Archive for July, 2008

Review: The Prata House (Upper Serangoon) sucks

Having moved away from the Thomson area where the crispy prata is overrated and has been deteriorating in quality over the years in both Casuarina Curry and The Roti Prata House, J. thought he’d wander over to the 24-hour prata house, grab a bite, have a drink and watch Electra on the television screen provided.

Electra sucks as a movie too, by the way, just in case you were wondering. So that didn’t help the mood.

J. had 3 items to try. No pictures, they weren’t worth taking pictures of.
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Just Tired

There’s really no inspiration for any posts at the moment. There’s been actually quite a few things that J. would like to talk about, but the words just aren’t flowing at the moment.

Activities that J. wanted to talk about:
1) Singapore Night Festival: Performance, The Dancing Sky
2) Drinking with buddies
3) JCI

He’ll get around to it. He hasn’t even finished talking about Beijing yet, and that was a ridiculously long time ago.

A Long 48 Hours

The past couple of days have been interesting.

Monday was the first day of a new ward rotation and J. was unpleasantly surprised by one patient who had had no bowel movement (i.e. um, passed faeces) for 5 days and was not responding to that most reliable of tools: the fleet enema.

As such, he had to go back to the old-fashioned technique of manual evacuation. Yes, it is exactly as it sounds. The patient, being unable to lie on his left due to a recent left-sided op, lay in a right lateral decubitus position with his legs drawn up. J., with the bedpan nearby, an incontinence sheet beneat the patient, double gloves on his hands and lubricant on his finger, proceeded to stick his finger up the patient’s behind and dig… and dig and dig and dig out as much faeces as his finger could reach.

Then, while considering giving a fleet enema immediately post-evac or giving PEG solution 2L, he absent-mindedly removed the left glove… in the process flicking shit onto the patient, the bed, and the unfortunate staff nurse helping him hold the patient. Damn.

Smelt like crap. That was not a good start to the day.

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Angry Rant: The Lazy Are the First To Complain

Firstly, congratulations to SGH for passing JCI accreditation. The multitude of changes in in place in the past 3 years and whatever modifications in the many weeks leading up to the audit have paid off for now. Of course, the JCI accreditation is meant to be a tool for self-improvement with the major outcome being patient care, but it’s nice to have that off the back of our minds.

Some time back, J. had one angry rant about a slacker colleague, KW, who was crazy obsessed over not having others relax over their work. It was a beautiful example of hypocrisy.

There’s a nurse from China (as made more obvious by her name T*** M*** and her accent) who’s a pathetic excuse for a nurse, earning the ire of both her peers, her seniors and the house officers.

In his weeks working, J. generally finds the nurses he works with pretty awesome, but finds the can’t-be-bothered attitude and whiny nasal voice of staff nurse TM a pain-in-the-behind.

Anyway, here’s what happened today.

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Breaking the Monotony

It’s only been a paltry 2.5 months since J. became a house officer at a major Singaporean health institution, and already he feels like he’s turning into mush.

Soft and aimless.

Mind you, it’s not that easy to avoid. You might think that you’re working hard and providing the best care possible for your patients, but before you know it you’re working 14 hour days and wondering whether it’s all worth it.

Otherwise, you’ll just be looking forward to your mid-day coffee. Then your tea-time coffee. And your breakfast coffee, often snatched while running from the MRT station to the morning round that you just might barely make it in time for.

Gelatinous… squishy…

Sometimes, you just need to give yourself a good kick in the nuts and get running forward again. Resume the energising morning runs. Sign up for surgical skills courses. Read a good book. You know, there’s always time.

After all, sleep is for the weak, that’s what they always say.

Pfft.

J.’s First Patient Who Didn’t Make It

Post-dated post from an undisclosed time in an undisclosed location. And looking at the circumstances, it’s kind of sad that it’s not an entirely uncommon situation.

One day, one of my patients didn’t make it.

From the time she came in, the odds were stacked against her:
– Over 90 years old
– Multiple co-morbidities of hypertension, hyperlipidemia and ischaemic heart disease
– Recent heart attack 2 months prior
– A left-sided intertrochanteric fracture

So here she was, stuck between a rock and a hard place.

Even without a cardiac consult, it was obvious that she would have at least a moderate to high risk of cardiac event (e.g. 5-20%). At least. Excluding the risk of intra-op stroke, adverse reaction to anaesthesia (well… by itself <1 in 10000). Yet if she didn’t have the operation and had to be bedbound on traction for weeks to months, she’d likely fall prey to sepsis from pneumonia, urinary tract infection or bed sores, unless she had an excellent caregiver who’d change her diapers quickly, keep her working on the incentive spirometer and turned her every 2 hours.

How? How?

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Huff… Puff…

The initial plan was to have finished updating on the Beijing trip and more by this time. As it turns out, however, as the dour face the nurses at J.’s station have to put up shows, he barely gets enough time to sleep, much less update WordPress.

Anyway, J. has done 4 calls in 11 days, including one set of 2 calls in 3 days.

In between, there’s been the Medical Dinner 2008, a meeting up with JC friends, and today, Commencement 2008.

Updates to come, honest… Just let J. catch a breather.