Sunday, May 18, 2008

Can't believe it's already been 16 days

Finally, after 16 days of work without an off day (not that it's anyone's fault, really), I get the Sunday off and can finally wake up late and lounge around lazily at home. Not to mention contribute something to my blog, keeping it in the half-alive state it has been in for an eternity.

I'm not too sure how much I can blog about work without disclosing too much about patients and stuff, but it's generally been really busy in Renal, though after some time and getting the hang of things one becomes slightly more efficient and competent so it does get easier. The people are just wonderful; there are no nasty senior doctors, everyone is kind and willing to teach and forgiving of small screwups here and there. The MOs are also really helpful even though they have their own work to do (I kind of feel sorry for them because they have to do HO work quite a lot of the time). The nurses are also marvelously good and helpful, a lot of times better at the whole job of looking after patients than I am (at least in the ward I cover :P). Renal's been a great department to start the posting in, and I feel there's so much I have yet to learn from here but already I'm nearing the end of the month - this insane workaholic is now seriously tempted to do a six-month MO posting in Renal, as well as playing with the idea of specialising in it. But then again that happens to me in every medical posting I do, which is entirely quite annoying as at the end of the day deciding on a specialty is rendered quite impossible.

Oh well. I'm having fun while it lasts. Though it really isn't always fun, certainly. There are always down periods, failing that umpteenth plug in the day, getting scolded by a patient for not being able to take blood from a huge vein ("Get a staff nurse to take it," he muttered irritably), handling difficult patients/family members, patients dying no matter what you do, or worse, because of what you do. I guess it's just part of the whole experience that one has to go through, and at times, momentarily, the crush of disillusionment and frustration can become too much to bear, but thankfully so far those feelings only last for a while and fade away among the little joys of the day. The people one works with become really important, because they make a lot of difference in making life so much better; I can't imagine if I had to work with mean seniors and incompetent nurses - I'd probably be itching to flee the hospital at the end of every day.

And calls, that's another subject that I can write a dozen monster-sized paragraphs on. Again the SGH nurses just keep amazing me with their greatness by pre-empting my questions and sometimes even suggesting what should be the appropriate course of action (even better, they've already tried doing something about it and only called me because the situation doesn't seem to be improving). Also it's really nice to have nurses call you to set plugs, then tell you, "Can take your time to do it later, it's not urgent", and then by the time you get there to do it (quite a long time later, unfortunately), the nurse tells you it's already been set. It makes me want to float away on a cloud of relief. And so far I've had wonderful MOs who help me do quite a bit of the clerking of new cases so I can handle the mountainload of passive stuff that just accumulates like crazy over the night.

I think I am very very lucky and must thank my lucky stars. I know it can be a million times worse than this, so it's really great that so far things have been mostly smooth-sailing.

Certainly, though, it is quite sobering that a lot of times I'm just crippled by not knowing what the appropriate thing to do for a patient is. We're so good at ordering symptomatic treatment - if breathless, prop patient up, increase the oxygen or give nebuliser to clear the secretions; if coughing, give cough syrup; if constipated, give lactulose/senna, fleet, dulcolax. I can't help but wonder if there's more I should be doing, if it's considered good medicine to be dispensing medications to respond to each and every complaint the patient has. I feel crippled by my lack of knowledge of how to deal with these situations practically, and I don't know if calling the MO up every time I am unsure of what to do will help - though so far, I've definitely learnt a few more new tricks to deal with these situations from watching MOs manage them. I guess it's all part of a learning curve - they learnt from their seniors and now I'm learning from them. Time doesn't allow much for learning though, when there are a million other things to do and you can't hang around very long to learn when you're needed elsewhere.

Deaths are the worst thing (and this paragraph is quite depressing so I'd advise you not read it if you don't want to get morose thoughts) - unfortunately for me I've had 5 patients on my team die so far (apparently patients in renal have a higher mortality) and I just can't help but wonder sometimes if their deaths were entirely preventable if we had done something, or not done something, or somehow forseen a complication before it happened. Can't really reveal too many details here, but it can be quite depressing especially when the patient looks well and you think he/she is going to be discharged soon and they take a sudden turn for the worse. And even the act of supposedly making things "comfortable" for them seems grossly inadequate; no matter what we do death can never be comfortable, it can never be dignified. It drags people struggling and screaming away from life and the pain of it is engraved into their faces and I can see it, almost as if you can still hear their cries in the heavy silence behind the curtains, and it kills a part of me every time.

Enough with the depressing stuff; I'm sorry if that just ruined your happy day.

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Went out to Orchard after work yesterday because I was told it's the Great Singapore Sale now and there are sales everywhere (indeed there are - I haven't had time to read the newspapers for ages so I had no idea) so I can start marking out what to get with my first paycheck lol. There really isn't much to buy out there for now, maybe a new pair of shoes because my shoes are wearing out really fast with all the walking. I also indulged in some New Zealand's Natural ice-cream which I haven't had in eons (decided against Haato because I forgot to bring the Haato card) - lavish Choc Fudge Brownie and Spotty Dog which was just delightful.

Back to work tomorrow, on call on Tuesday. I guess I'm sort of looking forward to work still (insane, yes) but I have a feeling it's going to be one insanely busy week ahead. Hope everyone's also doing okay at their respective hospitals and departments.

Avaris / 5/18/2008 01:18:00 PM

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