Aug 19, 2018

Spotify Playlist #5: Pedopedo

Alhamdulillah, as with every end of posting I will post about my Spotify playlist of songs that I resonated with during the said rotation. I hated Paeds not as fiercely as I thought I would be - it was definitely much better than my dreaded first rotation of doing O&G - partly may be contributed from the accumulated experience and foreknowledge of the dos and don'ts here in Paediatrics.

I did not enjoy much in Paediatrics, that's for sure. The screaming and the wailing of the patients, the dangers and the pitfalls that lurk in between medication errors and failing to recognize paediatric emergencies, the infamous attitudes of shitty colleagues producing questionable MCs and ELs, the potential and tendencies of extension - all of these are enough to make one miserable.

Help me, it's like the walls are caving in
Sometimes I feel like giving up
No medicine is strong enough
Someone help me
I'm crawling in my skin

Well, takdelah sampai level crawling in my skin but it's akin to that, just mildly so. I hated the busy wards and their patients. I lost count on how many times I had to rein in the strained effort of controlling myself from cursing into the heavens on why I needed to spend up to half an hour just to take blood from one patient. And so I screamed into this old song. God, missed you Chester.

I'm gonna run away, and never say goodbye
Gonna run away, gonna run away
Gonna run away, gonna run away

And over time the feeling propagated and became more depressive. It's hard to get out of it, what with how hard it was to get leave at the time I needed it most. That's one of the reasons why people are taking MCs and ELs left, right and centre I guess. When the outlet isn't there, people will find other ways just to breathe. Absent colleagues only bring about the vicious circle of hell in Paeds because the lack of HO coverage is the killer in any working environment. And that would leave me feeling raw and unnerved:

Everybody knows
Everybody knows where we're going
Yeah, we're going down

I was counting days to leave Paeds. My colleagues who had moved on to the next rotation only added to my envy. At times I wished they will stay and wait for me so that all of us should move on together. They all looked much, much happier in other rotation. While the theme of the song is different, I liked how Ed Sheeran delivered this line that suits my mood:

Cause baby you look happier, you do
My friends told me one day I'll feel it too

But finally when I finished my short and long case, with my logbook and greencard approaching completion - I cannot help but feeling motivated. The end had come and I never been happier to know that I managed to survive yet another rotation without (major) troubles. I thanked God for giving me the strength from going bonkers working in this rotation. I feel anew. Like a phoenix born out of ashes (over seyh kau Safuan. Hyperbole at its finest!). And for this, I felt that the song Glitter & Gold from Barns Courtney is my favourite song during this 4-month duration in Paediatrics.

I am flesh and I am bone
Arise, ting ting, like glitter and gold
I've got fire in my soul
Rise up, ting ting, like glitter
Like glitter and gold
Like glitter

Thus I bid you farewell and goodbye, Paediatrics. I will miss you not.
Hello, ED.

Jul 9, 2018

Mother's Love

What strikes me the most here in Paediatric posting is how strongly I was shown that a mother's love is the fiercest of all. Whether it's the new mother with the firstborn or the middle-age ones with lots of children. There's no compare of how strong their love of their child is.

Restrain your judgement to the mother who passed down her HIV blood to the baby boy who is still sick with various complications of the retrovirus disease infection. He's been admitted here for 7 months already. But when you look at how the parents never leave the baby's side, at how the mother only look at the baby all the time, even sleep with the baby in the small crib - you know. You know that her love is real.

You may have already encountered the real fussy and the dreaded overly-anxious mothers who don't trust doctors with their babies. The shouts, the complaints, and the mere look of distrust as they think we have no other work to do but to make their babies suffer for a number of accusations. But see properly and you can see that in between lines of worry or in the glazing eyes of fury they do what they do is because they are terrified for their child's safety. That is love in primal instinct all mothers of every creature has. The fierce love.

No matter how sick the child can be, or how hopeless the prognosis is - no mother I see abandon their love of their child. You see it in the children's silent tears. You heard it in their cry asking for their mother. You witness it from the shine in their eyes when they see their mother. You know it is true. That's love.

You see it more often in those moments. But you see it too in the moments of despair. When the mother was not there when the child is scared and lonely. When the child is very ill and neither the mother nor the doctor can do anything at all to make it go away instantly. Love is equally abundant both in sickness and in health. Love is there before the child is even born and love will always be around when the child leaves the world earlier than their parents.

And in lights of recent tragedy, I give my heartfelt love to the ones we all missed. To every children I loathe to take care of, I give you my love all the same and assurance that you are all loved. That whether it is shown, or seemingly abandoned, you are loved just by being born. To the ones who prompted me to write this post - the Indian and Malay mothers that took care of their bedside Chinese girl when the girl's mother is not around, I was deeply moved. A mother's love has no racial or religious boundaries. Thank you for showing me your love.

And last but definitely not least,
I love you too, Mama.

Jun 18, 2018

Unpopular Opinion: Medical Issue

I have never discussed any trending topics in the Internet before. I spend most of my times online using Twitter, where most of the top world and local news can be found there from various resources. I don't really like using facebook because people there so blatantly fabricate stories as real-life facts to garner likes and shares it is so sickening to look at. Twitter users, on the other hand, they tend to spill facts as what they claimed, and things like woke-realizations are a thing here. Well, some are superficial, and a few is loathing to read, but hey it's only a tweet of 280 characters. Easier to skip reading.

For the past fortnight this hashtag of ''unpopular opinion'' has been trending globally. Malaysians, as one of the rising addicts of social media, capitalize this by tweeting our own versions of unpopular opinions on a number of issues that is happening in Malaysia. One of them if Unpopular Opinion: Medical Issue.

Well, reading through this sensational thread generated a lot of mixed emotion in me. Mostly anger, a bit of exasperation, but also there's bit of the sense of unfairness. Stories upon stories came out about how government doctors are generally stupid and useless. Things get heated up when several users with healthcare backgrounds replied in defense to the accusations thrown around.

The gist of the arguments made regarding the issues are:
  1. Why Doctor A made a diagnosis and Doctor B made a different diagnosis?
  2. Doctors should never make a wrong diagnosis because:
    • they went to medical school for years
    • their wage is high
  3. Why Doctor A did not do the same investigations like Doctor B so that they can get the same diagnosis?
  4. Government doctors are subpar and irresponsible because of low wage/work load hence missing the right diagnosis.
  5. Waiting turn for a consultation up to half and hour for an actual consultation that lasted less than 5 minutes (LOL ini kelakar)

I think that I am qualified enough to give MY UNSOLICITED VIEWS regarding this whole mess. Just a two-cent worth of opinions. But here it goes:

People think it is easy to make a diagnosis (a.k.a putting a disease name to a patient) where in fact it can be quite difficult. There is no manual instruction to follow. This is not like an IKEA furniture assemble where putting two and two together becomes a four. 

To simplify: doctors make a diagnosis based on a combination or in isolation based on these things:
  1. what the patient tells us and what we can check physically on the patient
  2. blood investigations
  3. imaging like x-rays, ultrasound scan

These are the basics. And mostly patients come with simple diagnosis. There's a saying in Medicine, "common diagnoses are common", which means usually, patients come with common problems. Rare diseases, as the name implies, are not common. Hence, when we stumbled upon patients like these, we will run all the common diagnoses first as the differentials before moving on to the uncommon ones.

A complicated diagnosis will always indicate a more advanced (and expensive) array of investigations. Specific blood investigations, invasive procedures like lumbar puncture for example (taking out fluids from your tulang sum-sum), and imaging modalities like contrasted CT scans or an MRI will be considered, depending on the diagnosis.

So the question asked - why doctors make different diagnosis?

It is actually quite a valid question. If there is a disease name that has been researched and studied by doctors all over the world, why can't we accurately label it to the patient? For all the myriad reasons that exist and have been exhaustingly explained by everyone and anyone, I think it all boils down to a number of issues.

Firstly, we have to know that any disease, even with a well-known name, has a number of faces. Remember when I said making a diagnosis is not like assembling your IKEA chair? Diseases come in stages and often all its clinical characteristics or what we called signs and symptoms do not come out clear enough at the same time for us to recognize the disease for what it is.

It's almost equivalent to this famous story about four blind people trying to recognize what is an elephant merely by touching one body part of the animal. Meaning, one doctor may make a diagnosis based on what is showing to them at THAT time. A different doctor may be showed a different face of the disease as the course of the disease progresses/regresses. What they can and usually do is what we called 'watchful period' or the wait-and-see to catch the disease with a different or added presentation. A good doctor will always think of other differentials at the back of their head, hence, the waiting part, but hey, what's not shown will never be revealed to anyone, right? That's why it is easier to criticize.

Also, FYI, as one of the healthcare etiquette, we DO NOT criticize other doctor's work. We do not say, to the patient even more, that the other doctor is wrong at what they did.  We do not work with blaming others, nor we leave other members of the healthcare team defenseless. We will never know the exact situation of what's really happening during prior consultation and examination so that's why we never judge. Any doctor who criticizes others is a snob doctor and pretty much unethical.

Secondly, different healthcare settings have different resources. Now, resource is a big component of being a doctor. In fact, it is so much so that it is actually one of the four basic ethics of being a doctor: JUSTICE. I once explained briefly what Justice, as a component of ethics, is about, but for those who are willing to read up until this point (haha, this post is lengthy!), justice is about being able to fairly judge who deserves what based on the limited resources at your disposal.

The easiest example I can bring is this: Take one klinik kesihatan (KK) for example. Let's say that said KK only able to do 500 simple full blood test to know whether you are sick with infection or not. The lab only has 500 reagents to perform the said test. Now, let's say there are 800 patients that come to the KK on one day with complaints of fever. The ethical issue of justice here is this: which patient deserves to be tested and which is not?

Next comes the SOP (standard operating of procedures) or what we usually called the guidelines or a protocol. These instructions are usually locally tailored for specific institutions and there are also national guidelines or what we called the CPGs (Clinical Practiced Guidelines). Every country has it. In UK, they are known as the NICE guidelines (of which my uni heavily used on this seeing that it's a UK uni, duhhh) while the Europeans have their European guidelines. So these help us in deciding which patient deserves what kind of investigations and the treatment given.

Justice is also applicable when comes to waiting times and the duration of consultation itself. Is it fair, even if you have waited for an hour for your turn, to have a consultation with a doctor for half an hour over simple condition? Imagine that the attending doctors have 100 patients to see daily (that's an actual estimation, really. Not kidding). If one patient takes half an hour of their time, they can never finish their work. Hence, the longest consultation they can spare you is 10 minutes.

I wish I can talk more about other issues such as differences between a government doctor and a private one, but seeing that I have no knowledge about what being a private doctor is all about, I am definitely not fit to talk about it.

Honestly, I can safely say that whatever you imagined being a doctor is like, it's not. Doctors are not the only job that helps people, doctors are not paid lavishly, and yes, doctors have one of the most strenuous work load in the career industry. But all of those never, ever equate to the level of how we are treating the patients. We don't ever "paid peanuts, do peanuts''. Period. Makan peanuts, yes, but it's high in cholesterol, so eat moderately, yeah?

P/S: Happy Eid to those celebrating! Watch your sugar, watch your pressure!!

Jun 7, 2018

I Hate Kids (and Babies)

I am already 7 weeks into my fifth posting Paediatrics (wow, already fifth. How time flies erghh) and I. AM. NOT. LIKING. IT. ONE. BIT. I feel ill-equipped to work despite having to undergo tagging for three long weeks, all because I had the misfortune to catch a viral fever when working in the general paeds ward. It's not that the work is difficult or beyond my understanding - it's just plain annoying and irritating.

As I mentioned before in previous post, this department is generally stricter as compared to other department. Monthly finger-flex attendance sheet, NRP, short case and long case, compulsory Journal Club presentations and CPGs to attend, mandatory meetup with supervisor at certain weeks, and the very fact that the leave allocation is handled by an MO who opens it periodically pretty much makes it unbearable to take. 

I am so used to asking leave whenever I wanted to (within reason and time constrain, of course) from my houseman leader previously in other departments, that when I came to Paediatrics this limiting issue gnaws at me very much so it puts me in a near foul mood every time I think of it. I can't possibly plan my leaves a month in advance - what if on those days that I applied for leave I have a rescheduled assessment or something? Idiotic, kan? Why can't we have that freedom to ask for leave one week in advance like the rest of the housemen do in other departments? WHYYYYY

And don't get me started at the number one reason why I hate this department - the patients themselves. OH MY GOD this department is testing my patience very much so. There are two main wards all HO need to work at initially - the general paeds ward and the special care nursery (SCN) for neonates (babies less than one month old). Once they completed their rotations in these two wards they will move on to NICU, labour room, NBS, clinic, etc.

Now, the paeds ward is very much like my dreaded medical ward upstairs - full to the brim with patients but the difference is that the patients here are pretty much the mini-versions. They are small, fragile-looking, ill-looking, BUT VERY NOISY. True, adult medical ward has its own share of noise but here they are constantly screaming and shouting their lungs out. They do run around in the ward from one end to one end, shrieking or crying or doing both at the same time.

The most vexing of all comes when trying to take blood or inserting a line to the children for a number of reasons. One - we can only do so in the treatment room, far from the watchful eyes of other children and patient's parents. The thing is, there is only one treatment room for the whole ward that can reach full capacity of 65++ patients. In paediatrics we cannot draw the blood at the bedside. Kau gila apa nak buat macam tu. Once the other kids (and their uncooperative parents) see what we are doing, the whole cubicle will go bonkers thinking it's their turn next to be poked with scary big needles.

Two, that said treatment room is also used by radiographers who will come to the ward for any portable chest x-rays that we ordered. We will bring the child to the room and have it scanned there. So you see, if there are 10 children that needs to be poked, it will never take 5 minutes each. It will take at least half an hour each. What deems to be a simple enough process will take an unbelievable amount of time it drives me crazy.

And three - these kids are really something. They shout, they cry, they scream, they spit, they bite, they kick, they thrash around, and it takes a lot of energy and personnel to get hold of them to lie still so that any procedure can be done once successfully and without failure. I really cannot tahan with this. More so when I had to work at night where staffs are fewer and there's not much help available at that time. So apa lagi, cucuk je la selagi boleh sampai dapat. Doesn't matter if it's a small child or a baby - they all are intelligent enough to give me enough resistance and resentment.

So, to conclude - I hate them all. I hate those persistent cries and screams. I hate the inability of them to listen to reasons. I hate them all for having problematic parents who can't even take care of the branula site carefully and just buat bodoh je sampai branula tercabut and the bleeding just spurted out. I don't have time to poke your cute, chubby kid with bluish bruises again and again in a day just because you are so negligent in taking care of your kid. I hate it so much that I'm wasting so much time doing one stupid procedure when there is a lot more work to be done. 

I hate it all so much but rest assured, babies (and kids), you are in a good hand. Even if I hate you LOL.

Yeah screw you too, kid.

Apr 29, 2018

Chilling Things Wishlist

I'm gonna die here in Paediatrics, I kid you not. The mountainous challenges I discovered that are waiting for me here are quite scary, to be honest. I believe all of these stem from the fact that the posting in Paediatrics is very prone to being extended. Kau buat ini salah, hah, extend 2 bulan! That blood culture is contaminated? EXTEND! Clerking sheet's not completed? EXTEND! Tak approach assessor within the time frame? EXTERMINATE! It's like walking into a minefield blindly not with the blindfold but with your eyes blinded with fork jabbed into your already-blind eyes. So much blind. Much not see. Wow.

Anyway the reason I'm up so early in the morning is because 1) I'm an early riser (when I wanted to) and 2) last night I slept after taking a dump without performing my Isha' afterwards so I was awoken to pray at 5 o'clock in the morning and 3) today is my off day in this first week of my tagging in Paediatrics so I want to spend as much time that I have today waking up and not working. Lewls

So little time and so much things to do, as usual! I intend to just chill my ass off today, eating delicious home-cooked meal (I'm home now - just drove for an hour and half last night after work and arrived home at midnight last night) and planning to get my new pair of raya glasses (kelas kau Safuan ada spek mata raya hahahahoya). Being in the dreaded department with no guarantee of getting any leave makes you wishful for things that you want to do when given the chance of a time to do so, I daresay! There are things that I want to do in my spare time such as:

1. Go travelling abroad

My parents just came from a week++ holiday to Turkey whoahhhhh I am so jealous and happy for them! They brought home so many Turkish delights, baklava, figs and not to mention, souvenirs for all of us. Turkey was and still is one of my dream holiday travels. When I was a student blessed with a year in UK, I was fortunate to be able to travel to three European cities (Prague, Rome, Athens) and enjoyed my time there. I just renewed my passport and I intend to go somewhere abroad end of this year in sha Allah (hopefully by that time I will have finish this hateful Paediatrics!! AMEEENNN)

2. Reading novels

I have rediscovered my interest to read my currently-reading novel A Wrinkle In Time. I really do miss reading books. I have a modest collection of novels in my tablet that I have maintained for quite some years now. I always have this habit of rereading books that I love - it makes sense, doesn't it, with people who have library of books at their home? What else is the function of keeping the books for years if you're only going to read them once and keep them dusted in the bookshelves, serving as the food for the termites? Twice I have blogged about my novel collection over times - here are the links: Iqra' and Revisiting 13 Reasons Why.

3. Binge-watching seasons of TV series

Oh this is one of my favourite pastimes! Unfortunately I have ran out of series to watch except for a few that I'm waiting for the whole season to end first before I watch it all in one go. I used to keep track of my favourite TV series using website (which is quite good but doesn't really serve any functional purpose, really). These are my current watching list:

These are the series that I LOVED but either it had ended or being cancelled :(

While these are the series that I used to watch in the past but I stopped watching because either they are getting boring and refused to die (as a series), I'm waiting for the next season as they are on hiatus, or I'm not liking where the story is headed LOL

Alright, my ass is getting more and more kematu from sitting typing all this. Gonna need to stretch my legs (to the fridge in the kitchen LOL) and spend my precious one day offday to the max! Happy Sunday people!! 

Apr 13, 2018

Spotify Playlist #4: SURGICAL

This is, perhaps, the shortest playlist of all the department rotation I have been through. I started my fourth posting Surgical with Feel It Still, a catchy song with mischievous Tarantino-vibe tune. I didn't know what to feel about Surgical when I first entered the department - I was a bit apprehensive and was fighting to be alive despite having to go to work with the team I was put in, having to stomach the many imposed stupid rules and not to mention handling the antics of the wards and superiors alike. 
We could fight a war for peace
Ooh woo, I'm a rebel just for kicks, now
Give in to that easy living
Goodbye to my hopes and dreams

On a personal growth, after months of numbing the break-up of my relationship, I began to open up and learning to tolerate listening to crappy stupid love songs. But being tolerant doesn't mean I enjoyed listening to them. For instance - I vividly, viciously, vehemently and venomously hate that Perfect song by Ed Sheeran. That song is rubbing salt to my wounded heart with every syllable that ginger bastard uttered. The very first line,
I found a love for me

is enough to make me cursed out aloud in the car at him before joining up and sing along to the chorus. The version of the song that is in my playlist, though, is the Perfect Symphony where Ed is singing duet with some Italian master singer. I was introduced to this song by my lil sister during our family vacation holiday in Port Dickson and I like it, despite the anger I felt every time this song came up.

Next, the ever feel-good Macklemore graced me with the song These Days by Rudimental to be put in my playlist. The song is gentle and soft to the ears - it's a slow rap song that seemingly innocent at first listening but it's actually a fucking cutthroat song that kills me in my sleep.

Oh, I know it ain't pretty
When two hearts get broke
Yeah, I know it ain't pretty
When two hearts get broke

And when I thought this song couldn't kill me more, here comes the bombshell chorus:
I hope someday
We'll sit down together
And laugh with each other
About these days, these days
All our troubles
We'll lay to rest
And we'll wish we could come back
To these days, these days

There's no fucking way it's gonna happen. Not in any near possibilities nor in any future. I am in the process of healing myself. I want to forgive myself, more than anything, and to this to happen I need to let go of everything. Let me start anew with myself - away from everyone I know and everything I had known to love.

Okay enough with all that depressing matters. What's done is done. 

Lastly, from the same ginger bastard I mentioned earlier I came across the acoustic version of the song Ciao Adios by Anne-Marie. I love it, love it, love it. You'll be surprised how different the tone of the song changed when it is sang in acoustic. Cheating is never the theme of my fucking break-up (sorry I'm getting emotionally unbalanced) and in actuality there's nothing that I can relate to with this song. However, there is this part that really sums me up when I had to deal with all these flash floods of miserable memories (such as this moment):
Ciao adios, I'm done