28 November 2006
Phew! The A1 GP racing came and gone. I got lucky to be called again for the second time to join its medical cover team. Th experience can be summed up with 3 words - fun, hectic & wet.
The medical cover was organised by our own military medics, with the inclusion of some civilian docs.
It's always interesting to watch the way those army folks run the show. We got morning parades and briefing ala-ala "an officer & a gentleman" minus R.Gere of coz. I guess the take home message is teamwork begets success
We were devided into several key-teams, comprised of docs, paramedics/nurses. Each team had different role and were given unique call signs: e.g. zulu leader (team leader), papa lima (pit lane doctor), foxtrot sierra (flight surgeon) etc... this whole code-thing reminds me of J.A.G yeyeh!
The main role of each team will then be determined by the doc's (who lead them)specialities e.g. emergency physician, surgeon, anaesthetist, orthopods etc.
The Sepang medical center itself was turned (in just an overnight) into a 'mini-mi' hospital, we got everything from X-ray machine, observation ward to even an operating room! - Malaysia boleh kan! Even the mat-sallehs who co-supervise the whole action complemented our local effort as being among the best medical teams in the global GP arena. No play-play ah!
We had 3 days headstart purposely for only 1 thing = TRAINING. This includes from reporting accidents to evacuating drivers from their damaged cockpit. Most of the guys had been trained before in the previous race or tournaments i.e F1, Japan GT, so it was just a matter of getting back into shape & rhythm.
We also gotta learn and memorise the track well, esp. the dangerous turns & curves and the fastest & nearest route to the crash location and back to the medical center.
And oh boy! In Sepang circuit, when it rains it pours huhuh!
"Charlie 2 to Zulu leader, we've got a code red at turn 12, requesting Bravo unit assistance, do you copy? over".
PS: Did I hear somebody says F1 :)
19 November 2006
The morning after
Anaesthetist are bunch of docs who guard the ICU and OT (two places in hospital where tension can be quite nerve-wrecking). ICU patients are mostly unstable and usually connected to breathing machine. Which means they are not so verbal... and when they do complaint, it will be in form of 'dropping their blood pressure or heart rate'.
Perhaps that is why there is some form of global regulation that anaes usually gets a day off after being on-call for 24 hours. Whether that 'law' really exist or not, it is something that we do get and need after those semi-sleepless nights.
"Would you want an anaes who didn't get any sleep the night before, doing your surgical case; by choosing & calculating the correct drug types & doses to put you asleep on the operating table?"
Having said that, I pity our other colleagues from the other departments i.e paeds, surgical, orthopaedics etc. who don't get the post-oncall day off. This means they're working from 8am that day until 5pm the next day --> 33 hours straight.
So.. my most recent post-oncall day: I slept for good 6 hours.. pampered myself with 007 and a nice dinner at Piccolo Mondo! Now dat's my 'morning after' ;) Oh BTW, that blond chap... he is a perfect Bond (after Connery of course HAH).
09 November 2006
Box of chocolate
The on-call morning is likened to receiving your raya's angpow. The feeling of "You never know what u gonna get". You may end up with only one patient to look after or the whole 'full 10 beds' situation.
The passing over session is always d fun & crucial bit. Where the doc who was on-call the night b4 will go through all the cases in ICU with the one who is taking over that day.
i.e: "Mr James Bond is a 40y old Malay man who's admitted 8 hours ago for a gun-shot wound to the left upper chest causing left tension haemopneumothorax. GCS on arrival was 6/15. Intubated in ED with ETT 7.5mm @ 20cm under midazolam 3mg and suxa 100mg IV. Chest tube was inserted uneventfully in ED. The bullet was surgically removed 1 hour ago in OR. Blood loss 300cc. Haemodyamics stable bla bla.."
When reviewing patients, usually we break down the problems into systems i.e ventilation, haemodynamics, infection.. etc etc. That helps us to focus on specific problems or anticipate any future complications. Then we would go through the OT list -- cases need to be operated on.
Hmm.. I should start asking myself in Dirty Harry's style, every on-call morning...
"Ask yourself this. Do u feel lucky today ? Well do u punk??"
27 October 2006
The Master (program) and 'civil' servants
Come October every year, a substantial number of Malaysian doctors would compete to get into the Masters program which enable them to become a specialist. Another 4 years of their life will be devoted to exams, lectures, on top of daily clinical works @ hospitals (hey that's ok!)
However, the fustrating bit is the shenanigans we all have to face in order to apply for it.
Imagine all these paperworks and what not:
* u have to get sah lantikan, then sah jawatan (for whatever those mean actually)
* at least 3 years of service
* decide on the kwsp/pension options
* pass the 3-week 'induction' course
* security clearance (some have to filled this twice, since the first one gone missing) - a conspiracy that N.korea agents might infiltrate as under cover docs?
* etc etc
And if you wanna have those papers processed within 1 - 2 month instead of 1 year, one gotta climb the putrajaya stairs around 5-6x, 50x phone calls which may sounds like "Maaf encik, belum siap" or my favourite "..nanti saya passkan awak ke pegawai lain".
I seriously pity those docs who lives outside selangor or worse still @ sabah/sarawak.
Huhu don't forget that this special October - we only have 3 weeks due to the double festive season.. yeayy!
The clock in the OT is ticking my friend!
Shoits - i'm on call again this weekend
21 October 2006
"Dr atas panggilan"
Some hospitals still have "dr atas panggilan' stamped in front of on-call rooms. Yes-sirree your classic BI -> BM translation.
Yaiks! I never like being on call on weekends, it only means 1 thing: you're the only medical officer from your dept whom they will call should there be any emergency arise. The OT (operating theatre) of course is only open for emergency cases i.e appendicitis etc
Today i got 4 cases waiting in OT. That should keep me on my toes for d next 6 - 7 hours. Hopefully the ICU patients would be kind enough not to drop their blood pressure. Well another 24 hours to go before my shift/call is over. Then I'll hit the highway with my 'road-trip CDs'.
My kampung is waiting.. i hope the ocean is as blue as i remember it.
Selamat Hari Raya everyone!
20 October 2006
Breaking bad news
He had just turned 42. I could imagine him woke up that morning as usual. Maybe had sahur with his kids or kissed his wife on his way to work. It should have been another routine day.
Who would have guess that by 7pm he would be lying unconscious in a resus room with a group of strangers pressing on his chest.
The chest pain started around 6pm with no provoking factors. Crushing in nature and "it feeels like an impending doom". The ECG showed that the heart had been deprived of its birth right --> oxygen & blood supply and that caused the excruciating pain.
Without further warning his heart rhythm went berserk: supraventricular tachy (SVT), and caused the blood pressure crashed to 70/40. We need to stabilise his heart fast. I was called by Chan, the medical MO 'on call' to assist him in doing just that.
He's a moderate size guy, not the morbidly obese type, but a smoker. He's obviously anxious while his breathing was rapid and shallow. He's definity lost lots of CO2 and his ABG might shows an alkalotic picture.
I held his wrist feeling for pulse.
"Darn it, this guy is pale and sweaty, and the BP is way too low" I told Chan.
Maybe he knew that already. He didn't looked up, eyes still looking at the ECG in his hands obviously muttering about s'thing.
I told the patient what we're going to do, and 5 mins later I put him to sleep by using intravenous drugs while Chan connected 2 paddles to his chest.
"CHARGE to 100. Everybody clear!"
The machine delivers 100J of energy into the man's heart. The patient jolted while we held our breath.
We manage to arrest the SVT, but his heart suddenly went into 'heart block'. A nightmare. Within 1 minute the rate slowed down to 30 beats/min and changed to pulseless VTach. He went into cardiac arrest. Another type of battle had begun. Cycles of defibs, CPR and drugs were given plus intubation, but there was no respond at all.
One hour later his pupils were fixed & dilated. His hands were as cold as ice. No spontaneous breathing. Nothing.
"Time of death 20:05"
As i walked away to the counter i saw Chan talking to the wife. She bursted into tears in the arms of a relative. I saw his kids. Three of them ranging from 4 - 9 years old standing in a corner. The eldest seem to understand something bad had just happen to their dad. While the youngest looked unfazed by the whole commotion. I feel sorry for them, especially with Raya coming. They have now become anak yatim.
I wish there is a proper teaching in medschools on how to break bad news. Most of us learn it along the way by watching seniors. Then you sorta develop your own way of doing it. You definitely come across lot of styles, some bad examples too.
A useful method is to emphatize with the relative, to be aware that there is a lot of sadness and confusion going on. One has to be precise/clear and avoid using vague terms. I'd seen families who were still unaware of the death even after being told that the patient had passed away.
"Take a deep breath, choose your words carefully and don't rush it" my senior once told me.
Easier said than done.
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