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!

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...

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...

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.

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. :)

My humble thoughts on the SMRT Strike 2012

So now they officially call it a strike. And as you know, strikes are illegal in Singapore.

Nowadays COE so expensive, Dr Og also gotta take public transport. Compared to many countries, our transport system is very steady (bom bi bi) liao loh. In some countries, strikes are so common that they become a part of daily living. But usually, you have local people buay song their gahmen unlike in our case.

The Straits Times yesterday (not me hor) aptly pointed out  that Singapore is so reliant on foreign labour and talent even in healthcare sector.This to me is quite scary.

If strike how?

As we approach the ten years anniversary of SARs (Severe Acute Respiratory Syndrome - Singapore, 2003) and with news of a new strain of coronavirus (SARS-Like Virus Resurfaces And Infects A Family In Saudi Arabia) lurking, I can't help but wonder whether we can depend on any other than Singaporean healthcare workers should another pandemic erupt.

5 Steps to Becoming a Truly Patient-Centred Public Hospital

See Ma! Got carps and cigarette butts!

Hospital admins are always talking about missions and visions and senior management is always harping about patient centred care. But honestly, when you go to a hospital, do you feel like the hospital is meant for you the patient? When you want to get admitted, sure tell you not enough beds and kennah stuck in A and E. In fact, you may not even be able to find a car park space for your Mercedes in the first place! 

No scared. Dr Og reveals the 5 secret steps to becoming a truly patient-centred public hospital!!

Step One - Have a Lottery Store
Buying Toto and 4D are undoubtedly the favourite past times of Singaporeans. How can miss buying your lucky numbers just because you are admitted to hospital right? If you miss, the number sure come out one! 

Hospitals should have a lottery store right in 7-11 or Cheers like our HDB estates la. To make things easier, let the ah mahs (cleaners) in the ward help patients collect bets and earn some tips for themselves. In OT last minute before the anaesthesia sets in can also put last order. Its win-win for everyone!

Step Two - Have More Yellow Boxes
Ok, Dr Og knows this is controversial. Yah lah, smoking is no good. But isn't it cruel to make the ah pek with COPD (panting) crawl all the way out of the hospital boundary to smoke? Have a heart, condone off more yellow boxes in the hospital for them to smoke. 

But have our medical social workers station there to provide counselling and nag at all of them about smoking. This will also increase the work scope of our MSWs and stop them from complaining about "everyday only do financial assessments niah..."

Win-win again!

Step Three - Treat Your Doctors Better
Look. The simple fact is that patients go to a hospital to see doctors and to get treatments. You can have the most friendly counter staff around but all the patients really care about are the 15-minute consults where they get to interact with the doctors.

Du Lan (angry) Doctors (DLDs) are not going to be very nice to patients are they? DLDs will spend every waking moment in angst and in opposition to the hospital administration. All there are in their minds are how to siam the next admin meeting / hospital lecture on anything but patient care and how they will really like to trip the CEO as he walks out of his office before giving him a good piece of their mind. 

Yup, DLDs are not effective doctors. Is it really that difficult to make doctors happy? See my next post lah!

Wah Waterfall. Well done CEO!

Step Four - Kill the Water Features
I can understand why all CEOs want a pond or a fountain in their hospital. The official story is that the kois and sound of running water are soothing to our patients. In reality, the CEOs are probably comparing "is your pond bigger than my pond" during MOH meetings! Honestly, how many patients you ever see going to enjoy the water features? They are becoming places for people to throw rubbish and their unwanted neon tetras. Also poses a danger for drowning (don't look down on shallow waters ok)!!! Water features are useless, waste water and waste money. Get rid of them, make better use of the space (like 4D shops, yellow boxes or maybe extra hospital beds) and show that you are committed to patient care.

Otherwise, get rid of the CEO.

Step Five - Change Hospital Name Can??
Last time very easy. Hospital in Changi called Changi Hospital. Or named after Singapore. Or at the very least named after a great historical pioneer and philanthropist. Now suddenly named after people Dr Og has never heard before one. Must google then "ohhhh is the ancestor of some rich family." 

You really think our ah peks and ah mahs can remember all these names?? Now you ask them where they are when you do orientation, they all tell you they are in Tan Tock Seng coz thats the only hospital with a human name that they know.

So change the name back to like Yishun General, Jurong General before even the taxi drivers get confused. 

Especially when its impossible these days to drive to a hospital (even new ones) as there are no carpark one!!!!