JS

Among the first few questions that my preceptor asked me in the beginning of male medical was "Can you handle death?"
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I said it depends.
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One of the patients whose case that I was actively clerking passed away today. Intracranial bleed. My last few memories was him breathing raggedly, even as I stood observing his cardiac monitor during the grand round. His BP was crashing, and I was the one who struck off all his antihypertensives from the meds chart, under the specialist's order. Menial task. But I remember being on high alert, scared that I would miss out on anything. The MO's and the ward sister and the preceptor was concerned with the fact that the wife seemed more concerned about his mouth ulcers when the crux of the matter is that the patient was dying and she should be prepared for his demise. I think she was in denial and I don't blame her.
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20 minutes later, when I was at the other side of the ward, still in the middle of a round, the nurses started calling the MO. The patient was bradycardic before going completely asystolic, which means his heart slowed down until suddenly, it stopped beating. The patient's wife was asking why isn't anyone doing anything. The ward sister looked distressed and asked the MO to please could someone counsel the wife again about the patient being not for active resuscitation. I looked askance at my preceptor. I don't understand the business of not for active resuscitation. I mean, I do understand it, but I find it morally difficult to grasp. Even if it's technically not wrong to not try and bring back to life. At least that's what I remember from bioethics and flipping through the Catechism of the Catholic Church, but I may be wrong so do correct me.
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The heartbreaking thing was when the daughter and son tried to perform CPR. The family refused to let him go. When he was finally pronounced dead, I saw the wife started falling apart. Heaving, gasping for breath sobs. As I walked out of the ward, I had to bite my lips. They are taking out the biohazard bag, already starting to do clean up. I had to pinch my fingers. Do not get emotional. Do not cry. But then I saw the daughter outside, silently crying, sitting dejectedly in a corner. I cannot help myself but walk over to her, put my hand on her shoulder and told her I was sorry about her dad. I walked away to go for the mortality meeting. Thank God for the meeting. I wouldn't want to stay in the ward to watch the aftermath.
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Death can be so painful. I saw one last week, but that was so peaceful, I was quite happy to see him go, finally free from his emancipated body. Today was a bit hard to witness though. I said the Divine Mercy prayers as he died, so that was the most I can do. I love doing clinical, not for the deaths of course, but the intensity of it. It's different being in the ward compared to being behind the pharmacy counter where everything is clean and sterile and happy. It's difficult but immensely rewarding when the patients do get better.

Rookie Mistake(s)

Hospital called me again this afternoon. One of the wards needed chemo supply. The dose was really off though. Had to call the HO prescribing it to see if he really really wanted to give it that frequent. New guy. Just reported for duty beginning of the week. Probably graduated early this year. V reminded me to be nice. But to give me credit, I wasn't about to give him a hard time about it LOLs.
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Anyway, it feels weird when the doctor starts to apologise profusely for the mistake. Chill. That's why I'm there for. Besides, I know how it's like to be an intern. I am one.

Oct 07

Never thought I'd say this, but missing this hair length on me. But yala, the snip snip snip was therapeutic pre-finals.

ORS per purge Part 2

So I am staying in again today. I was up already in fact, showered and was getting ready to go to work when suddenly I had a sudden need to go to the loo. An episode of diarrhea and vomiting. Nothing left in there but bile. I'm hungry but I can't keep anything in.
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Had to go back to the hospital to get another MC from Dr N in the ward who started to look a tad concerned. Preceptors asking me to do a BUSE, which means blood urea and serum electrolytes. Electrolytes normally get low in vomiting and diarrhea. I refused because (1) I don't want to be poked for the BUSE and (2) I don't want to be poked for the subsequent IV drips. I don't think it's food poisoning. Now the general consensus is that this is due to stress, and the fact that I'm now in male medical ward. Male medical is crazy. Only done paeds before, so one thing that struck me is how big the adult male patients are, and how much space they occupy. It's quite rewarding so far, even if the workload is much higher.
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I'm actually on call this week but thank God, it's been safe so far. Someone is taking over my Saturday morning duty, so I just have to work on Sunday now, but I should be okay by then.

ORS per purge

Please, could someone remind me that I'm no spring chicken, that age is catching up on me, and I could not expect to be the same superhero in uni that can go without sleep.
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I'm at home. On a work day. Nausea, vomiting and diarrhea are unpleasant, but I suppose I'm thankful that I have time to work on my clinical presentation #2. But seriously, the ORS is horrible. And I need to stop skimping on sleep.

This is for RR

I am in enforcement. Correction, I was in enforcement and now I'm in between enforcement and male medical. I can't speak much when I was in enforcement, because of the nature of the work involved. We inspect, we raid, we investigate, we prosecute. It's so different, and so far removed from the hospital environment. But the moment they told me about you yesterday, boy, half an hour after they stopped resuscitating, I was immediately transported back. Back to that month, where I used to see you five days a week in paeds.
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E told me you looked fine that morning. Nothing on the case notes indicated that somehow you would take a turn for the worse. You were only 12. You crashed and by the hand of God, you were gone. Not even 3 specialists and 3 mos can bring you back.
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I remember you, boy. I remember the distinct smell of your room. Every time as I walked in and out the ward, I used to peek into your room, to see what you're doing. Sometimes you'll be sitting cross-legged on the bed, sometimes you'll be sleeping. Sometimes you will be smiling with your dad, sometimes he will be playing chess with you. I remember your dad weaving his fishing net. I know he loves you, he was always there with you. I remember the snowcap that you used. Just as your hair started to grow back in little tufts, another chemo course was started and the hair was all gone the next day. I remember issuing out the chemo drugs for your doctors. I remember the exact colour of your skin, I remember how your skin turned red with the cytarabine. I remember the infusion machines hooked up to both arms. I know you were not doing too well, but I didn't foresee that you would be gone either. Because we were doing all we can to keep you alive.
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I feel for you, because you have stayed isolated in that hospital room for months. You shouldn't have died in the hospital. If I can choose, I wish you could be on a grassy knoll with the sun on your face. But no one would have known. For what it's worth, I just want you to know that you are remembered. That a lot of people feel pain at your passing. Myself included, and I wasn't the only one who cried. This may be a sign of weakness, the fact that I get so emotionally affected that easily, but I cherish it, because that's what makes me human. I never want to lose my empathy. Why shouldn't I grieve for a young life lost?
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May you rest in peace, R.

Hot Cross Buns

It's Holy Week and Easter Triduum is starting. I am appropriately craving for hot cross buns. But shall I spend my day on leave kneading dough?
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I think not.