Archive for May, 2008

Hospital Turf Wars

There’s really no war in hospitals. As colleagues, generally (and it’s best) all work together in a mutually beneficial relationship. You win, I win. Win-win.

All patients in hospital are admitted under a consultant, under a discipline. Sometimes it’s not a suitable discipline (e.g. diabetic ketoacidosis admitted under General Surgery because of abdominal pain), but usually this gets sorted out quickly with a mutually accepted transfer of patient to the department best equipped, in terms of equipment, knowledge and manpower, to treat the patient.

Take for instance, a hypothetical patient who has an infection. Infectious Diseases does not usually accept all patients with infections because that would be manifestly impossible for them, especially considering the number of referrals (‘blue letters’) they see. They are, however, involved in the co-management of a remarkable number of patients and are an essential, essential department. J.’s learnt a great deal from ID. Anyway.

So let’s say this patient has sepsis, with septic arthritis of the knee and a liver abscess, admitted under General Surgery. The joint is aspirated, grows MRSA and Ortho fires off 2 blue letters to Orthopedic Surgery and Infectious Diseases accordingly. They help to co-manage the patient, who is still listed under General Surgery. The patient’s septic arthritis resolves and remains that way, unlike the liver abscess which recurs. Basically, there are no active GS issues, but Ortho feels that the knee abscess will resolve soon and refuse to take over the patient. ID agrees to take over the patient, but only after Ortho has no outstanding issues. So GS is stuck with the patient.

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The SGH Lift ‘Close Door’ Button

We Singaporeans are an impatient lot. Look in any lift in Singapore for the most worn button. J. guarantees it’s ‘Close Door’.

In SGH, this is no exception. Despite 5 visitor lifts and 3 patient lifts, most of which move at a decent pace, people are never satisfied. Until these become instant gratification teleportation devices, people will still jab their thumbs unrelentingly at the close door button.

Generally, these people believe that speed of door closure is directly related to one of 2 factors:

1) Pressure

The moment the door opens a crack on a floor they’re NOT getting off at, their thumbs jams into the Close Door button so ferociously that for a brief moment you worry it’s going to go right through the lift. And they don’t let up until the door is airtight.

2) Repetitions per second

Jab, jab, jab, jab jab jab jabjabjab jajajajajajajajajajaj bzzzzzzzzzzzzzzzzzzz… their hand transforms into an oscillator. These folks believe that the faster they press the door close button, the faster the door will close.

And now, J. will share a secret with all of you. Neither is actually true! These people are subjecting the pulps of their fingers to unnecessary torture!

You see, until the lift door has opened fully, the Close Door button does not work. So the trick is to watch until the exact moment the door retracts out of view and with one swift press of the button, voila! the door closes as fast as can be.

Which is still slower than what everyone hopes for, but hey, what’s best isn’t necessary what’s ideal, eh?

The Mentality of Unhealthy Lifestyles

It might not be politically correct, but there’s speculation that the obesity of some people is a reflection of their mentality. Perhaps their characters, but more so the mentality.

This excludes, of course, people suffering from medical conditions like hypothyroidism.

Take, for example, two siblings A & B. A was a medical school classmate of J.’s, and hasn’t had much time to exercise since starting work. B works in the financial industry which is of course busy busy busy. A is trim and fit with a BMI of 22. B is less trim and fit with a BMI of 28 (obese by Asian standards).

A, knowing he has no time to exercise, walks about 20min home from the MRT every day. He climbs the stairs at work, even though SGH lifts are easy to use, fast and arrive frequently. It’s his method of staying active in the face of limited time.

B flat out refuses, opting instead to spend $0.67 to take 2 bus stops distance from the other MRT station.

In a similar vein, one sees larger-sized people, carrying a box of donuts, get on the 1st floor lift only to get off on the 2nd floor, barely 2m from the stair landing. There’s something wrong here.

It seems we must change our mindsets, yes? But how? Stages of behavioural change? What if they’re just not interested, or think it’s too much work?

Read: Fingersmith by Sarah Waters

It’s been a long time since I’ve had the pleasure of sitting down and actually reading a book, and thus it was over the weekend that I read not one, but two books.

The second of the two is Fingersmith, written by Sarah Waters, which I borrowed at Ang Mo Kio Community Library (being in the region, despite not living in the region) and read over the course of 2 days.

It’s a story of schemes and intrigue (with a spot of lesbian love) viewed through the eyes of more than one person, with an eloquent painting of the scenes of the era. One can really visualise the darkness and gloom of London, paired with the loneliness of the country.

Definitely a book to read, aye.

Nepal Day 19, 20: Pokhara – Kathmandu – Singapore

Woke at 0500, 1hr earlier than the alarm. We had largely packed our stuff the day before so the morning was easy. Breakfast @ 0645 (hurray for curd), taxi arrived @ 0715, the bus left @ 0735. We took Swiss Travel, which at Rs400 a person, is cheaper and nicer than Grey Hound (pui!) at USD7 a person.

It was a ridiculously long 7 hour bus ride, this time in weather that was starting to become uncomfortably warm. Nepal is a country without simple straight expressways between cities, instead relying on wning mountain roads offering a great view of the hills. Of course, one small accident and all of us go over a cliff and die horrible, horrible deaths, but that’s too pessimistic and horrific to even contemplate.

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Nepal Day 18 (Rafting Day 3) – Back to Pokhara

Beautiful morning yet again. Woke at 0500hrs and was amused by the figure of the singing Iranian sleeping on the beach. We had a breakfast of pancake/prata, bread, porridge and a hot coffee, then packed up and went down to the water.

A few minor rapids later we were in still water. There would be no more rapids to run. That was kind of sad, since it was still early. We decided then to go for a swim. JW, who had steadfastly refused to go into the water “Giardia!” was unceremoniously dumped in by K, myself and the Danish slacker. I had swum over to their boat and boarded it.

Anyway, much rowing later, with one kayaker who was now the coxswain/captain of our ship who liked to make H scream and scream in her face too, we arrived at our destination and unpacked.

It was the end of 3 days of rafting and I felt somewhat unsatisfied. The next time I go whitewater rafting, it’s gotta be a river with class 4-5 rapids. 3-4 just doesn’t cut it, y’know.

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Nepal Day 17 (Rafting Day 2)

Early day again, as I woke at 5.30am. Previously woke up at midnight to take a leak and observed that clear skies plus an almost full moon allow enough ambient lighting withou the need for a headlight. Had a most satisfying um… never mind… in the morning, interrupted by a fat Iranian man (pet phrase: “But I siick…”) We have an interesting toilet system. On arrival, one of the guides digs a toilet-hole that is surrounded on 3 sides by a red cloth propped by 3 paddles. Back at camp, one paddle has a helmet on it. If the helmet is on it => toilet free for use. If the helmet is NOT on it => toilet occupied.

After breakfast (porridge, bread, eggs and potatoes) and potatoes, it was off again!

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