- Our PM used to wear batik a lot, but now he prefers jeans.
- We are expecting a change of government soon... from 3M (started from Tun M's time) to 1 'S'
- One can go to space & come back as an orthopaedic surgeon, no need to take exam.
Tuesday, August 19, 2008
WARD ROUND/ CLINIC JOKES
Monday, August 11, 2008
PAST MEDICAL HISTORY
My recent “role reversal” reminded me of the times that I had been a patient, since my Day 1 of life:
I was born a tiny baby, with periorbital oedema (swollen eyes). Doctors thought I had congenital liver disease. So, as a neonate, I was already subjected to blood tests & investigations. So kesian hor. Results were all negative of course, as the periorbital oedema turns out to be a ‘trademark’ that stayed till this very day. It becomes obvious when I don’t have a good night sleep (best example: post-call)
I come from an atopic family. I had my first asthma attack at the age of 3. My respiratory tract is tremendously super-sensitive. I have had infections from the top to the bottom (ie. from upper respiratory tract infections to bronchitis to pneumonia). My greatest enemies are dust & pollens. I was a regular patient at the local hospital, that the nurses there actually gave me an “accolade” (ie. the girl who takes Piriton like taking rice). Piriton (or Chlorpheniramine) is an anti-histamine which can be used for runny nose, allergic rhinitis or any allergic reaction. When I was studying in New Zealand, I dreaded spring the most, as pollens would be flying everywhere. My record was sneezing non-stop 30 times. (Of course I didn’t count lah, a very empathetic friend of mine did.)
My second greatest enemies are dogs. I was bitten by my neighbour’s dog when I was in Primary 4. Received 4 stitches. The scars are now still visible on my right shin. I remember wailing on top of my lungs when the MA (medical assistant) at the Queen E Hospital did the T&S (toilet & suturing). While my classmates treated me like a ‘princess’ (they carried my bag, bought food for me & I didn’t have to do any duty during recess), my PE (physical education) teacher wasn’t so kind. I had a “D” on my report card, with the comment “cannot run, cannot do long jump”.
It is never fun doing PR (per rectal) examination on patients, but at least I can tell them exactly how they are going to feel during the procedure. I fell (from height) & landed on my bum at the Outward Bound School, when I was 14. Suffered an anal tear (ouch!) & presented to the paediatrician with fresh PR bleed (eek!). The rest is history.
FOLLOW UP APPOINTMENT
I went for my follow up dental appointment on Saturday. I wished I didn’t have to go, but I didn’t want to be a non-compliant patient/ defaulter. Spent almost an hour & a half on what I call the “electric chair”. The dentist gave me LA before he started drilling & digging deep into the root canal of my affected tooth. Although there wasn’t any pain, I could feel the amount of pressure the dentist applied. It felt as if my oral cavity was the bonnet of a car & the dentist a mechanic trying to fix a defective component of the car engine.
I felt pain after the LA weaned off & had to take analgesics again.
It is no fun being a patient.
I felt pain after the LA weaned off & had to take analgesics again.
It is no fun being a patient.
Sunday, August 10, 2008
WHAT’S IN A NAME
Pic didn't turn out so well. It's the microbiology report of a patient whose tracheal aspirate was sent to the lab for culture & sensitivity. Note that the name of the doctor who ordered the test is underlined in red (which reads Dr. Trachea). It could be a typing error, but it sure reminds me of a Dr. Vena whom I have referred a case to before. If I can remember correctly, it was a Nephrology referral. It would have been interesting if it were a vascular case.
(Pic courtesy of Dr. LJ of SGH, Kuching)
Thursday, August 7, 2008
Monday, August 4, 2008
ROLE REVERSAL II – A PRETTY HORRIFIC EXPERIENCE
It was almost like a deja vu, but not quite. I started having toothache last Tuesday. It was a dull nagging pain initially, which I tried to ignore (again). Not surprisingly, it got worse the next day & affected my sleep. My cheek on the affected side was a little swollen & I felt feverish. I decided to consult a dentist at my hospital.
I first called up the Dental Clinic. The staff who picked up my call advised me to go to the Staff Clinic, which has an ‘in-house’ dentist. Unfortunately, I was not allowed to register at the Staff Clinic because I’m not their staff (I’m only doing a 6 month attachment at the hospital). Okay fine. The next thing I did was to go back to the Dental Clinic. I was willing to pay as a private patient, but again I was not allowed to do so as I’m actually a staff. What the ****
I was losing my patience already & decided to contact one of the dentists personally. I told her my problem over the phone. She sounded quite alright. Since the toothache was troubling me quite a bit, she advised me to start taking antibiotic (Augmentin) & pain killers first before she attempts to do anything. It would be too sensitive for her to examine or do any procedure at that point in time. That seemed like quite a reasonable approach. I was also advised to do an x-ray of the troubled tooth & its adjacent counterparts.
As a very compliant patient, I did exactly as I was told. The dentist said she would look at the x-ray & let me know later via her dental assistant (DA). She said perhaps she could see me in 2 days time. Meanwhile, I should continue on my antibiotic & analgesics.
The dull nagging pain then became a more severe throbbing pain which not just affected my sleep, but my meals & my work too. Naturally, I tried to get back to the dentist. She was busy, so I spoke to the dental assistant. She said her boss’s appointment list is full for the next 2 weeks & I can only see her after 2 weeks. 2 weeks? The gods must be crazy.
(This is roughly the conversation between me & the dental assistant)
Me: Can you please tell the dentist that the pain is getting worse & it is affecting my work? (I was then put on hold for a while)
DA: Dentist say if you want MC, just come over to Dental Clinic & she will give you MC
Me: Then what about the x-ray? What did the dentist say about my x-ray?
DA: Dentist saw the x-ray. Didin’t say anything
Me: 2 weeks is too long, can’t you give me an earlier appointment? (put on hold again)
DA: Dentist will see you next week, Tuesday, earliest appointment
That night (Thursday), the throbbing pain got worse & I actually went in to the hospital for ‘a shot in the arm’ (intramuscular Tramadol). That was the only parenteral (injection) analgesic available in the ward. The jab was superb, my pain subsided very quickly & there was no more throbbing. But at the same time, I also became drowsy quite fast. This is a side effect of Tramadol, which is an opioid (as mentioned in my original “Role Reversal” post)
I slept on & off till the next morning. Took a cab (was still a bit woozy so decided not to drive) to a private dental clinic. The Dentist was fully booked from morning till evening (which was good & bad). Good because the number of patients usually indicates the doctor’s skill & bad because I might have to come back the next day or find another dentist. But something which I wrote (or declared rather) on the registration form made them offer to slot me in between their pre-booked patients (ie. Occupation: Doctor)
An x-ray was repeated & showed a small abscess at the apical region- not at the same tooth, but the one adjacent to it. I wasn’t surprised or in denial, unlike before. I had sort of expected this when I started having the pain. But of course, I can’t help asking why me?
Like I said in my old post, I’m an obsessive-compulsive teeth brusher, who does it so many times a day. Some people I know brush only once a day & nothing of this sort happen to them. Isn’t that so unfair? My mum said maybe it is because I brush so many times that I get this problem.
I spent the next 1 hour on the dentist’s chair (which sounds nearly as dreadful as the electric chair). LA (local anasthesia) was given to numb my jaw before the dentist did his job in drilling, digging & draining my diseased tooth. I was put on a pair of dark glasses throughout the session so that I didn’t have to see what the dentist & his assistant were doing to my oral cavity. I thought that was a brilliant idea, on the dentist’s part. I burnt a hole in my pocket for the procedure, x-ray & consultation fee, but I left the clinic a satisfied patient.
Back at home, I continued taking my antibiotic & pain killers (namely Paracetamol, Voltaren & Tramadol – but not all at the same time, milder one first & slowly go up the analgesic ladder).
While the dental problem is almost solved (follow-up appointment is in one week’s time), another problem arose. The day after my visit to the dentist, I developed generalised body rash with pruritus (itchiness) which was most likely a delayed allergic reaction. I think I fit snugly into the description of a ‘high risk patient’ (see “Hospital Terminology” post). Fortunately, the symptoms subsided slowly with anti-histamine from my housemate, who was already prepared to send me to the ED (emergency department) if I had started wheezing.
I do not know what caused the the allergic reaction. It couldn’t be Augmentin as I had been taking it for many days. In fact, I had the same antibiotic, on top of Metronidazole (Flagyl) during the first episode. It could be Tramadol but Voltaren is more likely the culprit.
The last time I had an allergic reaction was to a type of alcohol, about 2 years ago when I was still in Kuching. I had pruritic rashes & asthma attack, where I sought treatment at the ED of my old hospital. In New Zealand, where I drank alcohol only on social occasions, I only experienced rashes but no wheezing. After the episode in Kuching, I had stayed away from all types of alcohol. Maybe that’s a good thing.
Anyway, what puzzles me now is that I never had any allergies to medication in the past. I had taken Ponstan before for dysmenorrhoea (period pain) & Voltaren is from the same family. Oh well…I guess life isn’t interesting if there are no events once in a while…
I first called up the Dental Clinic. The staff who picked up my call advised me to go to the Staff Clinic, which has an ‘in-house’ dentist. Unfortunately, I was not allowed to register at the Staff Clinic because I’m not their staff (I’m only doing a 6 month attachment at the hospital). Okay fine. The next thing I did was to go back to the Dental Clinic. I was willing to pay as a private patient, but again I was not allowed to do so as I’m actually a staff. What the ****
I was losing my patience already & decided to contact one of the dentists personally. I told her my problem over the phone. She sounded quite alright. Since the toothache was troubling me quite a bit, she advised me to start taking antibiotic (Augmentin) & pain killers first before she attempts to do anything. It would be too sensitive for her to examine or do any procedure at that point in time. That seemed like quite a reasonable approach. I was also advised to do an x-ray of the troubled tooth & its adjacent counterparts.
As a very compliant patient, I did exactly as I was told. The dentist said she would look at the x-ray & let me know later via her dental assistant (DA). She said perhaps she could see me in 2 days time. Meanwhile, I should continue on my antibiotic & analgesics.
The dull nagging pain then became a more severe throbbing pain which not just affected my sleep, but my meals & my work too. Naturally, I tried to get back to the dentist. She was busy, so I spoke to the dental assistant. She said her boss’s appointment list is full for the next 2 weeks & I can only see her after 2 weeks. 2 weeks? The gods must be crazy.
(This is roughly the conversation between me & the dental assistant)
Me: Can you please tell the dentist that the pain is getting worse & it is affecting my work? (I was then put on hold for a while)
DA: Dentist say if you want MC, just come over to Dental Clinic & she will give you MC
Me: Then what about the x-ray? What did the dentist say about my x-ray?
DA: Dentist saw the x-ray. Didin’t say anything
Me: 2 weeks is too long, can’t you give me an earlier appointment? (put on hold again)
DA: Dentist will see you next week, Tuesday, earliest appointment
That night (Thursday), the throbbing pain got worse & I actually went in to the hospital for ‘a shot in the arm’ (intramuscular Tramadol). That was the only parenteral (injection) analgesic available in the ward. The jab was superb, my pain subsided very quickly & there was no more throbbing. But at the same time, I also became drowsy quite fast. This is a side effect of Tramadol, which is an opioid (as mentioned in my original “Role Reversal” post)
I slept on & off till the next morning. Took a cab (was still a bit woozy so decided not to drive) to a private dental clinic. The Dentist was fully booked from morning till evening (which was good & bad). Good because the number of patients usually indicates the doctor’s skill & bad because I might have to come back the next day or find another dentist. But something which I wrote (or declared rather) on the registration form made them offer to slot me in between their pre-booked patients (ie. Occupation: Doctor)
An x-ray was repeated & showed a small abscess at the apical region- not at the same tooth, but the one adjacent to it. I wasn’t surprised or in denial, unlike before. I had sort of expected this when I started having the pain. But of course, I can’t help asking why me?
Like I said in my old post, I’m an obsessive-compulsive teeth brusher, who does it so many times a day. Some people I know brush only once a day & nothing of this sort happen to them. Isn’t that so unfair? My mum said maybe it is because I brush so many times that I get this problem.
I spent the next 1 hour on the dentist’s chair (which sounds nearly as dreadful as the electric chair). LA (local anasthesia) was given to numb my jaw before the dentist did his job in drilling, digging & draining my diseased tooth. I was put on a pair of dark glasses throughout the session so that I didn’t have to see what the dentist & his assistant were doing to my oral cavity. I thought that was a brilliant idea, on the dentist’s part. I burnt a hole in my pocket for the procedure, x-ray & consultation fee, but I left the clinic a satisfied patient.
Back at home, I continued taking my antibiotic & pain killers (namely Paracetamol, Voltaren & Tramadol – but not all at the same time, milder one first & slowly go up the analgesic ladder).
While the dental problem is almost solved (follow-up appointment is in one week’s time), another problem arose. The day after my visit to the dentist, I developed generalised body rash with pruritus (itchiness) which was most likely a delayed allergic reaction. I think I fit snugly into the description of a ‘high risk patient’ (see “Hospital Terminology” post). Fortunately, the symptoms subsided slowly with anti-histamine from my housemate, who was already prepared to send me to the ED (emergency department) if I had started wheezing.
I do not know what caused the the allergic reaction. It couldn’t be Augmentin as I had been taking it for many days. In fact, I had the same antibiotic, on top of Metronidazole (Flagyl) during the first episode. It could be Tramadol but Voltaren is more likely the culprit.
The last time I had an allergic reaction was to a type of alcohol, about 2 years ago when I was still in Kuching. I had pruritic rashes & asthma attack, where I sought treatment at the ED of my old hospital. In New Zealand, where I drank alcohol only on social occasions, I only experienced rashes but no wheezing. After the episode in Kuching, I had stayed away from all types of alcohol. Maybe that’s a good thing.
Anyway, what puzzles me now is that I never had any allergies to medication in the past. I had taken Ponstan before for dysmenorrhoea (period pain) & Voltaren is from the same family. Oh well…I guess life isn’t interesting if there are no events once in a while…
HOSPITAL TERMINOLOGY
VIP & VVIP
(Not those driving big cars like Mercedez or BMW or Perdana, these are very & very very irritating patients)
I don’t mind if patients like to ask a lot of questions (even if the questions are 2 pages long & written on A4 size paper), because as patients, they ought to know what exactly is happening to them & what treatment they are having, but it gets on my nerves when things like this happen:
Case 1
Patient: (with a rombongan of relatives coming to visit) I’ve been here for 3 days, no doctor come & see me, didn’t give me any medicine, I’m just waiting & waiting
Relative: (angry & looked like ready to challenge the small petite doctor) So what’s the status now??
Doctor: (very calm but a bit sarcastic) The status now is…..the same…. as what I’ve informed the patient & his wife….today, yesterday & the day before yesterday
Patient: No medicine for 3 days
Relative: Why no medicine?
Patient: You see this little canulla here (on patient’s arm)? Our nurses have been giving medicine in the form of injection 3 times a day for the last 3 days & patient is actually improving with the medication
Case 2
Patient: (loudly as if an emergency had occurred) Nurse! Nurse! Nurse!
Nurse: (rushing to patient) What happened?
Relative of patient at next bed: (also rushing to help) What happened?
Patient: (now in a soft voice) Nothing, I just want my walkman (which is placed at the cupboard next to the bed)
Case 3
Patient: I can’t go to toilet, I feel weak (which is actually fair enough)
Nurse: Okay, then I get you a bed pan. We will pull the curtain & you can ease yourself here
Patient: I don’t want bedpan
Nurse: How about pampers? Then you don’t have to worry till the next morning.
Patient: I don’t want pampers
Nurse: Then what do you want?
Patient: I want the doctor to put in a catheter
Nurse: Doctor is not here at night. Doctor will only come (from home) when there is an emergency
Patient: Then call the doctor to come now
UK
Stands for ‘ubat kampung’, very popular among Malay patients
Bomohs tend to promise something that doctors can’t (ie. CURE, for cancer & many other chronic diseases)
US
Stands for ‘ubat sinseh’
Ranges from powder to liquid or even tablet form (sinsehs are now getting more & more sophisticated, some even have name cards & distribute pamphlets to hospitals), usually made from plants, including grass & mushroom
TM
Not telekom malaysia but ‘troublemaker’, usually a relative or family member of a VIP or VVIP (Examples – as above)
High risk patient
Either a relative/ family member of a medical staff or is a medical staff, tends to ask a lot of questions & the more the questions, the more problems/ complications seem to arise
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