Merry Christmas!

Hi folks, it is Christmas again. For all the junior doctors on call today, hang in there and have a good call! For the rest of you don't party too hard and go easy on your liver with the alcohol! Yes, yes, yes, Lokuns like to nag....

Many many pain Part II

The Little India Riot really took Dr Og by surprise. Like I always emphasize, Dr Og is apolitical and this blog is not to kpkb about anything. But you see, working in a hospital, you tend to have met all kinds of people. From the migrant workers to the atas-nose-in-the-air Singaporean towkay who is too cheap to forsake his right to subsidised care.

One phenomenon about migrant workers is their pain threshold. This is something very important to understand as they may have clinical implications. (Disclaimer: As I am a fake doctor writing a humour blog, please don't quote this as scientific evidence. All facts presented in this blog are fake.)

The thing is that different races of migrant workers react to pain very differently. Our Thambis from India have the lowest pain threshold while the Thai migrant workers are on the other side of the pain threshold spectrum. The Chinese workers probably fall somewhere in between.

For the Indian worker, during palpation of the abdomen for suspected appendicitis, he grimaces and screams, "Mmmmmany mmmmany painnnnn.... ah mahhhhhhh". Only that my hands are still in the air and I haven't even touched you can... (And Dr Og is not a practitioner of Qi Gong or any form of martial arts capable of transferring energy through air.)

For the Thai worker, during palpation of the abdomen for suspected appendicitis, I am pressing hard on the right iliac fossa, I see the worker face turn green and is sweating away BUT he tells me, "No pain". CT abdomen then shows a ruptured appendix!

If the doctor is not careful or unaware of these cultural differences, unnecessary operations may take place or necessary operations may be delayed! In any case, all cases must be seen promptly and all evaluated carefully regardless.

So it came as a surprise, the Little India Riot. I always had this impression that our Indian migrant workers were timid gentle people with low threshold for pain. I dare not imagine if the riot had involved migrant workers from other races.

Toilet Games Part 3

Eventually, as a doctor working in the public sector, you become senior, a.k.a. lau kok kok  and lor sor, and you will be expected to do admin work. Already, no time to even go toilet liao, still got to do admin work!!!??? I also wondered why they hire health administrators if lokuns still have to do all these non clinical work.

If you think admin work is about filling this form and that form niah, then you are wrong. Admin work can range from simple (but endlessly tedious) things like claiming transport to sitting through (endlessly endless) meetings for another IT project, another CEO's bright idea or another dinner and dance committee. 

Believe it or not, Dr Og was once the team lead for an improvement project for clinic renovation. As a doctor I of course focused on how to improve patient safety and workflow, but it slowly became quite clear that the administrators had other agendas on their mind!

It seems the senior management had decreed that special attention be given to a certain area in the clinic. 

.

.

.

.

.

The Toilet.

Before you think they so good, want to reno the toilets nice nice for staff, let me clarify that it was quickly decided that staff will have those single cubicle UNISEX toilets. (more on unisex toilets next time!) Their concern was really the public toilets for patients. And if you think they are so concerned about the welfare or comfort of patients, think again! 

The toilet is indeed an important and strategic area for a public outpatient clinic. Based on many previous surveys done, administrators have identified that how good the toilets are in the clinic is directly related to how well the clinic fares in satisfaction surveys. Yes it is proven once again that patients do not go clinics to see doctor but actually to use the jamban!

So the whole improvement project was spent discussing where the toilet should be situated and finding the balance between having enough privacy in the toilet versus ensuring that a person who collapses in the toilet would be noticed. You mean patients come clinic and spend most of the time in the toilet meh? Is that the reason why I can never find them when I buzz their queue number?? And yes, must have queue numbers displayed conspicuously so that if they see their number flash, they can quickly get to their clinic room (without flashing, wiping backside and washing hands...) for their appointment.

At the end of the day, one joker actually recommended that we take a gemba walk (walk the ground) in the toilet. Honestly, I didn't know how that was NOT going to freak our patients out. Group of doctors and administrators entering the toilet to look at the process flow for their defecating ways. As the team lead and only rational member of the project, I vetoed this of course.

Plus, Dr Og already got no time for toilet breaks and now you want me go toilet but NOT to pang jio!!???!???! You must be kidding...

To celebrate the screening of Hunger Games, Catching Fire, Dr Og change all the toilet series posts to Toilet Games. See below for more instalments of the Toilet GameS!

Toilet Games Part 1

Toilet Games Part 2

Thor-rettes Syndrome

Found this on the web. Haha

Non medical dudes, please don't ask me to translate. Kum Sia!

If THOR Works in a Hospital...

Over the weekend Dr Og managed to catch Thor in the cinema. Rare occasion for me coz it takes all the stars to align for me to able to go to a movie.

[MAJOR SPOILER ALERT!!!!!!!!!!!!!!!!!!]

Incidentally, in this episode of Thor, the nine realms align. That is really besides the point coz the movie is about a goondu bad guy (as usual) trying to destroy the world and THOR (as usual) saves the world. Yah, usual stuff. In between all that, there are lots of flying, fighting and some romance. 

[SPOILER ALERT ENDS!!!!!!!!!!!!!!!!!!]

Well, this doctor enjoyed this movie. Honestly, as a lokun, you just wanna chill and watch something brainless. No gore and blood (lots of those in the OT), no family drama (lots of those in the general ward), no political drama mama (lots of those in the pantry). 

But I was just thinking, Superman saves the world, the Avengers saved the world, Thor saves the world... surely these superheroes must all have messiah complex! Surely, they belong in a hospital right??!!!

But what can Thor do if he works in a hospital? His super power is basically swinging that hammer of his in his enemy's face. Now, how many times can he do that to the CEO, tio bo? 

I think Thor can be a orthopod (orthopaedic surgeon). Orthopods are probably the only doctors to wield a hammer in their practice. The way Thor whacks through enemies with his hammer is really without any finesse and very chor lor (coarse). No way he can do microsurgery lor. But hammer and chip bones like our ortho friend, I think he still can. His strength will help too! Try assisting in an ortho surgery and holding up the leg of a 0.1 ton uncle! 5 minutes start sweating and 10 minutes back pain starts! With Thor, there will be no such problem! He can relac jac hold the leg and still flirt with the pretty OT nurse (hopes he brings along Natalie Portman ahahaha).

Thor will probably not do well as a physician or in internal medicine where more brain juice is needed. I mean look at how he kennah bluff by Loki time and again. Sibei kum gong.......

Whatever discipline Thor goes to in the hospital, I'm sure all the female doctors will go swarming to join that speciality, given his good looks. So, which department do you want Thor to be in? 

Thor is screening in cinemas now. Wah Natalie Portman chio le!

Many many pain (MMP)

Pain is a strange phenomenon. But for doctors, it is probably one of the most common chief complaint that all of us have to deal with.

To the neurologist, "Lokun tao tia! (Doctor headache)"
To the cardiologist, "Lokun xim gua tao tia! (Doctor chest pain)"
To the urologist, the patient will say "Lokun lumpar tia! (Doctor testicle pain)"
To the colorectal surgeon, "Lokun, kar cheng tia! (Doctor ass pain)"

And when a patient presents with all of the above and complains of "long zhong tia (Doctor, everywhere pain)", he is given a one way ticket to a psychiatrist.

Now in the assessment of pain, we were taught that pain has 6 characteristics:

1) Site - Where is the pain? Or the maximal site of the pain.

2) Onset - When did the pain start, and was it sudden or gradual? Include also whether if it is progressive or regressive.

3) Character - What is the pain like? An ache? Stabbing?

4) Radiation - Does the pain radiate anywhere? (See also Radiation.)

5) Associations - Any other signs or symptoms associated with the pain?

6) Time course - Does the pain follow any pattern?

7) Exacerbating/Relieving factors - Does anything change the pain?

8) Severity - How bad is the pain?

(Dr Og shamelessly copy from wiki hahaha, ..... WTF how come got 8! No wonder I almost fail medicine!)

So if you want to report pain properly to a doctor, don't just say, "He is a pain in the ass!" Because this basically describes the site niah!

It should be, "He is a extreme (severity) throbbing (character), persistent (time course) pain in the ass (site) since the day he was born (onset). Sometimes he pains my heart (radiation) and did I mention how much he makes me wanna puke (association)!!!??? Its better if he keeps his bloody mouth shut (Relieving factor)."

(the pain is) to be continued....

Happy Deepavali!

To all my Hindu friends and colleagues,

HAPPY DEEPAVALI!

It's Ok...

It's Ok not to shake your doctor's hand...

... especially if you have just been digging your ears during the consult.

FYI: Doctors are anal about contamination and we (really, really) hate to wash our hands.

Halloween Special: Those Little Devils

I remember last time as a kid, I go see a lokun, always very scared. My neighbourhood family doctor was not at all friendly, he was the very stern, never really smile type. In the clinic, the mothers would be busy telling the kids to keep quiet and if the children were too rowdy, they were brought outside for a good scolding. In fact when I was growing up in the 70s/ 80s, you hardly see rowdy kids in clinic because parents only bring you to a doctor if you are really really sick (or not just drink leng yong at home la).

Yes, in those days, clinic was quiet except for some "Shhhssshh" from parents. The kids were all waiting and trembling in fear of seeing the doctor. It didn't help that in those days, lokuns also like to give injections for everything. Fever, kennah jab. Vomit kennah job. Stomache, kennah jab. Ah pek cannot mari kita also kennah jab (but by chiobu nurse)! My mother was a firm believer in injections and always said, "Ah boy ar, get injection liao then immediately will recover!"

Funny thing is that the injections really worked. Even funnier thing is that until today I cannot completely figure out what the GP jabbed me with all those times...

But injections are not the point of this post......

Fast forward 30 years, kids RULE the clinic. These days as we become more affluent, parents bring their kids to a paediatrician rather than your friendly neighbourhood GP. The paeds clinic are nicely decorated in bright colours and have play areas for the children. The children arrive in style inside their gi-normous ride, the branded strollers! Parents will then park these ostentatious things strategically so as to block everyone else in their way.

Instead of a quiet and sterile atmosphere, you have kids screaming and wailing at the top of their voice. Instead of adults disciplining kids, they are running after them, coaxing, pandering and bribing them with sweets, iPads and PSPs. The kid has got to wait for the doctor, WAIL. The kid has got to get his temperature taken, WAIL. The kid has got to be auscultated by the doctor, WAIL WAIL. The kid has got to get an injection, both kid and mother WAIL WAIL WAIL.

Of course kids don't cry all the time. Sometimes they enjoy themselves sucking lollipop and leaving their sticky fingerprints and HFMD enterovirus all over the toys. This is when the parents start trying to get them to perform tricks like clapping hands, hi-fives, roll overs, sit, fetch the frisbee..... And the parents coo over their children, "OOoooooo look so cute, ar boy just made an angry face at the doctor." Man, no wonder the kids are pissed; being treated like circus monkeys.

And me in a not too distant clinic room (heng I don't see kids) can almost hear those kids shouting, "WE ARE THE KINGS, YOU OLD FROGGIES GET OUT OF THE WAY!"

Moral of the story?

from http://www.beansbeans.blogspot.sg/

If you don't know what to dress up as during Halloween, why not try dressing up as one of these little devils. They will surely scare the hell out of your healthcare-worker-friends!!!

The (Flat)Line Between Life and Death

Disclaimer: All characters depicted dead or alive are fictional. Any resemblance is purely due to your own imagination.

One of the first thing you learn as a medical student is that in Medicine, 1 + 1 is not always equal to 2. To put it simply, if the ah pek (whom I often abuse in my many stories) take two Viagra, he is not going to enjoy himself twice as much. This was not an easy concept to grasp for someone like me who liked hard concrete numbers and predictability. 

Eyes Wide Shut!

The fact is that things are never straightforward in Medicine. They are never black and white but shades of grey. Unfortunately these shades of grey applies to Death as well. How do we really know if someone has died? Is it after that last breath he took like in the movies? But what if his heart is still beating? What if his brain is still thinking? And what if his eyes are still looking?

Flatline - Asystole

To verify and pronounce death, the attending doctor has to first make sure that all resuscitative efforts have failed or the criteria of not resuscitating are met. There should be no pulse, no breathing, the pupillary reponse to light and corneal reflex are absent and there is no response to painful stimuli. In the hospital, an echocardiogram (ECG) has to be performed to show a flatline.

On call one day, I was asked to attend to an elderly patient who had collapsed. He had the DNR (Do Not Resuscitate) status and there was really nothing much I needed to do. By the time I was there, there were no pulse or breathing on auscultation, no constriction of the pupils when the torch light was shone on his eyes and no response on sternal rub or supraorbital pressure. I hooked up the ECG lead from the defibrillator but there were still wriggly lines and waveforms on the monitor. I needed that flatline and a printout to demonstrate asystole (complete stoppage of the heart) before I can pronounce death. The time indicated on the printout is also used as the time of death.

After waiting for a few minutes, the ECG did not looked like it was going flat any time soon. I instructed the nurses to keep the monitor on and to call me when there is a flatline as I had another emergency to attend to. In the middle of the night in the hospital, you are IT and I had no time to waste.

15 minutes later, I was back up in the ward. When I got to the bed, I was shocked to find the bed empty! I ran frantically to the nursing counter and one of the staff nurse told me that the patient had been pushed to another room to be with the family for mourning. I went, "What the fxxk! What about my ECG strip!"

The staff nurse reassured me that she had already printed the strip and proudly passed it to me. I took a look and went, "What the fxxk! This is not a flat ECG!"

My heart literally sank as this was not a flatline ECG and was STILL full of wriggly waveforms. The patient has technically not be pronounced dead and I needed to retrieve the patient / the body to get the proper ECG! I had no choice but to sheepishly enter the room where the patient /body was with an ECG machine. About 8 relatives were by the patient /body wailing loudly. I was a junior doctor then but I knew that approaching emotional relatives often resulted in catastrophic outcomes. I apologised to them for interrupting and asked if the relatives could excuse themselves for five minutes. Miraculously (yes in Singapore, nice relatives are miracles!),  they were kind enough to comply. I managed to get my ECG strip and quickly returned the room and the body to the relatives.

As I stared at the flatline on the ECG strip, I wondered if there WAS a distinct line between life and death.

Perhaps we will find out for ourselves one day...

or perhaps we won't...

Toilet Games Part 2

Someone left a comment that PJ / pang jio / urinating takes only a short time and the doctor should just go ahead. Of course not every lokun will hold his bladder for his patients (sounds darn wrong but I have no other way of putting this across). I have caught Medical Officers leaving halfway during their clinics to eat fishball noodles in the market across the road while their patients were waiting for them. For me, I really don't like to keep my patients waiting. When I go for my own medical appointments, I go on time and I expect to be seen on time. Likewise I try my best to accord the same courtesy to my patients.

A full clinic runs for about 4 hours. You would think that it is actually quite reasonable for a toilet break of 15 minutes to be included in a typical clinic schedule. But the hard truth is that in Singapore, none of the clinics in public hospital have toilet breaks scheduled. In fact the administrators like to double book or triple book a slot. Which means you are always trying to catch up and there is really no time to go pang jio la. It is not like Dr Og never feedback about toilet breaks to senior management but they just laugh in my face. You can't hold your urine, you better not be a doctor :(

Say I bochap that the patients wait until frustrated and still leave the room to pang jio pang sai, the patients see you leave the room dunno go where sure even more pek chek. Wah like dat sure tiok complain. But it is also quite strange for the clinic staff to broadcast through the PA system, "Dr Og from Room 10 going toilet ar, tolong tolong you all wait a while. He tahan a few hours already."

Some clinics also don't have staff toilets. So you quickly cheong out of the room, avoid the stares of all your patients waiting, cheong into the toilet, start PJing into the urinal, only to realise the person next to you in the next urinal is your patient! Worse, he looks over to your side and says, "wah lokun you very stress isit, stream very weak leh."

You get my point la.

For the above reasons, I prefer to just finish my clinic before attending to my physical urges. But hor, sometimes it is sibei irritating when patients are already late (by alot alot) and when you try to call them in for the consults, the nurse tells you that they have gone to the toilet. Some lagi jialat ones will even go makan first! Wah lau, hospital toilet and canteen very nice meh?

But then I suppose its wrong to expect patients to hold their urine like their doctors. After all, we have years of training through:

1) Medical Student: long boring lectures with super fierce lecturer who will kill you with their stares if you walk out
2) Junior Doctors: Super long ward rounds with lagi fierce Consultants who will kill you if you walk off from the round
3) Senior Doctors: Super long meetings with Chief Medical Board and/or Chief Executive Officer who will kill you if you walk off in the middle of their motherhood statements

(Please do not try to emulate these stunts at home. Like I say, doctors have had special training.)

Hari Raya Haji

Dr Og wishes all Muslim friends and colleagues,

Selamat Hari Raya Haji!

Toilet Games Part 1

From "http://blogs.telegraph.co.uk/news/donatahuggins/100166145/owen-jones-the-new-dave-spart-fearlessly-champions-the-right-to-proper-toilet-breaks/"

Dr Og often feels that one of my duty as a doctor is to dissuade others from joining this terrible profession. If you read my past posts, you would have realised that most of them are horror stories meant to give young impressionable pre-university (I don't dare say JC or not wait say I elitist) youths nightmares on the very mention of medical school. So here goes another one...

As a medical student, it became very apparent quite quickly that to be a good doctor, you have to be quite in control of your feelings. There can be emotional feelings and there can be physical feelings. Even as medical students, we became desensitised to emotions rapidly and soon acted like numb and unfeeling robots. It serves its purpose well when you have to tend to emergencies like resuscitation. You would rather be remembering resus algorithm and dripping sweat than to be all emo and shedding tears. After all, its enough that the nurses are already running around in panic like headless chickens. They are allowed to but as a doctor you ARE NOT. Period.

Whilst Dr Og never had much difficulty controlling my tears (as men we sooner shed blood of the non menstrual kind), I cannot say the same about controlling other orifices where fluids may overflow. Yes, this sounds gross but my blog has never been meant for the weak hearted and you chose to read this, did you not.....

Physical sensations are sometimes almost impossible to control. One day, I was sitting in an orthopaedic clinic as a 4th year medical student and the clinic ran from 9am to 1:45pm. During this time, the kopi-O-gow I had earlier was working its diuretic wonders. But those were the days when you guai guai sit in the clinic room to wait for the doctor you were tagging to come and left the room only after they left first. Going anywhere during the clinic session will earn you cold hard stares from the doctor and nurse and so going to Pang Jio (urinate) was never an option!

At the end of the clinic, the surgeon had obviously noticed my urgency from the frequent crossing of legs to aid my urethral sphincter. He patted my back and said, "You know, to be a good doctor you have to be able to hold your urine and tahan hunger! You will be ok next time. Come let me buy you a sandwich for lunch then we start afternoon clinic in ten minutes"

But..... er, Sir... Can I go for a toilet break first.

You know, last time when matah wore shorts......

You see, as people get older, they like to talk a lot about the past. One of the things that junior trainees get most frightened of is kennah stuck with the lao kok kok professor or senior consultant. 

If you are lucky, you may be listening to his life story for the first time in a nice restaurant over lunch. He will tell you how he struggled through a poor family and had to study with a candle. Nevertheless, he managed to get into medicine and eventually became the godfather of the fraternity. He will tell you how he had wanted to be in another speciality but fate has it that he was rejected and therefore he is in the present one (which explains why he hates a certain speciality so much). At times (if you are really lucky) he will share how he eventually fell out with his long time teacher and mentor or how he used to be best buddies with another prof but he cheated/ framed/ made used of him. Sometimes (if you are really really lucky), he will tell you how he had wished for his son to follow his footsteps but he did just the opposite. All these are really interesting and gives you a perspective into why so and so cannot be seated in the same table during the faculty dinner. This also may just keep you out of trouble by preventing you from offending one prof because you openly praised the other.

If you are unlucky, you may just have been caught by the prof at the corridor and you are standing there listening to the same story for the nth time. You know exactly what the prof is going to tell you next as you have already (by passive diffusion) memorise his whole life story. You are post call, tired but you seem to be nodding as if you are interested. Actually, your tired neck muscles can no longer hold your head in place and you are just falling asleep. At times (if you are really unlucky), you may really need to go pass urine but the prof just does not recognise the urgency (pun intended) in your contorted facial expression. Sometimes (if you are really really unlucky), his unfilial son has stood him up for dinner again and he invites you to continue the conversation at the same damn restaurant (so that he can continue the torture). All these putting up with the prof is necessary as he still yields power in the fraternity. This may also be the only reason you are still surviving as you have managed somehow to offend the other prof and guru in the speciality. But this one likes you as you are the only probably the only one who listens to his story.

If you are a girl, you may be with the (humsup) prof in the Alumni Building... but that is another story for another day... not sure lucky or unlucky... haha...

Mai Jiak Yok!

Lokun: Uncle you drink alcohol?

Ah Pek: Ya, I lim jiu with my kah kee at the kopi tiam every night. Song song drink until midnight den go home. You know la, dun wan hear the wife nag nag nag.

Lokun: Smoking?

Ah Pek: Wah I smoke more than 30 years. You dun ask me quit ok. They say too old quit smoking can die one! Now hun kee very ex, I only smoke one pack a day niah.

After completing the rest of the clerking...

Lokun: Uncle, looks like your condition like that need to take medicine. This one you take one tablet twice a day.

Ah Pek: Wah... like that ar... Mai jiak yok er sai boh (Don't take medicine can or not?). You know western medicine got a lot of side effects. You see the bottle here write POISON! Jiak liao sure tiok tiao! Will dependant cannot come off.

Lokun: No la. This medicine ok one. Anyway your condition needs it.

Ah Pek: Mai la mai la. Medicine no good one. Got anything natural or not??

It often fascinates Dr Og how patients are so paranoid towards "Western medicines". It is of course true that medications have side effects (sometimes severe) and drug companies have in the past attempted to play down on the side effects. But it really irks me when people who smoke and drink tell me they are afraid of taking medications (for fear of dependency and ill effects). Seriously? With all that addictive poison that you are already putting into yourself?

Now, if they stop smoking and drinking, they may actually not need the medications. 

An Interview with the...

Dr Og continues with his investigative journalism this week.

He tried to interview several big shot administrators on but they all siam like Dr Og tiok coronavirus. But  don't worry la, Dr Og never go Middle East recently. Admin people don't so scared leh.

Finally, one person agree to talk to Dr Og.

Let me introduce Ah Tiong, The Security Uncle.

Dr Og: Uncle, how long  have you worked in this hospital?

Uncle: Ten years liao lah. (blow smoke out of mouth)

Dr Og: Wow! Thats a long time!

Uncle: Si lor, lao liao. 

Dr Og: So what are your main duties?

Uncle: I security guard lah, just go jalan here jalan there lor.

Dr Og: You mean you patrol the area. What else do you do?

Uncle: Ar. This one important. We catch doctors.

Dr Og: You mean you catch doctors?!!! What do they do? You mean those doctors piak piak in their office with reps kind? (wink wink)

Uncle: You know la, lokuns like to park car any old how. See those lots in front? Only patient can park la. So if the lokun park, I catch them! And sometime also issue summons. Hahahahaha.

Dr Og: But uncle, but don't you think its a waste of your time to be "catching"doctors? What if they are rushing to see patients and cannot find carpark.

Uncle: That's not lim pek problem ok. CEO say I stand here catch doctor, I catch doctor. (Uncle buay song liao!)

Dr Og: But uncle this hospital just build leh, you don't think very stupid they never project properly and never build enough carpark meh? Also, if the doctor not there yet, patients also can't be seen. Can sometimes pang chance boh?

Uncle: You si ginah. What projection? Don't tell me all the cheem stuff. You not happy go see the CEO or COO or CFO or dunno what O. I going to get my ten year service award and best (catch doctor) service award at Dinner and Dance next week liao. I need the NTUC vouchers from the awards to buy hoon kee (cigarettes) can!??!?! Oh yah, I dressing up as policeman in D and D. You leh?

IT sibei Ho!

Recently my friend who was in charge of the IT implementation of his department told me that the new electronic medical record system is sibei solid.

Well, Dr Og suay suay kennah do IT systems in hospital many years. All I can say is that my youth was wasted (sob sob...) and the time spent evaluating IT systems for the hospital could have been better spent surfing the net for boh liao things (at least that would have brought me some joy tio boh?).

Anyway, since we good friends, I entertain him and ask him why so solid leh?

"You know ar, this time the system hospital want to buy is very customisable. Last time all the systems have to input this input that but this one no need! Means ar the old old lokuns who only want to write a few words in the electronic notes can be easily done. So the lao lokun can just type 'NAD' for notes can liao wor!"

Apparently, this current system costs a few million bucks unlike the cheap cheap ones we evaluated in the past. Understandably, it is more time consuming to be typing notes rather than writing them on paper when seeing patients.

Hmmmm, but to pay few millions so that we can over ride the system to type less...

Hmmmm, nothing that can't be done with simple paper and pen...

IT sibei ho ar!

I rest my case.

Never Learn

Some nice reader left a comment that I must be busy as I have not been blogging recently. To be honest Dr Og had been quite boh eng... this game called Candy Crush has been really sucking up all my time.
Since I kennah stuck at some stupid stage now, I thought take a break.

In between games, Dr Og somemore got to go queue up at MacDonalds... at first for Hello Kitty then the Minions. Really sibei boh eng ar...

The worst thing was when queueing up for Hello Kitty some more got haze! It was really terrible queueing up in the N95 mask and having flashbacks of SARs days.

So while I queue here and queue there, a good friend who works in hospital admin called me.

"Eh brother, you got N95 masks or not?"He ask me.

"Yah la, still got some."Dr Og is a hoarder and I still have those 10 year old N95 masks from SARS days.

"Ooi, don't mind pass me some can?"He pleaded.

"But I thought you work in public hospital, how come no mask ar?" I was puzzled.

"Yah la, the hospital short and now cannot sell to staff...." He replied angrily.

"Wah liao!"

In the end I gave away all my N95s and had to use my recycled nuar nuar (rotten) one.

So it seems, always like that loh. Masks no enough, don't take care of own people and panic only when things happen.... what is new.

Remembering SARS - Part II

We know that ward sisters like to hoard stuff. Can be pens, rulers, toilet papers, swabs and a variety of other daily supplies. I had always conveniently attributed this to our frugal ways since Singapore was a third world country not too long ago. Though of course when you need something in the ward it can be really frustrating. One example was disposable ECG leads. We were always made to reuse ECG leads sometimes to the extent that it is full of (many) patients' (many) hair and was no longer sticky. If you have the experience of holding on to loose ECG leads with your fingers and trying to use your leg to press the start button on the ECG machine, you will know how frustrating and humanly impossible that can be.

Inconvenience is one thing that I can accept. Potentially dying is not. 

When SARS first struck, some ward sisters decided it would be a good idea to hoard the N95 masks. With the virus full blown in Singapore by April and fatality climbing, the possibility of getting infected and dying became real! It was like a movie playing around us, somewhat surreal. Perhaps for some in the hospital, they continued to be in denial.

Being the lowest lifeform in the hospital then as a houseman, we were bounced around each day when we try to get our daily stock of N95 masks. We were told by the ward to get it from the OT but the OT told us that the supply there is only for surgeons operating. When we asked the ward, we were told by the ward sister that there was no stock.

"Zero, no more stock." She told us affirmatively.

We retreated to the MO Room to how our usual kpkb support group sessions.

"Er, I saw the sister carry so many boxes into the nurse manager room leh! How can be no stock ar!!???" One friend cried foul as everyone started complaining loudly.

"Wait ar....." Another fellow houseman stood up and shouted before exiting the room and crouching slowly towards the nursing manager's room.

He disappeared out of sight for a few minutes and returned to the MO room with one box of N95 masks. Enough to last us for a couple of days.

"Wah you went to sister's room and kapok ar?" I exclaimed.

"Well, you can't steal that which does not exist in the first place." He told me with a wink.

RESPECT...

In the next few days, N95 masks became readily available with the hospital's official decree. 

SARS despite being all bad did improve infectious control in the wards. I'm sure ward sisters won't hoard disposable ECG leads anymore these days. Even if its not unhygienic, reusing leads with hair-stuck-on, seriously gross la.

Remembering SARS - Part I

Early March 2003. 
A new strain of virus have been reported and was apparently causing deaths in countries like China, Hong Kong and Vietnam. A recommendation was made for doctors who were seeing feverish patients to don N95 masks in addition to other universal precautions. 

I was a junior (very junior) doctor in a surgical unit. Honestly, I was never surgically inclined and this was just one of those postings I had to pass through. In fact I was near the end of the posting and celebrations were round the corner. 

The news of the new deadly viral strains were causing some concerns but no one seemed to really care, definitely not the nurses. When I questioned them why they were not wearing masks when treating febrile patients, they laughed in my face.


"Why, you scared is it... hahahha......"


Is China, HK and Vietnam really that far away? I asked myself.  


One night, I was asked to see a febrile patient with abdominal pain. He had a travel history. I asked the ward  staff for a N95 mask. The nurses refused. I asked to speak to the nursing officer. 


"Aiyah, its just appendicitis. Why you need the mask?" She said, attempting to dismiss me. 


I insisted on the mask and threatened not to see the patient if not given. She could have called my bluff but she relented begrudgingly and not before making threats about how my Consultants would hear about this.


After slapped the mask into my hands and she couldn't help adding, "You better keep this with you for one week. This very expensive mask!"


None of us would have known that this very nursing officer would be the one who will soon be going after doctors who did not follow infectious protocols as the pandemic exploded  in our face soon after.


In the next week or two, the new viral strain was named Severe acute respiratory syndrome SARS)  and the very first cases appeared in Singapore.

Thank You

After a long while in a place, Dr Og decided that it was time to move on. And when you are no longer useful to an organization, you suddenly realise how much they really do care about you..... they don't. Well, it can be rather disconcerting and sad, especially when this Dr is narcissistic and suffers ego bruising easily, but as the Chinese saying goes, short pain better than long pain.

So here I was sitting at my new office opening up envelopes and in one of them I found a thank you card. It was from a patient (from my previous hospital) and his family wishing me all the best. I'm sure the little kiddo was made to sign the card rather unwillingly. Hahaha. It was a nice simple card with a nice simple message.

But seeing the card, I knew that the time I spent in my previous organization was not all in vain (wished I've done less silly admin work though).

Thank you for the card, it was important for me :)

Dr Og's Off-White Paper on Preparing Singapore Healthcare for 6.9 Million People

Dr Og is apolitical and will not comment on the quality of toilet paper in public hospitals let alone the recent White Paper on Population. Honestly Dr Og is a small lokun with little helicopter perspective and the last time I comment on TCM also tio scolded... haiz

Anyway, whether in 2030 we got lak bak gao chup ban lang (6.9 mil) or not, Dr Og thinks we better start preparing our healthcare system and hospitals. Don't goondu goondu buy super tight skinny jeans and discover after Chinese New Year all the goodies cannot wear liao, right!!??!!

So Dr Og presents his:

Off-White Paper on Preparing Singapore Healthcare for 6.9 Million People (And A Core of 3 Million Singaporeans).

1. Health Promotion

HPB monkey! Source: HPB loh

Health Promotion Board has always been very solid in providing educational materials to promote good health and well being. From animals to vegetables, their adverts (almost) always strike a cord with fellow Singaporeans. In fact I think they are well prepared because the mascots they use are very international, like generic elephant, giraffe and monkey instead of recognizable local species like orang utan or dugong. So our ever increasing international crowd will have no problems identifying with these beasts.

However, in my Off-White Paper, I will like to propose having overseas health promotion! After all by 2030, most of our residents will be foreigners. It will be too late for any brainwashing form of health promotion by the time they are parachuted in at their middle age. And don't you want to see those HPB monkeys speaking in Tagalog?

2. Training of Doctors
If you are not in the medical line, you may not know that postgraduate / specialist training for doctors has undergone a major change in the past few years. We have cleverly adopted the American system of residency training (think Dr Doug Ross (George Clooney) in ER or Dr Meredith Grey (Ellen Pompeo) in Grey's Anatomy). That's cool right? Particularly when we are becoming a really international nation.

What is even more cool is that while the old training trains doctor to be fast and accurate when seeing patients, the new residency programme allows the trainee doctors to slowly take their time. But with 6.9 million where got time, tio boh?

Therefore in the new residency, not only need to learn how to see patients fast fast, also need to learn to hold urine and skip lunch. The exams will not be about clinical work but how long your bladder can tahan before you need to use rubber band (for guys, for girls, can someone from the female sex advise?). Indeed, with 6.9 million people, there will just be people(not urine or faeces) overflowing toilets lor!

3. Improvements in Hospitals
3a. Increasing Hospital Beds

Hospital Beds in 2030!

Given that there is simply a lack of hospital beds now with just 5.3 million people, there needs to be innovative ways of increasing hospital beds! We are already parking beds on corridors. So Dr Og suggest triple decker beds! Never mind if its so crowded until like those 雾锁南洋 (The Awakening) refugee boats! By then we all will be so use to being pack like sardine and be totally desensitized!

Since there are so many water features and ponds in hospitals, we can also have floating beds on them. So patients can now truly enjoy the soothing sound of water running. These luxurious water beds will of course only be opened up to rich private patients.

3b. Translators

Being truly international, we need to hire translators. No, we do not need translators for the various South Asian or exotic European languages. First we need English to English translators. Strangely in the hospital, everyone speaks English but nobody seem to understand each others' English because of the accent. For eg. we will need a translator for someone to translate Indian English to Singlish or from American English to Filipino English. The combinations are scarily more than Street Fighter 4 combos and we need to hire translators now!!!

Secondly, we will also of course need translators for our local spoken languages and dialects as we will soon be the minority. Even now, our ah pek ah emmm are having a hard time communicating with the medical staff in the wards and clinics!

4. Engage TCM and  other traditional healers
My last suggestions. Get TCM and traditional healers to help out! Sure, they don't practice evidence based medicine but so what? There are 6.9 million people can?!! And all deserve some form of medical help right?

Mostly, I'm adding this in to appease the dude who posted an angry comment on my TCM expose. :)