First on call @ home

Quite a nightmare I would say.

It's my first on call tonight (and I'm actually blogging whilst on call..) and it did start off being quite unpleasant with phone calls going off every less than 5 mins from different colleagues handing over ill cases, and outstanding jobs to do.

Honestly, I don't think I can ever be more polite to anyone here and hence, cannot quite understand why some colleagues are downright rude. Really hated it when another MO sounded really pissed having to repeat to me the ward and bed number of a patient he wants to handover. Was there really a need to get upset? Then there are also some nurses who r super rude and pays no respect to anyone. I dread it even more when they try to boss me around too. Maybe like what my colleague said, I'm probably too nice, hence people start climbing on top of my head and abuse me....hahahah. Anyway, there r assholes around, just like there would be some angels.

I felt really crap barely less than 5hrs into my on call, and I'm actually thinking how the hell am I going to get through my life feeling this way for the next few years. Being thrown in a jungle with a completely different system is sheer agony, and I have lost count of the number of times I feel like a useless bum, thinking twice if this place is where I should belong.

I am learning bit by bit, but at the same time frustrated by the fact that I haven't got any life outside the hospital and even more frustrated that I start panicking if I don't go to bed by 11pm every night (I hate waking up feeling sleepy). I have some really wonderful nurses and colleagues, but somehow this place doesn't seem to fit me very much. I'm consoling myself that perhaps I'm still green to everything here, and somehow, things will all fall into place soon. I guess a positive mindset is my only solution to overcoming the odds.

Had a nice chat with Dearie over the phone at abt 11pm. I was just traumatised over an emergency case before then, and needed to talk to someone. It was both consoling and heart-warming just hearing his voice. I wish I had a little hug.

3 more hrs to go before I end my call, and start my Saturday day shift. And my next call wouldn't be until next mth. I shall do some serious studying during this period, and gear myself up for my next on calls.

Hopefully with time to come, I'll feel better about everything here... :(

Phone Conversations

These are some of the funny/ridiculous phone conversations I had with patients' family/relative. VERY Singaporean indeed.

Case 1

Me: (introduces myself) Sorry to disturb you. I just need to let you know that Mdm X is fit for discharge.
Relative: Why you call me? Call her son leh.
Me: I did, but there was no response.
Relative: Aiyah..the son no use one lah. Married, got wife already all like that.
Me: Erm..I'll just need to find out if u'll be able to bring her back home today or tomorrow.
Relative: Can..but today cannot because my son and daughter-in-law coming to my house tonight for dinner. Tomorrow is ok. But you call the son again later and see if he can bring his mum back.
Me: Sure. I'll ring him in a while
Relative: Doctor, if I pick her up tomorrow ah, the bill how? I pay ah?
Me: I think it's best if you ring the ward later and speak to the nurse. They'll know better.
Relative: Ok ok...u call the son ah!

*rings patient's son*

Son: Hello!
Me: (introduces myself) Just calling to inform you that your mum is fit for discharge, so she can go home today.
Son:OH MY GOD...
Me: Is there a problem?
Son: Ya. I not free lah.
Me: Ok, then is tomorrow ok with you?
Son: Also not free..
Me: Then when is best for you?
Son: Actually ah, I'm always very busy. U ask her take taxi home herself lah.


Case 2

Me: (introduces myself) I'm calling to inform you that your mum has caught an infection which will need isolation, so I'll be transferring her to a single bedder.
Son: Ha?! Single bedder ah?! Expensive or not?
Me: The price is the same..
Son: What class ah?!
Me: The class remains the same, just that she has the whole room to herself.
Son: Okok..can can.

(geez..didn't even say a "How is my mum now?" throughout the whole conversation)


Case 3

Me: (introduces myself) I need to discuss with you abt the patient's home situation. I understand that there's some problems with caring for her in the house.
Son: Ya, difficult lah, because she keeps waking up in the night and wander around. And because she's so unsteady on her feet, she keeps falling down and I have to keep sending her to the hospital.
Me: Ok, so do you have any plans of how to cope with the problem?
Son: I thought of sending her to a home, but she is against it. You go and convince her lah. Then if she say yes, I'll put her in a home.

Brand new environment with a brand new "life"

I seem to have disappeared from the virtual world for the last few weeks.

My life outside Medicine has come to a halt ever since I took my first step into the local hospital here, since it's a 5.5 day week, and I have to work on Sundays on alternate weeks too. My typical daily life has become so routine - wake up, go to work, eat, work, go home, eat, study, sleep. My concern everyday is "I must make sure I sleep 8 hrs a day" just to save myself the agony of dragging my sleepy body out of bed the next morning. No more shopping, no more movies, no more meet ups, and even the word "pak tor" has ceased to exist (gotta admit that it's frustrating).

And my sleeping habit has never got better, sleeping at 10.30pm sharp, and getting up at 6am.

My job is a whole new experience compared to that in the UK. Here I am serving my own fellow countrymen, hence, a greater sense of closeness, but there comes with it new challenges and frustrations.

I can no longer take histories in English when clerking the little old lady. Thank goodness I have help from my other colleagues who can speak other languages, and I would count myself very lucky if I get one who can speak Teochew to me, yet understand me when I reply/question in Mandarin.

Then I have pitiful patients who simply don't have a home, and their being in hospital is like a wonderful thing to their family, and all the drama starts when you start ringing their family up to inform them that the patient is fit for discharge and querying when they'll be able to take him/her home.

The drugs being used here are different from the UK too. It's a torture for me, because it drastically hinders my ability to manage a patient on the spot. Many times, I prescribe drugs I would use in the UK for a particular situation, only to be told my the nurses/pharmacist that they don't know/don't have the drug I prescribed. And trade names are used here more often than generic names, something I dread most, since I'll end up wasting time checking up what the generic name of that drug is. It's simply weird how I tend to find it easier to remember generic names rather than trade names which are more simpler to remember.

I start my ward rounds at 7.30am, before my Consultant comes round. It's amazing how these patients get up so early in the morning, because they all tend to be sitting up in bed, all ready for me to examine them. And I never fail to always greet them with a loud "Good morning!!!!" with a smile, no matter how sleepy I am. It brightens my day when they respond back with a smile. Serving these elderly people can sometimes be a real joy, and the older they are, the more grateful they are towards you when you are doing things for them, no matter how small.

Ward round is the most happening time of the day because I have a brilliant Consultant guiding me. He's extremely knowledgeable, and ever willing to impart his knowledge and skills to his juniors. When he does so, I can sense his excitement through his very warm smile, and this increases my enthusiasm of wanting to read up about the topic and find out more. I never have to be shy to ask him questions, and I must thank my lucky star to have a mentor who would so willingly sit down with me in front of the computer to teach me how to analyse results. It also makes me happy when I have learnt something from me, and be able to apply it onto another patient who comes in, afterwhich it does pleases my Consultant that I have done things right.

My other colleagues are brilliant as well. I don't have to feel shy asking for help/advice, and my nurses are like the best nurses I can ever get. It's been so much of a joy having them with me in the battlefield, that sometimes I wonder if they feel the same way working with me too.

The only point which can be improved is it'll be better if the other medical colleagues in my team were more humourous, noisy and crappy. I'm basically full of crap, but I tend not to do so if I don't know certain people well. Besides, it's a team of guys, so naturally a distance is kept. Things would be better if we were closer to one another, and enjoying lunch together etc.

Nervous

In a week's time, I will be starting my new job as a MO in a completely new and different environment and system.

I was excited initially, hoping that this day would come quickly. But now that the day is coming, I'm feeling nervous, curious, worried and probably a tad scared.

I was looking through the list of MOs attending the compulsory orientation, and apart from my elder cousin and someone I did my attachment with once, I knew no one else. And I'm one of the few "New Hires" in the list.

It's not important actually. In fact, being given a fresh start is great. I'll get to meet new people, and hopefully, make a few sincere friends.

I've been spending the last few nights, asking myself and Dearie various questions. I knew neither of us had the answers to them and wasn't expecting any answer anyway, but somehow, it made me feel better voicing them out.

I spent a good amount of time pondering if I am still competent in bleeding a difficult patient, inserting venflons, clerking patients, examining them, list out differentials, manage them etc etc. The questions which raced through my head were uncountable, and many times, I started scaring myself with my sudden lack of confidence.

The break was probably somewhat too long and I should be thankful that it's coming to an end. It's only a matter of time I get back into momentum, and this is what I've been telling myself to calm my nerves a little.

Being new to the medical system and training here, I have no idea how competent my fellow colleagues are and I wonder what my level of competency is compared to them. It's not a matter of wanting to win, but surely I wouldn't want to be one of the rare few struggling to survive.

Life as a doctor is well-known to be tough, and from the memoirs written by various local doctors, it seems that what lies ahead of me is living hell. I'm not sure if I'm gonna agree to that (hopefully not), but I shall stay mentally prepared that it's not going to be easy. However, I shall try my very best to stay positive.

Farewell to being a House Officer

I have successfully completed my training as a House Officer!!!!!


My day ended with handing over all the necessary information to the House Officer who will be taking over my place.


I think you only know if the nurses and doctors hold regards of you when you are about to leave. In fact, I was quite worried that no one will really care abt me leaving.

But that wasn't the case!

My senior suggested a farewell dinner, and I had fun going out with them last night. It wasn't a high-class dinner, but I enjoyed the company a lot. My ward nurses also a gateau for farewell. I was also touched when my senior bleeped me today to ask if I'll be going up to the ward at some point to chat with them before saying a final goodbye.

The chatting session was nice because other seniors whom I know also came and joined the session in the doctor's office. Emails and phone numbers were exchanged. I'll definitely keep in touch with them. If it weren't for them, life would have been miserable and I wouldn't get through my year so smoothly.

Samya left yesterday, but at least we got to have our girly chat before she left. It'll be her first day as a SHO (aka MO in S'pore) in ICU. Scary. Will definitely find out she's coping. Bet she's panicking and feeling so worried that she'll have problems sleeping tonight. Sadly, I'm not her colleague anymore, or else I'm sure we'll spend a lot of time chatting in my room tonight.

Owain came to visit me a while ago. It was really sweet of him to specially come over. I'll miss this guy as well. Hope things will go well for him in NZ.

My other colleagues bought me presents too, one being a painting of a beach in Wales, and another a bag with the Welsh Dragon. I'll be bringing them back with me to remind me of my time with them here.

I've also submitted my audit presentation to my Consultant today. I've been spending a lot of time doing it, and I'm really glad that he thinks it's excellent. I was quite worried that he would like the humour I've added to the presentation, but fortunately, it wasn't so and it even made him laugh :) It's quite a pity that I won't be around to present my findings to the entire hospital, but let's hope this big project we're currently doing will produce some fantastic results and have a chance for publication. *cross fingers*

All packed and ready for Home. Hello to Singapore and Goodbye to the UK.

My lovely patients

Although I've only been in this line for a year, I have met a variety of patients.

Some gets on my nerves, some bosses me around like as if I'm their slave, some are over-inquisitive, some can't be bothered abt their illness, some are patronising, some are weird, but there are also some who cares abt my well being, makes me laugh, respects me, treats me like their daughter/granddaughter.

I have days when I do feel frustrated, but sometimes, at the end of the day, it's the patients who make me smile and laugh all over again.

Introducing some of the lovely patients I have met...

Mrs C is a lovely lady who has been having multiple admission with diarrhoea. Each time she got admitted, she gets told that there's nothing wrong with her, and she gets sent back home again. Finally, after thorough history taking, I diagnosed that her diarrhoea was due to an anti-diabetic medication she has been taking. After stopping that medication, her diarrhoea resolved. I remember how miserable she looked when I first met her, but now that her diarrhoea has resolved, she's all happy again. Every morning when I'm doing my ward round, she would be happily smiling while sitting in her little corner, waiting for me to ask her my daily questions. And whenever it got to questions abt her bowels, she'll happily tell me that it's resolved. She's also one lady who loves taking walks, hence, I'll always find her strolling around the wards using her walking stick. She never fails to say "Hello Doctor" with a motherly smile whenever she sees me too. Because she's so petite (much smaller and shorter than me), she's like a little girl to me. I remember having to coax her to let me do blood tests on her one afternoon, since she claims that her body will run dry of blood with such tests being done regularly. "Your body will not allow you to run out of blood" I said to her. It was only then she looked at me like a scared innocent child, slowly putting out her arm for me to draw her blood.

Mrs A is a patient who has poor control of her diabetes. As a result, she has recurrent infections and blood flow problems in her foot, which is so bad that amputation was the only option left for her. But she has repeatedly refused the operation. She looked really pitiful when she asked me what she should do about her foot. I explained to her the options, bringing up the option of amputation. As expected, she objected and told me the reason why. "Let me show u what I can do now" she said. She pushed herself slowly off the bed to get onto her wheelchair, and then pushed herself up slowly to get onto the bed. I could tell that she was very proud of what she could do. "Doctor, without the amputation, I can still do this. But if I have an amputation, I might not even be able to do this again. The surgeons said they can give me an artificial leg, but they also mentioned that there is no full recovery and there are complications with the surgery too." she said, while tearing and massaging her infected leg. I could tell it would kill her self-confidence if she loses that leg.

Mrs T is the typical granny with a hunchback. This morning, she was sitting at the doorstep of her single bedder, smiling. "U look happy." I said. "I love sitting here, because I can watch people walking past and being busy." she answered. And when she got bored in the afternoon, she went to the nursing bay and sat behind the nursing desk. She was looking really cute with her smile. She was to be "Ward Clerk T", our ward clerk for the afternoon. She seemed to enjoy a lot sitting there, while I do my writing next to her. She also decided to pick up the British National Formulary to read, and when she realised that she didn't understand anything, she just threw the book aside with a frown.

Mrs W is a confused patient who gets lost in the ward all the time, but everytime, she would still get up from her chair and mobilise around the ward with a walking frame. She isn't very steady on her feet, hence, she has the tendency to fall when she's not careful, resulting in bruises on her face. But because she's so confused, she never remembers what has happened, and would wonder all the time where she's got the bruise from. She's also the vainest patient I've ever seen, despite being in her 80s. Everytime I see her, she would be combing her grey curly hair. She's also fussy about her dressing. She's never in hospital gown, but in proper quality sweaters, skirts and stockings (she insists that it must be from Marks & Spencers). She also makes sure that her clothes matches well with her shoes.

Mr W is a patient who has visual hallucinations, which is due a psychiatric disorder. He has this pair of eyes, which made me wonder if he was a looney when I first met him. But with the appropriate medications, the hallucinations are now gone. Every morning when I see him, he would be happily sitting on his couch, enjoying his cup of tea. I could tell he was one happy man who loves company and visits, because he never fails to talk non-stop whenever I'm on the ward round. It does make me feel bad each time I have to stop him from going on forever, since I still have patients to see.

Mr S is a patient in his 40s, but due to an extremely rare neurological disease, he is no different from a 12 year old child. His disease is genetic, and his mum died at a very young age from it. Apparently, the descendents of patients with this rare disease will die at an even younger age compared to their parent. There is also no cure for this illness. In other words, he's just waiting for his time to go. But he's still happy everyday. Just by watching him, u will realise how life can be happy with even the simplest things. He would be in joy when u say simple things like, "Wow, that's a very nice t-shirt u've got on". I feel small about myself whenever I think about how much unhappiness I have created for myself with my needs/wants in life. I was asked to do a mini mental state examination on him, and honestly, I hate doing this test on patients because they take a long time. But when the nurses went "Pleeeeeaaaasssseeee", I couldn't bring myself to reject. Just to make the test look less interogative, I sat on the mattress next to Mr S and told him that I shall play a game with him whereby I will award him points for getting answers right to the questions I will be asking him. "OK!!! I LOVE PLAYING GAMES!!!!" he replied excitedly. It made me laugh many times while doing the test on him, because he looked really lovable when his eyes would look up into one corner when he's thinking of the answer. He loved the maths component the most. "I'm good at Maths!" he exclaimed. Obviously, he wasn't with a score of only 1 out of 5. He was disappointed at the end since he only scored 13/30, but his smile still told me that he had enjoyed this game session. And I also enjoyed myself as well.

Mr B is a psychiatric patient who got kicked out of a home because he had beaten up another patient there. Hence, he has been waiting for months in the ward for a suitable placement. He definitely looked like a looney with his messy hair, weird way of walking, and dirty clothes. I was scared when I first met him, but with time, I realised he was like a little boy who loves curling up on his bed when he's bored. He would also come out of his cubicle to look for the nurses when he's feeling lonely. And if u buy him something really small, he will give u a very bright smile, and love u to bits.

Mr W is a demented patient with weird habits. My Registrar told me that it is highly impossible for a person to hyperventilate for a very long time because it tires a person out. But Mr W is someone who manages to do it without getting tired. He just does this without a reason/cause. He also loves to cough and gurgle, and for those who have never met him before, would panic and think this little old man is choking. Even I got tricked many times. He's prone to getting hospital infections, which accounts to why he's often in an isolated room. But he doesn't know that he's got an infection, and continues to come out of his isolated cubicle all the time. And I often have to chase him back into the room. "Why can't I come out?" he would often ask, giving me a puzzled look of a 5 year old. I would then have to lie that there's a lot of infections going on outside his room, so he has to stay in the room to prevent getting infected. "Oh!" he would say, and then hurriedly shuffle himself back. Little does he know that he's the source of infection on the ward.

Mr E was an elderly gentleman whom I pulled out from the gate of death. His condition was poorly despite me reviving him, and honestly, I had never expected him to last very long. But things started picking up for him. I never though patients would remember me if they haven't seen me for a long time, but when I went up to his ward to insert a venflon, he smiled when he saw me.

Mrs X was a middle aged patient who had bleeding from the back passage. She had a phobia for cannulation because of bad experiences when she went into labour during her younger days. A nurse had to talk to her to distract her attention whilst I inserted the cannula. It was success at my first go, and before she knew it, I had finished cannulating and taking bloods. She was so pleased with me that she praised me during the Consultant ward round. The Consultant on call then said, "Looks like she did a good job. Shall we let her do your colonoscopy later?" Mrs X was really happy when she heard that, and did ask me later if I was going to be the one doing the procedure. "If I were to be the one doing it for u, it will not only be a failed procedure, but I might even make u end up in ICU" I told her. She was a bit puzzled, until I told her that I'm too junior to be trained for this.

Another Mr E was a patient with an irregular heartbeat. He was difficult to cannulate, and many have failed doing it on him. However, I managed to cannulate him at first attempt, accounting to why I would always be looked for by the nurses whenever he needed a new venflon to be sited. I was still a green doctor when I got to know him, and wasn't very confident of myself. But he placed a lot of faith and confidence in me, and I have never let him down by succeeding to cannulate him at first go everytime. On his birthday, I also performed cardioversion on him to revert his irregular heartbeat to normal. This was also successful, and he gave me a big hug when he woke up from the sedation.

Mr L was a patient with depression. His wife and him would always want to speak to a doctor for their queries, and I was always be the one speaking to them. Many times, I would stay after working hours to talk to them. I must have gradually formed a bond with them, because he had asked if I was willing to be his god-daughter before he was discharged.

Mrs Y is a confused patient who has been to every ward in the hospital except the Children's ward, HDU and ICU. Another social case. She's extremely deaf. U have to write on paper to communicate with her. Shes loves her food very much, especially on Fridays where she'll be served Fish & Chips. She would always offer me a Chip when I'm doing my ward round during her lunch time.

Mrs J is a heart failure patient. She enjoys guessing which country I am from, but always gets it wrong. Being determined to make a correct guess, she made her husband buy her a world map, which she will spend time referring to daily. It's quite pathetic that she still couldn't get it right after a long time when there were only that few countries in Asia. I had to tell her where my homeland is, and from then on, she never forgets.

These are only some examples of patients I have met who have made my life in the hospital interesting.

It's meeting these people that makes me feel at times that it is worth putting myself through the hardcore training in med sch, and slogging my ass off at work.

Lunch of the UK Doctor

No doubt free lunches are provided by drug reps and during weekly teachings, but with the same type of food everytime, there must come a point where we get sick of it and subsequently develop a phobia.

Having spent so many years in the UK, western food has become something I'll violently object to if someone suggests it when taking me out for a meal back home. I know it's rude to go "Can u not have western food pleeeeaaasssseeee?" if someone's treating u, but with sandwiches like at least 3 times a week for so many years, I can't put myself through swallowing more of the gunk. Fortunately, Dearie HATES western food, or else it'll be a torture having him bringing me for western dinner with the typical thought of ppl these days that it's meant to be high-class and romantic. I think I would rather find a plate of roasted chicken rice and a glass of soya bean more romantic that slicing up a steak.

It sucks when your tummy is grumbling during the ward round, and u're kinda losing it since your brain has decided to go on strike frm starvation, your legs are sore frm all the climbing of stairs n endless walking (if there's a walking competition, doctors r bound to win), and your patience is put to the test with a patient screaming. The ONLY thing that gets you excited is a nice lunch, only to realise that it's "Sandwich Day" again.

Then u decided to be cheeky, and skip teaching to avoid sandwiches, happily going to the canteen, hoping to find something nice to fill the tummy. And...

TAaaaaaaDaaaaaa!!!!

In front of u is a menu with a list of sucky food that honestly, isn't appetising and not really fit for proper human consumption. Makes me wonder how the British live with food like this for the rest of their lives. Do they even care abt what goes in? Or food is just.....foood?

I can just about imagine how overjoyed I'll be when I get back to Sg. At least having fishball noodles for lunch everyday beats having the crap I'm eating here.

How not to get depressed in this place huh? How can I even put on any weight here?