Am back from the US. Am extremely jet-lagged and tired now due to the non-stop traveling.
It's time for me to make some decisions now. However, the ball is not just in my court. It's a two-way system. The US programs have to want me and vice versa. I just need to decide which programs do I want and hopefully, they feel the same about me.
All will be revealed in mid-March.
Meanwhile, I need to get started on my list of things to do which has been accumulating and accumulating. Not to forget another exam and more assignments to complete.
I think I bite off more than I can chew.
Sunday, 18 January 2009
Saturday, 10 January 2009
US trip
Am off to the US today for a week. It will be an important week for me as it will determine if I decide to move to the US to further my postgraduate medical training.
Lots of people have asked me why I am considering moving to a new country for training when I am already established in the UK training system. To be honest, I don’t know but somehow, I feel as if I am not getting the training I need here in the UK. It could just be due to the hospital I am working in, which might improve if I move to a different hospital. Don’t get me wrong, I have really enjoyed my time working in my current hospital. I have met really friendly and helpful consultants and registrars who have taught me well. But somehow, the daily grind is wearing me down. I can feel my enthusiasm for going to work each day decreasing day by day.
Maybe all I need is a good break, a good holiday.
Or maybe I am getting restless and would like to explore new pastures.
We shall see…..
Lots of people have asked me why I am considering moving to a new country for training when I am already established in the UK training system. To be honest, I don’t know but somehow, I feel as if I am not getting the training I need here in the UK. It could just be due to the hospital I am working in, which might improve if I move to a different hospital. Don’t get me wrong, I have really enjoyed my time working in my current hospital. I have met really friendly and helpful consultants and registrars who have taught me well. But somehow, the daily grind is wearing me down. I can feel my enthusiasm for going to work each day decreasing day by day.
Maybe all I need is a good break, a good holiday.
Or maybe I am getting restless and would like to explore new pastures.
We shall see…..
Friday, 9 January 2009
I survived!
Oh what joy! I survived my first week of nights on the unit.
Phew!
And repeating the same process in early February and late March. Hopefully by then, I would have had more experience and no longer be so stressed out.
Phew!
And repeating the same process in early February and late March. Hopefully by then, I would have had more experience and no longer be so stressed out.
Wednesday, 7 January 2009
Stressful sleeping
Am having extreme difficulty sleeping for the past few days. The reason for this is because I am currently working the night shift on the unit. The stress of working the night shift is giving me sleepless days, as I keep on worrying about my shift.
Why am I so stressed? Let me explain.
During the night shift, I am the sole doctor in the unit. I look after 14 patients in the unit. Patients with multi-organ failure and are the sickest of the sickest. Me! A doctor who is only 18 months out of medical school. Of course, I have been told that the on-call consultant (who is at home) is just a phone call away and I can call them for any queries/problems/issues that I have. Furthermore, the on-call consultant lives very close to the hospital and if needed, they can arrive within 5 minutes at the hospital.
Besides that, I attend cardiac arrests and take referrals for admission from other specialties. Luckily for me, I don't make the decision whether to admit or not. I review the patient, gather the information and present the information in a coherent and succinct manner to my consultant (over the phone). And what worries me is that there is a potential that I might not present the information correctly, thus resulting in a wrong decision made, which could either be
1) Admitting a patient who actually doesn't need intensive monitoring
or
2) Turning away a patient who actually does need intensive monitoring
(I prefer scenario 1 rather than 2, obviously)
In some patients, it's very easy to tell that they need admission to the unit. It is the grey cases where they seem to be manageable on the ward but have the potential to deteriorate which makes it difficult to decide whether to admit them or not. Of course, if we had unlimited resources, we could admit everyone but this is not the case. A bed in the unit is a precious commodity which should only be used if necessary.
Now, you understand why I am so stressed out?
Why am I so stressed? Let me explain.
During the night shift, I am the sole doctor in the unit. I look after 14 patients in the unit. Patients with multi-organ failure and are the sickest of the sickest. Me! A doctor who is only 18 months out of medical school. Of course, I have been told that the on-call consultant (who is at home) is just a phone call away and I can call them for any queries/problems/issues that I have. Furthermore, the on-call consultant lives very close to the hospital and if needed, they can arrive within 5 minutes at the hospital.
Besides that, I attend cardiac arrests and take referrals for admission from other specialties. Luckily for me, I don't make the decision whether to admit or not. I review the patient, gather the information and present the information in a coherent and succinct manner to my consultant (over the phone). And what worries me is that there is a potential that I might not present the information correctly, thus resulting in a wrong decision made, which could either be
1) Admitting a patient who actually doesn't need intensive monitoring
or
2) Turning away a patient who actually does need intensive monitoring
(I prefer scenario 1 rather than 2, obviously)
In some patients, it's very easy to tell that they need admission to the unit. It is the grey cases where they seem to be manageable on the ward but have the potential to deteriorate which makes it difficult to decide whether to admit them or not. Of course, if we had unlimited resources, we could admit everyone but this is not the case. A bed in the unit is a precious commodity which should only be used if necessary.
Now, you understand why I am so stressed out?
Monday, 5 January 2009
The value of life
A fit and healthy 65-year old man was hit by a motorcycle while out jogging in the evening and was admitted to a district general hospital. On examination, he was found to have suffered a complicated fracture of his hip, which required specialist input. He was due to be transferred to a tertiary medical centre for further management. Unfortunately, due to the shortage of beds, he waited 6 days before being transferred.
On the day of his operation, as he was lying on the operating table, he suffered a cardiac arrest secondary to a massive pulmonary embolism (clot in the lungs). They performed CPR for a total of 45 minutes before a return of spontaneous circulation was obtained. Unfortunately, during that time, the brain lacked oxygen and he suffered hypoxic brain injury.
The operation was postponed and he was transferred to the unit for post-cardiac arrest management. Following stabilisation of his condition, he had his operation 2 days later. Unfortunately, his neurological status never improved due to the prolonged hypoxic brain injury.
What is the next management plan for him? What will his quality of life be? Considering that he will very likely be mentally-disabled for life, is prolonging his life in his best interest?
Difficult issues to consider, difficult decisions to make. What would you do?
On the day of his operation, as he was lying on the operating table, he suffered a cardiac arrest secondary to a massive pulmonary embolism (clot in the lungs). They performed CPR for a total of 45 minutes before a return of spontaneous circulation was obtained. Unfortunately, during that time, the brain lacked oxygen and he suffered hypoxic brain injury.
The operation was postponed and he was transferred to the unit for post-cardiac arrest management. Following stabilisation of his condition, he had his operation 2 days later. Unfortunately, his neurological status never improved due to the prolonged hypoxic brain injury.
What is the next management plan for him? What will his quality of life be? Considering that he will very likely be mentally-disabled for life, is prolonging his life in his best interest?
Difficult issues to consider, difficult decisions to make. What would you do?
Saturday, 3 January 2009
Rest in peace
Case 1 : Elderly man with past medical history of Crohn's disease, and has had multiple abdominal surgery in the past, was admitted for acute confusion and high temperature. Blood results showed severe sepsis with a coagulopathy, while the CT abdomen showed multiple collections in the abdomen. Was transferred to the unit for stabilisation prior to surgery which involves correcting the coagulopathy with multiple blood products. Had a laparotomy by the surgeons which involved removing 3/4 of his large colon and then transferred back to the unit for further management. On Christmas eve, he suffered a massive myocardial infarction (heart attack) of which the risk of treating outweighed the benefits due to his coagulopathy. Family and unit consultants agreed for conservative management and the patient was transferred to the ward for palliative management. He died on Christmas Day.
Case 2 : Elderly woman, known alcoholic abuse, admitted on the eve of New Year's Eve for shortness of breath of 2 days duration. Daughter reports patient normally drinks a lot (unable to quantify) but has been drinking more than her usual amount since Christmas Day. Initial diagnosis was community-acquired pneumonia and was started on antibiotics. However, due to the lack of respiratory symptoms of cough or sputum, a pulmonary embolism was suspected. A CT pulmonary angiogram was performed which was unable to rule out a pulmonary embolism. Patient started on treatment for PE. While on the ward, she suffered a respiratory arrest and was found to be in pulseless electrical activity. Appropriate cardiopulmonary resuscitation (CPR) was performed. Patient intubated, ventilated and transferred to the unit on New Year's Eve. Despite adequate ventilation, she developed renal failure (requiring dialysis) and heart failure (requiring inotropes). Due to her progressive deterioration, the family and the unit consultant agreed to withdraw treatment to prevent prolonging death. Terminal weaning plan was started and the patient died on New Year's Day.
Looking at the 2 cases, they are both individuals who, despite all our intervention, did not survive. However, there is more.....
What would you say if I told you that case 1 and case 2 are husband and wife? May they both rest in peace.
Case 2 : Elderly woman, known alcoholic abuse, admitted on the eve of New Year's Eve for shortness of breath of 2 days duration. Daughter reports patient normally drinks a lot (unable to quantify) but has been drinking more than her usual amount since Christmas Day. Initial diagnosis was community-acquired pneumonia and was started on antibiotics. However, due to the lack of respiratory symptoms of cough or sputum, a pulmonary embolism was suspected. A CT pulmonary angiogram was performed which was unable to rule out a pulmonary embolism. Patient started on treatment for PE. While on the ward, she suffered a respiratory arrest and was found to be in pulseless electrical activity. Appropriate cardiopulmonary resuscitation (CPR) was performed. Patient intubated, ventilated and transferred to the unit on New Year's Eve. Despite adequate ventilation, she developed renal failure (requiring dialysis) and heart failure (requiring inotropes). Due to her progressive deterioration, the family and the unit consultant agreed to withdraw treatment to prevent prolonging death. Terminal weaning plan was started and the patient died on New Year's Day.
Looking at the 2 cases, they are both individuals who, despite all our intervention, did not survive. However, there is more.....
What would you say if I told you that case 1 and case 2 are husband and wife? May they both rest in peace.
Friday, 2 January 2009
Auld Lang Syne
Went to work as normal on New Year's Eve, and managed to finish work at 6-ish pm. Then, it was a dash home to shower and change for a small gathering at a friend's house for dinner. As my friend had no television or radio, we resorted to using the internet for BBC radio 1 to listen to the countdown. I had an enjoyable time despite my emotions running wild as a month back, this was not how I had thought I would be celebrating the New Year. But then again, who could have predicted that it would have ended up this way?
New year's resolution. Hmm... Looking back at 2008, I realised that I had not been looking after myself. Due to my now-ex-relationship, I had become too complacent and had slack off in many areas, particularly exercise and beauty care. For 2009, I resolve to look after myself first and to make an effort to pick up where I had slack off.
And I hope that I get over this current predicament that I am facing, and that I will also be able to find it in my heart to forgive him.
The passing of the new year will not be complete without the song Auld Lang Syne. A song that I know very well but never knew the true meaning of. Auld Lang Syne is a Scottish poem written by Robert Burns in 1788 and is set to the tune of a traditional folk song.
And for old long past, my joy (sweetheart),
For old long past,
We will take a cup of kindness yet,
For old long past,
Should old acquaintance be forgot,
And never brought to mind?
Should old acquaintance be forgot,
And days of old long past.
And surely you will pay for your pint-vessel!
And surely I will pay for mine!
And we will take a cup of kindness yet,
For old long past.
We two have run about the hillsides
And pulled the wild daisies fine;
But we have wandered many a weary foot
Since old long past.
We two have paddled in the stream,
From morning sun till noon;
But seas between us broad have roared
Since old long past.
And there is a hand, my trusty friend!
And give me a hand of yours!
And we will take a right good-will drink,
New year's resolution. Hmm... Looking back at 2008, I realised that I had not been looking after myself. Due to my now-ex-relationship, I had become too complacent and had slack off in many areas, particularly exercise and beauty care. For 2009, I resolve to look after myself first and to make an effort to pick up where I had slack off.
And I hope that I get over this current predicament that I am facing, and that I will also be able to find it in my heart to forgive him.
The passing of the new year will not be complete without the song Auld Lang Syne. A song that I know very well but never knew the true meaning of. Auld Lang Syne is a Scottish poem written by Robert Burns in 1788 and is set to the tune of a traditional folk song.
The English translation of the song is as below.
And for old long past, my joy (sweetheart),
For old long past,
We will take a cup of kindness yet,
For old long past,
Should old acquaintance be forgot,
And never brought to mind?
Should old acquaintance be forgot,
And days of old long past.
And surely you will pay for your pint-vessel!
And surely I will pay for mine!
And we will take a cup of kindness yet,
For old long past.
We two have run about the hillsides
And pulled the wild daisies fine;
But we have wandered many a weary foot
Since old long past.
We two have paddled in the stream,
From morning sun till noon;
But seas between us broad have roared
Since old long past.
And there is a hand, my trusty friend!
And give me a hand of yours!
And we will take a right good-will drink,
For old long past.
Auld Lang Syne by Mairi Campbell (from Sex and the City: The Movie)
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