removed a part of the calcaneous, the heel bone. Surgery removed the damaged tissue, and the chipped bone was smoothed out so that post injury, walking wasn't too much of a problem.

Gradually the doctors began to see crushed ankle joints and lacerated calf muscles. Then one day my boss (who was at the time working at the Anuradhapura hospital) was called in to see a soldier whose foot was completely blown off, knee joint shattered and muscles ripped apart up to the upper thigh. An above knee amputation was the only option. Later, my boss had to face an inquiry as to why a "simple batta injury" needed such drastic surgery - a question he was more than prepared to answer as he had detailed records including photographs of the incident. Since the end of the 1990's, the batta injuries have gotten progressively more horrific as the terrorists packed in more and stronger explosives into the little device. I have seen and read of injuries where the pelvic ring was blown apart to smithereens, where the bowels have been ripped and torn by the blast and one instance on ruptured diaphragm and damage to the lungs.

Every time I remember the mangled flesh and horrific wounds, I curse the people who invented landmines and those who used them, and continue to use them. They rank high among those guilty of crimes against humanity, IMHO at least.

I believe there is a special part of hell reserved for them.

Monday, February 15, 2010

These people, I tell you....!


So some time ago, this guy walks into the hospital complaining of tummy pains and constipation, and is sent over to the casualty unit. After giving the same story to the examining doctor, he reluctantly agrees to a rectal examination. The doctor is quite peplexed to find first a sili sili bag, and then a hard immovable object stuck "up there". Frantic x-trays were taken.



Picture quiz... can you guess what this is?


After stern questioning by the senior doctor, the patient mumbles something about a perfume bottle, and says he was assaulted by rouges (brandishing said perfume bottle) who had also robbed his house the previous night. Various methods were tried in order to get the bottle out... including a pair of obstetrics (delivery) forceps hastily borrowed from the nearby OBG ward, but to no avail. The patient was finally wheeled to surgery, sliced open and relieved of the offending object.



Of course, this account won't be complete without mentioning a famous story by one of my Profs. who never fails to regale successive generations of medical students with his wit and wisdom. Apparently while examining a similar patient, he had noticed a faint buzzing against his fingers... at which point he had asked the patient whether he wanted the vibrator taken out, or whether he simply wanted the batteries changed! After the operation (or so the Prof. claims) the vibrator had gone mysteriously missing. He then goes on to say he strongly suspects the ward nurses to have filched it for their own diversion...! (Of course, all these is said in a spirit of humour, esp. when Ms. A, one of the senior nurses, is present. She usually laughs and shakes her head - I think she has heard the story far too often to react in any other way!)

According to the 25th edition of A Short Practice of Surgery by Baily & Love, "The variety of foreign bodies that have found their way into the rectum is hardly less remarkable than the ingenuity displayed in their removal". It then goes on to describe the discovery and removal of turnips, pepper-pots, glass tumblers, screwdrivers and live artillery shells, just to name a few...

Ah well... and life goes on....

Sunday, July 26, 2009

Male Chauvinist Oinkers

What is it about some Sri Lankan males that make them just not able to speak with due respect to educated women? My rant is specifically aimed at all those idiots, who over the last year, kept referring to me as "Miss".

Now that is a perfectly respectful form of address, unless you're a lady doctor, treating them/loved ones. In which case, the term becomes an insult, more so when the male doctor next to you (who is actually junior) is addressed with a bent head as "Sir".

For those of you who think I'm making an a big deal out of a petty issue, it's a big deal to me. My education means a lot to me, I sacrificed time and energy and youth in order to become the best doctor I could. At least have the decency to respect my education. And for those of you who think attire has something to do with it, trust me, I've been dissed while in saree, dress and skirt-and-blouse.

One guy was idiotic enough to snap his fingers at me (accompanied by an imperious, "miss") and beckon me over.... why? because he wanted me to get the urinal from under his bed. I was not amused.

One guy actually had the gall to ask "what do I call you then?".

He comes to a hospital.
He approaches me expecting the services of a doctor
I offer the services of a doctor, minister to his ailments etc.
He has no problems in referring to my male colleagues as "doctor" And he calls me "miss"

The worst offenders* (and I hate to be racially discriminating) are muslim males (young and old) followed very closely by young sinhala males. Tamil guys have in general been quite charming, forces personnel are extremely respectful - and meticulous about following medical advice - and old seeyas generally very sweet. I have never had this problem in the female ward, unless it is from a male relative of the patient.

*Note that the above is merely what I specifically have experienced over the last year.

Okay, okay, I'll get off my soapbox now. I know it's not a life-or-death issue since frankly, I've dealt with enough of those to know one. It just pisses me off, and at least here on my blog, I can rant the frustration out!

Have a good week, all!

Sunday, July 5, 2009

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...

_________________________________

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

Sunday, May 3, 2009

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!

________________________________

Doesn't happen often...

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

Sunday, April 19, 2009

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.

_______________________________________

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...

____________________________________

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.

____________________________________

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!

___________________________________

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.

_______________________________________

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.

_______________________________________

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!

Sunday, February 8, 2009

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...

___________________________________

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

___________________________________

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...

___________________________________

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!)

___________________________________

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?

___________________________________

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! :)

Sunday, January 25, 2009

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...

___________________________________________________

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.




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...

_________________________________________________

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... :(

__________________________________________________

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...

__________________________________________________

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...

Sunday, December 28, 2008

Oh well...

Kala died last week... was too rushed and too bummed about it to blog. The moment she became "bad" her mother ran to the male ward and I had Mahesh watching me and moaning in the background while I administered CPR. Not fun.

_____________________

December 25th Casualty wasn't too bad. The next couple of days were though. However, my best buddy is in SL and I met up with her on Saturday, which was really really good. Let's see how the January 1st Casualty goes... fingers crossed!

_____________________

Happy New Year, all! And remember, if you drink, drive and crash your car, you will end up in my ward and I will not be amused. So beware! Don't get behind the wheel unless you're sober! :)

Cheers!

A

Saturday, December 13, 2008

Dammit!

My last pair of work shoes broke this morning... I am now faced with the choice of going to work in
a) broken shoes
b) rubber slippers
c) hooker heels

______________________

I'm sorry my last post came out all whiny and self pitying. I'm not the first or the only one to go through this... everyone does it. My Colleague M went home to Mathara today after 5 weeks (and was entirely cheerful about handing over her ward to me).

______________________

So I'm now handling the female ward. Slightly lesser number of patients but full of old achchi's suffering from APR (athe-paye rudha/ anga-patha ridenawa) . Since I've been suffering from APR. meself, I'm a bit more sympathetic than I would have been otherwise. The ward also has Kala*.

______________________

Kala is a 19 year old with a 43% kerosene oil burn - accidental, she claims but the pattern of the burn injury makes us question that. She has a 2 year old daughter and was pregnant with her second child when she was admitted. Her husband Janaka is in my old ward with a "rescue burn"... he has essentially burnt the skin off both hands trying to save her.

Janaka looks a real rasthiyaadu type... dirty teeth, silver earling, breath smelling of stale ciagarettes. He drives a three-wheeler and lives near the place Kala was boarded at a couple of years ago while working at a garment factory. Romance blossommed between the brash sinhala youth and the shy tamil girl. His family was ok with the match... hers opposed it. So they eloped and in true Sri Lankan style, all differences were settled when little Tharushi was born. Kala's family came from Trinco and were living in a house paid for by Janaka.

Janaka had tears in his eyes when he told me how Kala made him tea and stroked his hair untill he fell asleep that fateful night. He was woken up by her screams of agony and had rushed to the kitchen to find her blazing like a torch. He carried Kala with his burnt hands into the threewheeler and then to the Accident Service.

Two days ago Kala developed labour pains and was rushed to DMH where she prematurely gave birth to their second child. She's back in NHSL while the kid is in the PBU.

In Sri Lanka, anything more than a 30% burn injury carried a pretty poor prognosis... i.e. 99% die. Kala has an inhalational injury as well... her lungs have been burn from inside by the kerosene fumes. We're pumping in fluids and plasma and high protien food... but the truth is that she can die any minute.

She scares the daylights out of me.

She's conscious and rational.... her breathing pattern sucks and she knows it. She asks me if she's going to die. Janaka asks me if she's going to die. Her mother asks me if she's going to die. I don't have much to say.

Everytime I leave the ward, I leave in grim anticipation of the call "Doctor, Kala has become bad".

Would appreciate any positive energy you guys can spare to be sent her way.

Monday, December 8, 2008

Last day off...

Literally...

Until sometime after the 7th of January...

I will be working everyday and be on-call every night till then... every weekend and every public holiday too..

Life sucks.

My feet hurt and I have got fairly large, possibly infected callosities on both feet. It hurts to walk. Sometimes I get pains in my feet that make me feel as if they are on fire. They only last a few seconds but sometimes it's difficult to stop from going "ouch" out loud. Maybe I'm getting some kind of neuropathy... maybe it's just that they need a rest.

Three of the guys who were admitted to the last casualty came with the complaint "pain in the big toe". It was hard not to be exasperated... they were eating up time that could have been spent on patients who were much more ill. The Consultant didn't play around... all were sent home with instructions to attend the clinic and get a routine date for surgery, if needed.

_________________

I need new shoes. I started off this job with 6 pairs (2 different designs each in black, white and brown) and now am down to one (ONE!) because the others have all worn out / broken.

I need new clothes because everyday on call = 14 outfits a week. I don't have that many clothes and I can't see myself doing the laundry (or, to be honest, bugging Darling to do the laundry) more than once a week.

_________________

Not much time to surf/blog... you may have noticed fewer and fewer posts... by the time I get home, I'm usually too tired to get Darlings laptop out and trawl the net. All I want to do is to sleep.

_________________

The "season" is upon us and am not really feeling very festive. I'll be doing a casualty on December 25th and on January 1st... :( Did I mention that it's been a year since Darling and I tied the knot? Our first anniversary pic has me in a dressing gown and Darling in his vest, cutting a one pound chocolate cake sent by Brother... the messy kitchen of our apartment is in the background, making me feel guilty whenever I see it.

It wasn't bad... we went to the hotel for dinner and the following weekend (my last off-weekend incidentally) we went out of Colombo (not very far) and just chilled. (details in a post to come...)

_________________

Anyway, I'm just feeling really depressed at the moment.

Sigh...

Saturday, November 1, 2008

Physician, heal thyself...

I managed to leave the ward by about 5.30pm during last week's post casualty. Post casualty on-calls always suck... the ward is full, half of the patients are after surgery and invariably the number of patients exceeds the number of beds.

Anyway, it was a quick break - rush to the flat, welcome wash and then grab a bite to eat, a banana and a piece of cheese, as it happened. 15 minutes later I felt a horrible burning sensation around and inside my mouth... rushing to the mirror, I saw horrible ugly red wheals form on my lips and tongue... eeeek!

Okie... food allergy (but to bananas and cheese??) Horrible pictures started swimming through my head. Things like angioedema and Stevens-Johnsen syndrome start off like this. There was no one at home, so, mildly panicked, I rushed off to the OPD with the vague uncomfortable knowledge at the back of my head that whatever this was, it could kill me.

The OPD doctor took one look at me and said "admit!!". So there I was, jittery as hell, clutching the admission sheet while my name was being jotted down into the admission book of a medical ward. The doctor there - an intern like myself, let's call him R - took my history, my blood pressure, listened to my lungs and said with interest that the taste buds on my tongue were so swollen that he could count every single one of them.

And then we ran into a problem. One of the drugs I needed, promethazine (also known as phenargen) would knock me out completely - and I was on-call that night! A brief argument ensued. I had every intention of going "LAMA" (leaving against medical advice) after getting the shots I needed. There were a hundred things to do in my ward... there were at least 2 patients who were "bad". Dr. R said in that case, there was no way he would give me the promethazine because then he would have to restrain me in his ward - I would be in no condition to do an on-call.

After a few minutes of roundabout conversation "but I have to go"... "then I can't give you phenargen"... "but I need the phenargen" we reached a compromise. I would get the non sedating drugs and wait in the ward. He would go and have a quiet cup of tea. We would decide on what to do once he came back.

My symptoms improved somewhat, my BP continued to be stable and the horrible itching didn't spread beyond my face. So about an hour later I signed myself out of that ward. I cajoled the nurses into letting me keep the cannula - after all, if I collapsed, there would be a handy pathway for nurses in my ward to give me the phenargen or whatever.

So there I was, doing a ward round, cannula on my hand as large as life and patients giving me odd looks and asking "Doc what happened to you?" Happily my Registrar took a firm stand and said he'd be on-call instead of me so that I could go home and get a good night's rest.

Which brings me to the hypocrisy of it all.

Had it been someone else asking my advice, I would have snapped that they needed in-patient treatment and that the universe will survive for one night without them. But no, doctors are the worst type of patients. They are stubborn, idiotic and know-it-all. As a general rule they take poor care of themselves - irregular meals, inadequate water intake, erratic sleep patterns and not enough quality time with loved ones/family. In short, they (i.e. we) are hypocrites of the worst sort.

Sigh... looks like I fit pretty neatly into the stereotype!

Tuesday, October 21, 2008

Rain...

I'm not sure I like the rain anymore.

Yesterday, I forgot to take my umbrella, had to take a trishaw to the flat and then got frickckin' wet anyway, because my neighbour had a lorry parked down the lane and the trishaw couldn't negotiate the last 100 yards home.

I was wearing a red saree.

I discovered that the afore mentioned saree is not colour-fast.

I ended up trailing pinkish streams of water all the way along the living room, past the pantry and into the bedroom.

In an absolutely foul mood, soaked through, I tear off the offending saree and dump it in the laundry basket... failing to notice that two of Darlings light coloured office shirts are in it.

Saree has been banished from wardrobe.

__________________

On the positive side, the flat is no longer like an oven when I get home from work.

And heavy rains means we get less admissions. Of course it does mean that those who do come are the dead-or-dying. Sigh. Oh yeah, it also means that those who don't have a dry place to sleep in also get admitted. So no real difference in number of admissions... :S

The hospital corridors flood too... and I always get paranoid about worm infections and take vermox "just in case". It's not very nice squelching along, with damp hem of saree sticking to ankles. The lift guy advised me to keep my umbrella up even when walking the corridors "because Nona, the roofs were built only to keep the sun out, not the rain".

Yup, I think that settles it. I don't like the rainy season.

Sunday, October 19, 2008

Tired....

Sigh.... joints and muscles I wasn't even aware I had have been aching for ages. I have been working the night on 6 of the last 9 days. Of course, this is after working the day shift as well. Even Darling got tired of me coming home well after 10pm, but to be honest, on most occasions I chose to stay back... I couldn't leave the ward until I was sure that X's BP was stable and Y was out of pain, and Z had stopped vomiting blood.

I'm not a saint. I did it not for the love of humankind. X is 90 years old and is in absolute suffering with a dozen medical problems that will push him to the grave sooner rather than later. Y had crashed his bike while drunk, killing someone, and Z is a wife-beating drunkard.

Ideally, I should not care less. Yet they are my patients, under my care, in my ward. They are my responsibility. It would be wrong if because of a lack of something on my part, someone should die a little sooner or that someone else spend a sleepless night due to pain.

This is my job. It is my responsibility and it's not a very comfortable one. It's a horrible feeling to come in the morning and realise that someone has had unnecessary pain because the morphine had been prescribed 8 hourly instead of 6 hourly. Lapses do happen, because in spite of everything, I am human, and I'm just an intern. And when they do happen, I am so very very sorry.

_________________________

Ouch, ouch, ouch. Achy muscles suck.

It's also that time of the month.

Since panadine is the strongest painkiller I use, drug-relief is minimal. What I really need is a hot bath and a good foot rub. I shall have to settle for a cold shower.

I've got lots of comments to reply to... thanks to all who took the trouble, your input is appreciated. Will update when less crazy-busy.

Work again tomorrow. Tomorrow's a new day - a new week.

______________

3 and a 1/2 months down... 8 and a 1/2 more...

Monday, October 6, 2008

Daily ditties

Sri Lankans frustrate me in general.

Those in my ward are frustrate me in particular.

But they are my daily fare.... my bread and butter, so to speak. Every day I ask patients about their bowel movements and whether they are peeing comfortably. I stick my finger up innumerable back-sides. I poke and prod and tap and listen. I feel sweaty and uncomfortable and sick at times. These days, dehydration is almost a by word. And still, in spite of doing our best, patients don't do what's best for themselves... why do people have so much trouble in taking responsibility for their own health?

Take the guy in bed X for instance. After devoutly fasting for 20 days, he decides to prematurely break-fast by going on an alcoholic binge.... which lasted till sunrise. He then lands in our ward with a ruptured stomach ulcer, bleeding like mad and has to be rushed into emergency surgery. After days of being kept nil by mouth, we cautiously asked him to drink water - and water only - not exceeding 30ml an hour. The next thing you know the guy is found with a huge buriyani in hand! Aaarrrgh!!!

Then there's the fellow who stabbed himself in the stomach with a bread knife. He seems to have wriggled it around a bit also because his bowels were cut and torn in multiple places and he needed 6 hours of surgery in the wee hours of the night, ICU care and constant monitoring after that. After looking disgruntled for a day or two, he starts yelling at the doctors accusing them of starving him to death. After frustrated conversation and repeated explanations that food will kill him if taken too early, our only conclusion was that next time, he should aim slightly higher and to the left. Hmmmph!

My last casualty saw three admissions with bad diabetic foot ulcers. All three patients had delayed coming to hospital by at least 2 weeks after developing what was initially a small sore. This is in spite of repeated verbal and written information by doctors, nurses and medical and nursing students of the importance of foot care and getting early treatment. One foot ulcer was actually swarming with maggots!! (Eeeeuw!!!) They all turned up after 11pm in the night and all had to undergo amputation. Depressing.

Come to think of it, our countrymen and women seem to have a particular affinity for coming to hospitals in the middle of the night for quite routine complaints. I guess they finish up the house work, sort out their accounts and bills and feed the poor and hungry before they come. Almost every casualty has an admission or two where the patient has been constipated for days... sometimes weeks... who then decides that they want to move their bowel at 2 o'clock in the morning! Honestly, if they came at a decent hour that day... they would have got prompt treatment, a date for endoscopy and been sent home quite comfortable... instead of having to sleep on the floor because there are no beds. And probably wouldn't have had a sleepy doctor (virtual pitchfork threatening alarmingly) getting irritated at their complacence.

Finally there's the guy in bed Z... the bane of my existence. He has multiple anal abscesses caused by constipation, caused by his not taking his thyroxine for 3 frikkin years. The abscesses are oozing pus (eeeuw... why am I in this profession?) and the area needs to be kept meticulously clean with frequent dousings of salt water. And he refuses to wash. Instead he asks for more tablets and pills and injections. Jeez... he frikkin refuses to wash!! (Did I say that already?) And he refuses to go to the toilet - which is the root of all the evil in the first place. The only thing that finally got him to the bathroom was my dark prediction (said out loud and to the ward in general) that unless he does so, his bottom will completely rot and fall off.

Well, that's all for now, folks. I have to go early to the ward tomorrow... there are more back sides that need examining.

Sigh...

Wednesday, October 1, 2008

Occupational hazards

I think I'm going to quit medicine - it's becoming bad for my health.

Apart from the minor heart attacks and nervous breakdowns caused by patients, the getting-yelled-at by the relatives because we hadn't given the patient soup or papaw or something (dude - this is a government hospital. All we can afford to give is rice and curry for all 3 meals.. be thankful!) and the occasional romantic overtures from the more inebriated, hospital life can become a threat to safety, peace of mind and even life.

A friend of mine had her chain snatched a few months ago. She was leaning over to examine a patient who ripped off her chain (causing deep cuts around her neck) and run out of the ward. He was subsequently caught and found to have swallowed it. X-rays showed the chain and pendent - close to 2 sovereigns of gold - lying there as large as life in his bowels. So he was given laxatives... and everyone patiently waited for the chain to pass. Eeeeuw. The chain didn't come out, the patient was taken in to remand, and that will be the last my friend hears about her necklace. Honestly, if it had been me, all ethics would have been put aside and the patient would have been sliced open on the operating table the very next day!

As a precaution, I don't wear any jewelery to work. Not my wedding rings. Not even a necklace or a pair of earrings, unless a particularly festive mood calls for a pair of imitation danglers. Rings interfere with the scrubbing at theatre, and it's difficult to pull on a pair of gloves in an emergency. Earrings get caught in theatre masks and caps. Chains get snatched. I sometimes walk home alone, down a couple of poorly lit streets. Who knows what type of desperate weirdo will accost me?

The there was the murder.

Lady doctor shot dead in Hambanthota
. She was a group mate of some of my colleagues and the atmosphere in the ward yesterday was one of deep shock and distress. She had been a lovely girl, they said. Quiet and unassuming and totally unlikely to get embroiled in arguments.

Apparently there had been a disagreement with an army soldier and this guy had stalked her for months, tracked her down to her quarters and shot her in front of her father.

OMG!

We treat many personnel from the armed forces on a daily basis, some for routine surgery and some from the front lines who come for specialized trauma care. There are plenty of stories, some heartbreaking, some shining examples of courage that I don't blog about, simply because I don't want my posts to raise any unnecessary red flags.

My point is that even though we're very kind and give them priority at every point, sometimes we have to be firm. Many's the time I had to tell patients (or the bystanders) off for not following medical instructions. Sometimes information needs to be repeatedly yelled out before it can penetrate the thick Sri Lankan skulls. Goodness knows how many of them walk out of the ward bearing a grudge and even now may be plotting to kill some medical officer or the other.

It's not just the forces personnel. This is a nation of twisted, violent and ignorant people and at hospital we deal with the scum - drug addicts and dealers, mafia hitmen, government hitmen, kassippu brewers, pimps.

Eeeek!

I think I want a nice, safe job... with set working hours, in a comfortable air conditioned environment among people who are not sick.

Monday, September 15, 2008

The death of rats...

With apologies to Terry Pratchett


Picture from here.

____________________

I'm tired.

A casualty to handle, a week end on-call, and personal emotional turmoil.

But all that's besides the point of this post.

______________________

I walked into a medical ward yesterday... sat down near the house officer (an old friend) and started a random chat. I can't explain the difference I felt... was the air somehow heavier in this ward? Was there somehow less light than the one I worked in, or was it just the generally overcast day?

These musings at the back of my mind were cut short by wails and screams of agony. Over and over again... now high pitched, now low... different voices... different levels of torture ripping through souls. At times a confused babbling.... at times just incoherent moans. Over and over again...

I listen for a full minute, mouth agape... "what is that?" I ask, horrified. My friend looks glum. "Them? They're the lepto patients..."

Leptospirosis.

The farmers call it mee una (rat fever). The spiral like bacteria lives in the kidneys of rats... and when they pee, get passed into drains and canals and paddy fields. Unwary farmers go sloshing around... and get infected through the cuts and scrapes on their feet. The fever sets in and chills shake the bodies of these young, strong, healthy males. Blinding headaches. Uncontrollable vomiting. Delirium. And the complications are killers : inflammation of the heart and brain, liver failure, kidney failure, relentless bleeding tendencies.

It is "Lepto season" again in Sri Lanka. There is an epidemic going on... but I don't have the statistics or the numbers yet. Many many are transferred to Colombo... from all over the country and they die like flies... young men, reduced to moaning shells of their former selves. Women die too... young and old... some who have only stepped into the paddy field to help a friend during the sowing.

There is hardly enough space in the dialysis unit for patients with chronic kidney disease. The unit is full of lepto cases, their blood being fed into machines in a desperate attempt to clean out the toxins that are poisoning them. The wards overflow with the infection... the systematic removal of bodies is only matched by the relentless inflow of even more patients.

Antibiotics can cure... if given early. As soon as there is even a faint suspicion of the presence of Leptospira. Before the complications set in. I believe there's an island wide awareness programme going on. Cut off as I am from newspapers, TV and other mass media that is available to the normal population, I haven't a clue as to what they're saying. But please listen, and take care.

____________________

It was close to 9 pm as I walked to the flat, the full moon radiant overhead. I bump into another friend, moodily making her way to the canteen.

"Heavy weekend eh?"

"You have NO idea. Three early morning arrests today"
(cardiac arrests... not good, obviously)

"How many survived?"

"None."

"Damn! Poor you... hope the rest of your day was better..."

She looks at me... tiredness, and something else I can't define seeming to ooze out of her very being.

"I got a call from the dialysis unit at about 10, a patient had arrested during dialysis. While giving CPR, I got a call from the ward... another arrest."

I didn't have much to say after that. Obviously her weekend was a helluva lot more shitty than mine. I only had one question.

"All lepto?"

"Yup, all lepto."