Posted by: Jas | April 5, 2014

Of MET calls & Code Blues

I keep telling myself I should blog more often so that I have a record of things that have happened, so that I can look back and see what I’ve learnt. Maybe I’m worried about breaching patients’ confidentiality. Or maybe I’m just being lazy.

Anyway, I’ve taken a break from ED and I’m currently working in ICU. To be honest, it was all quite daunting at first. I’m looking after the sickest patients in the whole hospital. I’m dealing with complex patients with multiple issues. I’m managing the continuing care of patients when I was used to fixing the immediate problem and handing the rest over to the inpatient teams. I’m now on the receiving end. Don’t even get me started on how disappointed I’ve been in some of my ED colleagues.

2 months in, there is still heaps more to learn, but at least I’m a bit more comfortable in this environment. I’ve picked up lots of procedural skills along the way (art line, CVC, vascath, ultrasound-guided peripheral IVs), and also turned on my physician brain to think about issues such as acid-base balance, fluid balance etc. I’m really thankful for the fantastic support by the other registrars, the consultants, and the nurses.

I remember the first MET call that I attended. I guess I knew what had to be done to treat the patient, but I was definitely very uncomfortable being the one in-charge and making the decisions. However, as I attended more of them, I began to build more confidence and learnt to trust myself whilst seeking advice when needed. It also helps that I know most of the med regs by now (and they, me), which makes it easier to work together.

The first Code Blue that I attended didn’t go very well. Both ICU regs were there, and my co-reg who has some anaesthetics training took charge of the airway while I was helping with CPR. She was sort of running the code, but the whole situation was quite chaotic and on hindsight I felt that I should have stepped up to be the leader so she could have concentrated on what she was doing.

The next Code Blue was a paediatric one that I attended with the senior reg, and we didn’t do much because the paeds reg was happy managing it himself. Then there was one where it was someone who had just been discharged from ED and had collapsed along the street. He was fine by the time we got there and was brought back to ED. At the next one my consultant came up not too long after I had arrived so he took over. The following one was in ED so it was run by the ED senior reg.

It wasn’t until yesterday that I had my first experience at a Code Blue as THE team leader. My co-reg is an anaesthetics trainee, so she headed straight for the airway. This time I clearly stated to everyone there that I was going to be in charge. It was nice that I knew the names of the residents, the med reg & the anaesthetics reg; it’s so much easier to assign tasks directly when you can actually call the person to your attention. Despite a bad outcome for the patient, I think we did well as a team and tried our best to maintain some sort of control over the chaos. Stepped out to call my consultant after 30 mins and when he asked me what I thought was going on, I was kinda at a loss for words. I think he was trying to prompt me to go through the 4Hs & Ts, which we kinda did, albeit a bit haphazardly which resulted in us not thinking about 1-2 possibilities. By then, despite us trying to reverse what we could based on the first VBG, the repeat VBG showed a worse result that was probably incompetent with life. 45 mins in, a collative decision was made that any more resuscitative efforts would be futile. Had a debrief with my co-reg & the anaesthetics reg and I think we all felt that we managed this pretty well. Of course, there is an art to all this and I hope I’ll get better with more experience! Although obviously I’m not hoping for more patients to arrest.

A few different people have asked me if I would do ICU. Perhaps it’s a bit premature to tell, having only done this for 2 months, but I think I still prefer ED for the fresh start at each shift, for the wider variety of procedures, and for the lesser degree of intensity/complexity. I still have 4 months to go, so we’ll see!

Posted by: Jas | December 30, 2013

2013 in review.

It’s been 6 months since I last blogged. I don’t know why I don’t have the motivation to blog these days.

Well, another year is coming to an end, and I must say, 2013 has been a fabulous year for me.

On the personal front:

  • I got engaged to the man with whom I would spend the rest of my life :)
  • We bought a house, finally a place to call our own.
  • Fulfilled one of my travel dreams and visited a few major cities in Europe.

IMG_4251

  • Bought my first Balenciaga bag & first pair of Ferragamo shoes, strangely enough, in the same colour. I say ‘first’ but I don’t know if they will also be my ‘last’ given that I’ve contemplated for a long time before deciding to splurge (and only because it was cheaper in Europe). To be honest I never thought I would buy the bag in Bleu Tropical; I thought I would go for the conservative black/grey. I was attracted to the Rose Corail but already have a Fossil bag in pink. Was flipping through the book of colour swatches when the sales assistant brought out the Bleu Tropical with G12 silver hardware, and I was sold. The shoes were a lucky find. There weren’t any in my size on sale until I found a pair at the very last minute at the airport prior to departing from Rome. I was intending to buy a pair of red/maroon shoes, but for 30% off I was happy to settle for the turquoise.

IMG_2092

IMG_2086

  • Kept myself healthy. Been running 1-2x per week unless the weather didn’t permit, and recently I’ve discovered a free yoga app (yogify) which I’ve used on the days I didn’t manage to run. Finally pushed myself and completed 10km earlier this month. Also finished the year with a 11km run.

Nike Run

  • Post-exam life has been filled with lots of leisure reading and TVB drama serials (namely On Call 36h II and Triumph in the Skies I).

On the career front:

  • As much as I bitch about work sometimes, I do enjoy what I’m doing.
  • Consolidated old knowledge and learnt some new skills (eg inserting an arterial line, removing foreign bodies from the eye).
  • Passed the primary exams in one go, yay!

Here’s to another wonderful year ahead in 2014!

Posted by: Jas | June 22, 2013

Home

Every year I struggle with what to do with my annual leave. On one hand I would love to come home to spend time with family and friends; on the other hand I would also love to see the rest of the world. This time, I have elected to spend 10 days in Singapore, and then 3 weeks in Europe with the immediate family and the fiance. I also have the added ‘burden’ of having to study for my exams which are about 8 weeks away. Well, actually I had planned for the trip before I planned to sit the exams (thought of sitting the 2014.1 but I had put in more effort than expected and feel ready to sit now), so I’m just going to try to balance things out and see how I go. That being said, the MCQs already cost me $1380, and it would be an additional $900+ if I make it to the vivas, so I’m really trying my best!

Have achieved quite a fair bit in the last week. Essentially my daily routine would be to get up at 9-10am, surf the net, work through about 200 MCQs, do some leisure reading (yes I have permitted myself a book or two just because it’s the holidays. I last read a book in Feb, boo), dinner with family or friends, then read through 1 viva before I go to bed at 1-2am.

As always, I’m thankful to my dearest friends who never fail to make time for me when I’m back. Caught up with the JC mates, the uni mates, Fi & Nico. It was great seeing all of you :) For those who couldn’t make it, hope you have been well and I’ll catch you the next time!

Other random things that I have done:

- Visited Gardens by the Bay.

20130621-010635.jpg

- Went for a family photoshoot again now that both my sisters have graduated.

20130621-010851.jpg

- Wandered around town one arvo and indulged in the GSS spirit. Managed to exert some self discipline and only bought a top from H&M to wear under my scrubs and some hair ties. Saving the pennies for Europe!

- Managed 3 runs (3.5km, 5.5km, 5.2km) despite the heat/humidity/haze. I guess I won’t be exercising for the next 3 weeks so hopefully it won’t be too much of a drag to resume running once I go back to the Melbourne winter.

- Lunch with grandma and her friends. It was nice to be able to spend some time with her, and heartening to see how well she is being looked after :’)

- Helped my aunt at her workplace and earned some pocket money. In fact, it was a slack job and I spent most of the time doing my MCQs.

- First-hand experience at a 30min train delay. I can accept it if I have to wait because of overcrowding, but trains never used to break down that often did they?!

- Ate all sorts of stuff: home-cooked food, hawker fare, new restaurants. Thank you friends for bringing me to new places! :D

20130621-152743.jpg

So excited about Europe! It’s a destination I’ve dreamed of for years, hopefully it doesn’t disappoint :) Will update on my travels when I’m back, tata for now!

Posted by: Jas | April 16, 2013

Random Post

Random memories of the past 2 months:

What a twist: 23yo female triaged as anxiety/hyperventilation, turned out to be non-compliant T1DM with DKA (pH 6.9, pCO2 14, HCO3 4, BSL 28 & ketones 5.6), and was admitted to ICU eventually.

*********

Because we all need to feel appreciated sometimes. This was at the end of a mad busy shift with a shoulder dislocation & 3 GAMPs so I was essentially running fast track by myself whilst my consultant was fixing those with the ortho team.

IMG_1703

*********

Whirlwind trip back to Singapore for Mel’s wedding. And managed to spend some quality time with the family :)

IMG_1731

IMG_1733

IMG_1735

*********

Inherited Rick’s old iPad for $150 for studying purposes (so I don’t have to lug my MacBook Pro back to SG & then to Europe), I must say it’s been really handy at teaching sessions so far. Study has been going alright. I need to stay focussed and hopefully not burn out, only 4 months to go!

*********

Intern: Are you on the morning or afternoon shift?
Me: Afternoon.
Intern: Oh, so you just started like, an hour ago. No wonder you look so happy. *slight pause* Well, actually you are happy all the time.

Evidently I do enjoy my work :)

*********

Med reg to me (after the 4th referral of the day): You’re doing a good job, keep it up.

*********

It’s kinda awkward when your intern is a maxillofacial surgeon-to-be and you could have possibly referred patients to him in the last 2 years.

*********

Joy is when you go collect your new pairs of glasses and find out that your health fund covers more than expected thus giving you a refund on your initial deposit. 2 pairs for only $30 out-of-pocket! :) Finally time to retire my 6-year-old pair.

Posted by: Jas | February 15, 2013

A new chapter.

I wanted to start off by apologising for neglecting this space, but really, I don’t know who actually reads my blog, haha.

So the work year started 2 weeks ago and I’m enjoying being back in ED. To be honest, I still feel awkward introducing myself as a registrar. I think I’m worried about the associated expectation that others will have, I’m worried that I’m still not good enough (of course, when are we ever good enough?). However, I must say that I have gotten more prompt/positive responses from specialty registrars, haha.

I was actually quite nervous on the first day, because the consultant who was on was someone I hadn’t worked with before. Of course, my fears were unfounded as she was really nice and gave me heaps of encouragement. You would never guess what happened to me when I saw my first patient of the day – I got punched in the jaw! He was psychotic, and I was trying to examine his hand wounds as he had punched his hands into windows. I think I am too naive and trusting, haha. I honestly didn’t find him threatening and I was more surprised than anything else. Luckily I wasn’t hurt. I need to learn to be more careful next time!

On the second day I got asked to help a HMO with a paed IV bung. It’s nice to be able to help and teach the juniors! Fast track shifts have been good learning in terms of orthopaedic and plastics stuff; did my first femoral nerve block as well (although the patient didn’t seem to get much relief from it, oops). Being the rover and helping with the Cat 2s gave me the opportunity to think on my feet, and to learn how to multi-task and prioritise.

Looking back on my HMO2 year, the first part probably didn’t benefit my learning by much. On one hand, it was great that I had some medical specialty exposure; but on the other hand, having not received much feedback meant that I had no idea whether I was doing things right or not. The 2 weeks of ED in the country were good in the sense that I saw a wide variety of cases and had more hands-on, and it helped point me towards the direction of my future career. The 5 weeks of nights were essentially a holiday; it was so quiet we slept 6h on most nights. Well, on hindsight it was probably an easy progression from an intern to a HMO.

Then came an awesome 10-week ED rotation. Loved every bit of it, and like I’ve said multiple times, I was really lucky to be there during the time of job applications. So thankful to have been offered the job for this year. O&G wasn’t exactly my cup of tea, but at least now I’m more familiar with common conditions in pregnancy (eg pre-eclampsia), I’m more comfortable doing speculum examinations, and if I really have to I can probably help deliver a baby in an emergency. I was a little disappointed that I didn’t enjoy my paeds rotation as much as I thought I would, but better to know now than later. It was a steep learning curve, but I’m glad it has given me the confidence to deal with children and also the chance to practise some IV cannulation and basic neonatal resuscitation.

On the personal front, the bf of 79 months has popped the question and I said yes :) Thank you for all your love and patience, I look forward to spending the rest of my life with you!

IMG_1641

2013 has been great so far. I’m so so so happy that I got off to an awesome start in both work and personal life. Can’t wait to see what the rest of the year brings! :)

Posted by: Jas | January 12, 2013

Interesting reads.

Happy 2013!

For the first post of the new year, I thought I’d share some articles that I came across recently that I found really insightful.

Dr Roberts, chairman of emergency medicine and director of division of toxicology at Mercy Catholic Medical Centre, writes an open letter on How to be a Real Emergency Physician. Plenty of wise words of advice which I will most certainly bear in mind, of which my favourite was ‘above all, always, always, always be nice’.

Dr Riner, a retired emergency physician, gives a list of 10 things that you could incorporate to your daily practice. I have already done some of them, and will certainly try to keep them up + try out some of the other ones when I return to ED in 3 weeks’ time.

Yes, only 3 weeks to go before I become a registrar – I’m excited but nervous at the same time!

Posted by: Jas | December 28, 2012

Tis’ the season to be jolly.

A collection of Instagram photos over this festive period.

Countdown-board on the ward.
IMG_1534

Our very first humble little xmas tree.
IMG_1540

One of the many presents that the bf received from his students. Awesome drawing!
IMG_1550

Attended the bf’s school’s Christmas function, where he performed with another colleague on stage.
IMG_1555

My self-created e-card ;p
IMG_1562

Thought about this for months before I finally made the plunge; I decided that it would be a reward for getting the job I wanted for next year, and it should satisfy my lust for a Bal bag for now, lol :) Thankfully I found a forwarding company that had reasonable shipping prices, so I paid only about $20 on top of the actual price of the item.
IMG_1572

Working on Christmas day = 30% doing actual work + 50% eating chocolates + 20% going around the ward taking photos/having random chats/noticing random stuff (I’m sure people who write ‘pussy tonsils’ do not realise how bad it looks when written).
IMG_1576

Boxing day lunch party at the Montgomery house. Kudos to John for organising & preparing this vintage suitcase for our Kris Kringle gifts!
IMG_1577

I hope everyone’s had a good year. May 2013 be an even better one! :)

Posted by: Jas | December 8, 2012

Change of heart.

4 weeks into my much-anticipated Paediatrics rotation and I ask myself what drew me to it in the first place.

I don’t know if it’s because of the way this particular unit runs. Different consultants are on call each day, who are responsible for the day’s intake, which means multiple consultant ward rounds a day that can occur as and when the consultant rocks up. The registrar roster is all over the place, with the same reg on for a maximum of 2-3 days at a time. Don’t get me wrong, the consultants & regs have all been very patient and helpful. But because of the lack of continuity, there’s just no real feeling of a ‘team’.

Or maybe it’s because I didn’t like paeds for the ‘general’ stuff. Or perhaps working as a resident is completely different from being a student.

The Special Care Nursery job got boring after a while. Most of the time, it is either potential sepsis admitted for IV ABx, or jaundice admitted for phototherapy, or NAS admitted for morphine, or premature/low birth weight babies admitted for feeding establishment. Every day it’s ‘how is baby feeding?’, ‘is baby gaining weight?’. Yawns. Also, probably because of the demographics of the population surrounding the hospital, we deal with a fair bit of social issues, eg drug use, homelessness, domestic violence. In some cases, these mums need to be hassled to come to the nursery to visit and bond with their babies. Yet there are people out there who want babies but cannot conceive. Ironic, isn’t it. The nurses there can be quite pushy, sometimes insisting on doing things their way, overriding the decisions of the regs or consultants. Yes I respect the fact that you have plenty more experience than I do, but you don’t need to come across as condescending, and you don’t have to put me down in front of my seniors.

The Children’s Ward job isn’t that much more exciting either. Recently it has mostly been asthma, bronchiolitis and gastroenteritis. Most of them get admitted for overnight observation and by the time I see them the next morning I’m doing their discharge paperwork. We’ve got a couple of kids with FTT at the moment, which honestly doesn’t interest me. I think all these growth and development stuff is not my cup of tea. One of them is a 5 month old child who has put on < 2kg since birth (normal is about 1kg gain a month). He’s got good growth in length and head circumference, and all investigations so far have come back normal. We’ve decided that it’s likely due to insufficient caloric intake rather than any organic cause. Mum is adamant about not giving formula because ‘it is not natural’. Like seriously woman, would you rather your child starve?!

Attending elective Caesars is part of our job as well, and sometimes if the reg informs me I’ll go with them to the emergency ones, just to get experience. Went to 10 in total last week, which is more than what I assisted in when I did O&G! (Un)fortunately, all the babies have come out well and healthy, and I haven’t had to do anything more than give one baby some free-flow oxygen.

What drives me insane are the referrals from the postnatal ward. Gosh. I thought I was done with a certain group of people when I finished O&G, but I am still haunted by them every day. I was told that they have to refer anything that is not normal because it is outside their scope of practice. Surely some education on what’s acceptable as normal variants (eg pale red eye reflexes, small fontanelles) can help reduce the number of referrals we get a day? On top of the 3-4 that we have on our list to review daily (eg low birth weight, premature babies, potential sepsis awaiting blood test results, babies on BSL monitoring), we usually get an additional 3-4. Sometimes I feel that we’re practically seeing all the babies on the ward! Seriously, they might as well set aside an hour every day where the babies are lined up for us to review.

We always get hassled to see these ‘abnormalities’ found on discharge checks asap because they are waiting to go home, but please understand there is only one of me (and one registrar), and we have our own patients to see and our own discharges to do as well. Most of the time these aren’t even abnormal anyway. That’s where prioritising comes in, and there is no point telling me ‘not till tomorrow’ when I say ‘this can wait’. It will wait until I have done everything that has a higher priority, and then I will decide whether I can see the baby today or it will have to wait till tomorrow. I’ve also gotten useless pages such as ‘please review new referral on postnatal ward’ with no name/patient details/phone number, and I would have absolutely no idea whether it’s urgent or not.

I don’t know if I’m feeling this way because I’ve had a bad week, but I haven’t really enjoyed myself so far. 8 more weeks to go, I hope things improve. The good news? Now that I’ve tried paeds, I’m fairly certain ED is the right choice for me.

Older Posts »

Categories

Follow

Get every new post delivered to your Inbox.