Tuesday, November 11, 2008

The Two Towers

Some thoughts about the posting so far, in Paediatrics. It's already more than halfway through the posting, might be a little late to be writing about it, but I figure that feeings do change over time.

I won't deny that at the beginning of the posting I really questioned my decision to pick Paeds as a HO posting; after all, I never had an aspiration to do Paeds in the future, and I have a self-professed dislike of screaming brats, so why did I put myself in this crap place for 4 months? I started off in High Dependency, which was an additional culture shock in addition to the switch from adult to paediatric medicine, as all the patients were sicker and the changes to be done every day were in the truckloads. Having to set plugs and take bloods from little kiddies is very different from doing so in adults, and having to call the MO in for help for every single plug on my first call was a very demoralising experience, but it also pushed me to figure out the technique and jump at every opportunity to set one, to get enough practice. Having to call for every blue letter referral, try very hard not to stammer on the phone, and get the essential details across, was something I didn't have much practice doing in SGH, where almost all blue letters are simply written and faxed without any phone calls. Most of the time the person on the other side of the line is nice, but the times where you get scolded on the phone can spoil the whole day. Suffice it to say, my first month was quite a harrowing experience, having to learn all these new skills along the way, and though a lot of the people are really helpful and nice about my blur-ness, I also met my fair share of not-so-nice people.

The second month was not going to be any easier, as I ended up in ward 62, widely agreed upon to be the busiest paediatric ward in the hospital due to its "exclusive" B2+ class status (the only ward in the hospital of its kind) where the charges are only 10-20 dollars higher per day than the B2 rate, but there is air-conditioning. Knowing Singaporeans, this would be the first choice for most of them. As a result, the turnover is quite massive, and you can be sure that every bed that is emptied will be filled by the next morning, most of the time. Given our call systems where we almost always cover the same ward we're working in during our calls, the calls in 62 are also known to be the worst. During my first month I once did a Women's Tower call, covering wards 62 and 31 on a Saturday, and boy, was it a nightmare. 16 admissions and not a bit of sleep at all, and I was doing changes until 830am without breakfast too. It was not without a lot of trepidation that I went to 62, and yes, it was crazy. Piles of files sit on the front counter after rounds every day, separated into two stacks - the 1pm discharges and the 5pm discharges - and we have to finish the prescriptions for all of them and also the 1pm summaries before (duh) 1pm, while doing changes, and preferably also finish the summaries for the 5pm discharges too, so there are no leftover summaries for us to do another day. One thing you realise is that unfinished summaries tend to snowball, and before you know it you're staying back until 8pm to finish them, thus the policy of finishing everything when we can, even at the expense of lunch sometimes. On one particular crazy day there were 19 or 20 discharges. Usually the distribution between 1pm and 5pm discharges indicates whether it'll be doom for us during afternoon rounds (all the 1pm discharge beds getting filled while we do rounds, and us having to break away to clerk them) or doom for the on-call, which is us, at times. There is no incentive to discharge patients, unlike in adult med in SGH, where discharge beds can be filled by patients of other specialties or other teams in the same specialty, because every bed that you empty gets filled by someone that you have to look after. Bleah.

Okay, having written 2 very lengthy paragraphs about how horrible paeds is (have I scared off the people coming in for the last posting?) I must say that I have gradually come to like the posting. For all its madness, HD and 62 both have excellent nurses that help us a lot for the non-important changes, and even help to explain simple things to parents without having to call us for every small thing. Compared to other wards where nurses call for every tiny complaint and document it in the notes (won't say which ward), it really makes quite a big difference to the working environment. The lifestyle is actually pretty good, as we get a lot of weekends off; weekend rounds for HOs consist of the 4 on-call and 4 post-call HOs as well as one extra "rounder" HO who only does rounds, thus the rest get to have an off day. Definitely as many, if not more, weekends off compared to my SGH Med days. Calls tend to be easier (unless you're on call in 62 haha, but even then some nights can be quiet) and less changes to do. And, of all things, I actually find it *gasp* fun to work with kids. Well, okay, sometimes when they're really annoying, like one kid who kept hitting me and screaming (make that 2 kids) when I was trying to examine him, then you want to whack them silly, but most of the time they're really cute and lovable. And you don't really need to stay there and face them when they're crying, haha. Like one of my MOs said, when it's not your child, it's cute; when it's your child, you'll be really annoyed and whack them. Truism number one.

Maybe it's just a knack of mine to always look at the positive side to every posting - I mean, if you kept thinking of how you hated the life here, you'd really be very miserable - that makes me gradually like every posting that I've been in so far. It's hell when it comes to thinking about future choices because everything appeals to one side of me or another, and well everything also has its downside, so balancing all of that is a huge headache. I'm starting to wonder if maybe paediatrics would be nice to work in, but seriously I don't think I'm half as obsessive-compulsive about details as most of the paediatricians are, so even as I may like it, it's probably not something I would be very good at. And that's another important thing to consider. At the end of the day, I often feel that we're not really treating patients, when more than half the ward have GE or bronchiolitis, and are just getting supportive management mostly, and lots of explaining to parents. As another MO very aptly put it, we are entertaining expectations, not practising medicine. The rare occasion that someone comes in with something big, like a child with newly diagnosed leukaemia, someone with Stevens Johnson's, or a patient with DKA, that requires real management, are few and far between. But they do create some excitement in the ward, definitely.

Another thing I love about KK is the bridge joining the two towers, and the lovely view from it especially during sunrise and sunset. Once during a call on the day before Deepavali, my MO and I were crossing over from the Women's Tower with a capillary tube of blood to do a capillary blood gas, the machine being in the HD in Children's Tower. This was around midnight, and there was some Deepavali celebrations over in Serangoon Road, and just at that moment a multitude of fireworks were released, which was quite a splendid sight. My MO and I were so excited we whipped out our camera phones and started filming the fireworks, the capillary blood gas temporarily forgotten. It was really amusing. Unfortunately the contrast difference makes the video look quite crappy on my lousy phone camera, so the video just shows bursts of light and sound without the different firework patterns.


Sigh, already half my leave gone, and I've just been vegetating every day away. Very, very slothful.

Avaris / 11/11/2008 09:38:00 PM

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