Q = Question asked by me.
A = Answer I get.. or rather did not get.
Sometimes it may be due to hearing (wrongly heard) and sometimes maybe because the questions are not specific enough.
Scenario 1
Q : Aku tak pernah jumpa lah si polan binti polan tu? Orangnya baik tak?
A : Oh, aku selalu jumpa dia. Orangnya ..badan besar-besar.
Q : ..erk.. so baik ke tak baik tu?
Scenario 2
Q : Anak you tengah demam ni, makan minum semua ok?
A : Ok doktor.
Q : Bagus. Jadi tak ada muntah2?
A: Muntah2 ada.
Q : Oh, ada muntah. Jadi minumnya cukup ke tak tu?
A : Minumnya kurang doktor. Makan pun sikit.
Q : Baiklah. Kencing berak semua ok?
A : Ok doktor.
Q : Tak ada cirit birit?
A : Cirit birit start pagi ni doktor.
Q : .... Anak you tak sihat ni dah ada bagi apa2 ubat?
A : Tak ada bagi ubat lagi doktor.
Kecuali ubat demam.
Q : (doktor pun rasa cam nak demam mak oii)
Thursday, November 29, 2018
Wednesday, November 28, 2018
discharge please
"Tak boleh discaj ke doktor? Doktor saja je kan nak tahan anak saya lama2 kat wad ni,"
"Cucuk sana cucuk sini. Doktor nak buat anak saya bahan ujikaji/eksperimen ke?"
These are comments that my colleagues and I are quite familiar with receiving.
My short and immediate response?
"Tak."
Honestly, as a paediatrician working in a busy government hospital, I definitely do NOT want my ward to be full with patients. I prefer to have zero admissions. If patients do need to be admitted, I will try my best to make sure that they don't have to stay more than they have to. In paediatrics, patients are babies, infants, toddlers, children. So lagi la orang kata "Kasihaaann. Budak kecik."
So yes, the less veins we need to prick, the less pain we need to inflict, the better.
Believe me, even though pricking patients for blood or IV cannulation will help junior doctors to master this skill, no house or medical officer ever groans at me when I tell them "no need to take blood" or "no need to insert IV line". Lagi diorang happy adala.
For us, the less work the better.
So why do we still admit patients to the ward? Why do we keep some of them longer in the ward compared to others? Why do we send multiple investigations, not just blood, but also, urine, stools, sputum and even the often "feared" spinal fluid sometimes?
Well, why are the children brought to the clinic/hospital in the first place?
Children don't bring themselves to the clinic/hospital.
I do not go to your house or look around town for ill children to take with me to hospital.
YOU bring them, you the parents and caregivers.
Because you are worried that something is not right with them. They may be sick. Ill. Unwell. Not their usual self. Have a toy stuck up their nose. Breathing funny. Whatever.
If they are okay, we reassure you and send you home. If they are unwell, but we think you can just treat them at home, we send you home. But if we think otherwise, we ask to admit the child.
Various reasons.
The child is too ill.
We don't know what's going on so we need to investigate.
We think we know a little bit but we need to make sure.
We do know what's going on, but the treatment needs to be given in the ward/hospital, not at home.
Why do we keep them long in the ward?
Various reasons as well.
The child is too ill.
The treatment needs to be given a long time.
The treatment is not working. We need to try another way/treatment.
We still do not know what's going on.
Definitely NOT because we like or saja-saja.
We may "try" different treatments, especially if one is not working, but we're definitely NOT doing "experiments" or treating your child as a lab rat. We may not have all the answers but we can't and won't just give up that easily.
In the end, we want the same things as you. For your child to get better, so we can discharge you.
Less patients in the ward/clinic, means less work for us.
We do like having less work.
Don't take it personally.
We assume when there is less work for us, there are also less sick children out there. And that's always good.
Ah. But there are people that say to me "But that's how you make money whaaat."
Again, I reiterate, I work in a government hospital.
Ada patient ka, tak ada patient ka, gaji aku sama whaaaaat.
"Cucuk sana cucuk sini. Doktor nak buat anak saya bahan ujikaji/eksperimen ke?"
These are comments that my colleagues and I are quite familiar with receiving.
My short and immediate response?
"Tak."
Honestly, as a paediatrician working in a busy government hospital, I definitely do NOT want my ward to be full with patients. I prefer to have zero admissions. If patients do need to be admitted, I will try my best to make sure that they don't have to stay more than they have to. In paediatrics, patients are babies, infants, toddlers, children. So lagi la orang kata "Kasihaaann. Budak kecik."
So yes, the less veins we need to prick, the less pain we need to inflict, the better.
Believe me, even though pricking patients for blood or IV cannulation will help junior doctors to master this skill, no house or medical officer ever groans at me when I tell them "no need to take blood" or "no need to insert IV line". Lagi diorang happy adala.
For us, the less work the better.
So why do we still admit patients to the ward? Why do we keep some of them longer in the ward compared to others? Why do we send multiple investigations, not just blood, but also, urine, stools, sputum and even the often "feared" spinal fluid sometimes?
Well, why are the children brought to the clinic/hospital in the first place?
Children don't bring themselves to the clinic/hospital.
I do not go to your house or look around town for ill children to take with me to hospital.
YOU bring them, you the parents and caregivers.
Because you are worried that something is not right with them. They may be sick. Ill. Unwell. Not their usual self. Have a toy stuck up their nose. Breathing funny. Whatever.
If they are okay, we reassure you and send you home. If they are unwell, but we think you can just treat them at home, we send you home. But if we think otherwise, we ask to admit the child.
Various reasons.
The child is too ill.
We don't know what's going on so we need to investigate.
We think we know a little bit but we need to make sure.
We do know what's going on, but the treatment needs to be given in the ward/hospital, not at home.
Why do we keep them long in the ward?
Various reasons as well.
The child is too ill.
The treatment needs to be given a long time.
The treatment is not working. We need to try another way/treatment.
We still do not know what's going on.
Definitely NOT because we like or saja-saja.
We may "try" different treatments, especially if one is not working, but we're definitely NOT doing "experiments" or treating your child as a lab rat. We may not have all the answers but we can't and won't just give up that easily.
In the end, we want the same things as you. For your child to get better, so we can discharge you.
Less patients in the ward/clinic, means less work for us.
We do like having less work.
Don't take it personally.
We assume when there is less work for us, there are also less sick children out there. And that's always good.
Ah. But there are people that say to me "But that's how you make money whaaat."
Again, I reiterate, I work in a government hospital.
Ada patient ka, tak ada patient ka, gaji aku sama whaaaaat.
Tuesday, August 07, 2018
Jom lari!
A: Aku stress. Berat dah naik.
B: Jom lari!
.......
A: Aku stress. Banyak kerja/projek/assignment/exam (pilih).
B: Jom lari!
.......
A: Aku stress. Duit takde. Hutang banyak.
B: Jom lari!
.......
A: Aku stress. Gaduh ngan laki/bini/anak/gf/bf/bff/adikberadik/cikgu/boss/binatangpeliharaan (pilih).
B: Jom lari!
.......
B: Aku stress.
A: Apalagi. Jom lari!
B: Aku baru lepas lari le ni. Tapi tak dapat upload lak kat running/health app ni. Penat je lari sejam.
A: Pulak..
......
#larisebabstress
#stresssebablari
B: Jom lari!
.......
A: Aku stress. Banyak kerja/projek/assignment/exam (pilih).
B: Jom lari!
.......
A: Aku stress. Duit takde. Hutang banyak.
B: Jom lari!
.......
A: Aku stress. Gaduh ngan laki/bini/anak/gf/bf/bff/adikberadik/cikgu/boss/binatangpeliharaan (pilih).
B: Jom lari!
.......
B: Aku stress.
A: Apalagi. Jom lari!
B: Aku baru lepas lari le ni. Tapi tak dapat upload lak kat running/health app ni. Penat je lari sejam.
A: Pulak..
......
#larisebabstress
#stresssebablari
Sunday, July 29, 2018
it's okay to cry
In practicing medicine, doctors generally cringe at the term "breaking bad news". Bad news in medicine can either be finding out that you have an incurable disease, or that you can never have children of your own, or that you will never walk again, or that you or your loved one is dying, or finally, that your loved one is already dead.
Back when I just started in medicine, and was a jovial, enthusiastic young woman who was proud to be a doctor albeit totally naive of what was expected to come, I used to believe that it is not okay for a medical staff, especially a doctor, to cry in front of a family or a patient when you are breaking the bad news to them (or "informing DIL" as what is commonly used in Malaysian hospitals today).
I felt that it is okay to show a sad face, but not to the point of tearing up or crying. I felt that crying in front of them made me appear unprofessional, that instead of showing sympathy/empathy, I would be showing too much emotion, and probably a sign of weakness too. I was even proud to be able to do all of my "inform DIL" orders without shedding a tear all all through my housemanship and into the early years of being an MO. Until one day, and I remember this vividly, I was an MO in charge of NICU, and we had this one particular baby girl that died.
The baby had been critical for many days from a severe infection, and we already had to actively resuscitate and perform CPR on her multiple times. I had repeatedly explained to the parents that their baby was really ill and that the next time we have to do a CPR again, we might not be able to revive her anymore, and that she might die at anytime; standard "informing DIL" stuff.
Every time I told them the news, the mother would sob and cry.
The father would repeatedly mutter "Yelah, baiklah doktor," hands on his wife's shoulders, his own eyes red.
The nurse sometimes too can be seen wiping off her tears as she stood behind the parents.
And I would stand there and look at them, pausing my explanation for a moment of respectful silence, solemn look on my face, eyes dry, and in my head thinking "ok don't you dare cry too emie. ok how long is this gonna take, I have other babies to see". For me, in order to dissociate myself from the atmosphere of engulfing sadness and tears, I turned the baby into another job task, just a checklist on my long list of work to-do list.
On the day that the baby finally died, the parents have not reached the hospital and by the time they arrived, we had pronounced the death and I was already writing up all the necessary paperwork. So I went to see the mother as she stood by her baby's body and was ready to explain to her what happened; how she had continued to deteriorate and how we tried to resuscitate her. Again, standard stuff, when the mother turned to me and actually smiled. I was a bit puzzled seeing her smile at that moment so all I ended up saying was "Takziah ye mak" (I'm sorry) and she nodded and actually said "Thank you doctor."
Before I could say anything else, she said "Saya nampak setiap hari, pagi petang siang malam, bagaimana doktor dan nurse menjaga anak saya dan anak2 orang lain dalam icu ni. Saya tahu doktor dan nurse2 semua bekerja keras untuk cuba pastikan anak saya dapat baik dan hidup lebih lama. . Tapi Tuhan lebih sayangkan dia. Saya harap doktor dan nurse2 semua jangan putus asa ye. Dan jangan sedih. Saya amat2 menghargai segala apa yang doktor dah cuba buat untuk anak saya ni. Saya redha dia pergi."
(I know how hard you and the nurses work all day and night to help by child and the other children in this icu. I know how all of you have tried to keep my child alive, but God loves her more. Please don't be discouraged and don' be sad. I am truly grateful for all that you have done for my baby. I accept her death.)
And for the first time ever in my medical career, I let my tears roll down my cheeks right there in front of the mother. I couldn't stop them even if I wanted to. And I didn't dare open my mouth to say anything for fear that all that would come out are loud ugly sobs.
It was like a huge slap on my face. I was not sad at the time but the mother thought I was. Because I could be sad, and perhaps should be too. Because of her unexpected gratitude and encouragement, in the wake of her baby's death, I was woken up instead. That in being a doctor, it wasn't JUST work that I'm doing, that it wasn't JUST a job. A patient is a human being. A patient is somebody's mother/father/daughter/son/sibling/spouse/friend. He/She is somebody's loved one. Even if you don't know the family or the friends or the loved ones. A patient who has been under your care, whom you have looked after, whom you have tried to treat, who was your responsibility, of course you can be sad too if they die. You don't need any permission.You don't have to suppress your sadness. You can definitely cry if you want to. You don't have to of course, but it's okay if you do. (Hopefully not to the point of the patient's family having to console you instead of you them, but you get what I mean.) There's no need to be ashamed.
Because doctors are humans too. And we all need to remember that.
Back when I just started in medicine, and was a jovial, enthusiastic young woman who was proud to be a doctor albeit totally naive of what was expected to come, I used to believe that it is not okay for a medical staff, especially a doctor, to cry in front of a family or a patient when you are breaking the bad news to them (or "informing DIL" as what is commonly used in Malaysian hospitals today).
I felt that it is okay to show a sad face, but not to the point of tearing up or crying. I felt that crying in front of them made me appear unprofessional, that instead of showing sympathy/empathy, I would be showing too much emotion, and probably a sign of weakness too. I was even proud to be able to do all of my "inform DIL" orders without shedding a tear all all through my housemanship and into the early years of being an MO. Until one day, and I remember this vividly, I was an MO in charge of NICU, and we had this one particular baby girl that died.
The baby had been critical for many days from a severe infection, and we already had to actively resuscitate and perform CPR on her multiple times. I had repeatedly explained to the parents that their baby was really ill and that the next time we have to do a CPR again, we might not be able to revive her anymore, and that she might die at anytime; standard "informing DIL" stuff.
Every time I told them the news, the mother would sob and cry.
The father would repeatedly mutter "Yelah, baiklah doktor," hands on his wife's shoulders, his own eyes red.
The nurse sometimes too can be seen wiping off her tears as she stood behind the parents.
And I would stand there and look at them, pausing my explanation for a moment of respectful silence, solemn look on my face, eyes dry, and in my head thinking "ok don't you dare cry too emie. ok how long is this gonna take, I have other babies to see". For me, in order to dissociate myself from the atmosphere of engulfing sadness and tears, I turned the baby into another job task, just a checklist on my long list of work to-do list.
On the day that the baby finally died, the parents have not reached the hospital and by the time they arrived, we had pronounced the death and I was already writing up all the necessary paperwork. So I went to see the mother as she stood by her baby's body and was ready to explain to her what happened; how she had continued to deteriorate and how we tried to resuscitate her. Again, standard stuff, when the mother turned to me and actually smiled. I was a bit puzzled seeing her smile at that moment so all I ended up saying was "Takziah ye mak" (I'm sorry) and she nodded and actually said "Thank you doctor."
Before I could say anything else, she said "Saya nampak setiap hari, pagi petang siang malam, bagaimana doktor dan nurse menjaga anak saya dan anak2 orang lain dalam icu ni. Saya tahu doktor dan nurse2 semua bekerja keras untuk cuba pastikan anak saya dapat baik dan hidup lebih lama. . Tapi Tuhan lebih sayangkan dia. Saya harap doktor dan nurse2 semua jangan putus asa ye. Dan jangan sedih. Saya amat2 menghargai segala apa yang doktor dah cuba buat untuk anak saya ni. Saya redha dia pergi."
(I know how hard you and the nurses work all day and night to help by child and the other children in this icu. I know how all of you have tried to keep my child alive, but God loves her more. Please don't be discouraged and don' be sad. I am truly grateful for all that you have done for my baby. I accept her death.)
And for the first time ever in my medical career, I let my tears roll down my cheeks right there in front of the mother. I couldn't stop them even if I wanted to. And I didn't dare open my mouth to say anything for fear that all that would come out are loud ugly sobs.
It was like a huge slap on my face. I was not sad at the time but the mother thought I was. Because I could be sad, and perhaps should be too. Because of her unexpected gratitude and encouragement, in the wake of her baby's death, I was woken up instead. That in being a doctor, it wasn't JUST work that I'm doing, that it wasn't JUST a job. A patient is a human being. A patient is somebody's mother/father/daughter/son/sibling/spouse/friend. He/She is somebody's loved one. Even if you don't know the family or the friends or the loved ones. A patient who has been under your care, whom you have looked after, whom you have tried to treat, who was your responsibility, of course you can be sad too if they die. You don't need any permission.You don't have to suppress your sadness. You can definitely cry if you want to. You don't have to of course, but it's okay if you do. (Hopefully not to the point of the patient's family having to console you instead of you them, but you get what I mean.) There's no need to be ashamed.
Because doctors are humans too. And we all need to remember that.
Saturday, July 21, 2018
kesah seorang boss
Alkesah, ada seorang boss.
Di suatu pagi di hujung minggu, di kala boss sedang bercuti, boss terima khabar ada timbul masalah di tempat kerja. Masalah itu bukan masalah baru, kadang2 memang boleh berlaku. Tetapi selain dari itu, boss diberitahu ada juga masalah kedua yang telah timbul, yang berpunca akibat dari kecuaian anak2 buah boss.
Boss naik angin lah.
Boss mulalah membebel. "Aku dah cakap kat diorang ni berkali2, jangan buat begitu, jangan buat begini. Budak2 ni degil juga. Tak mahu dengar cakap aku. Tak percaya cakap aku. Sekarang dah jadi macam ni. Aku jugak kena pergi selesaikan."
Suami boss yang mendengar di rumah itu mengangguk2 saja melihat boss bersiap2.
"Awak bersiap ni nak ke tempat kerjakah?"
"Yelah, saya nak basuh diorang cukup2!" dengus boss penuh marah.
Selesai bersiap, boss seperti biasa mencium tangan suaminya sebelum keluar. Kemudian dia singgah di bilik mak mertuanya yang kebetulan datang melawat dari kampung. Niat nak beritahu mak, dia terpaksa keluar bekerja pula.
Boss selalu mengingatkan suaminya, orang boleh kata suami itu "boss" kepada isteri, (atau isteri itu boss kepada suami - sukahatilah) tetapi mak tetap big boss kepada kedua2nya.
Tiba di bilik, dilihatnya mak sedang bersolat. Masa itu pukul 10 pagi.
Mula2 boss pelik, tapi terus teringat. Oh, mak solat dhuha.
Tiba2 boss insaf.
Baik boss ambil wudhu dan solat dhuha dulu. Sudahlah pada waktu hari2 bekerja boss memang jarang dapat solat dhuha.
Selepas solat, hati boss automatik tenang.
Boss tukar niat. Baik dia pergi kerja untuk cuba selesaikan masalah yang timbul itu dulu. Kemudian baru dia akan tegur dan tangani isu kecuaian anak buahnya itu. Boss tanam azam akan cuba tangani dengan berhemah dan profesional, tapi tetap tegas. Marah2 sahaja tak ada gunanya. Jiwa boss juga yang bertambah stress.
Boss bersyukur sebelum keluar bekerja dia sempat diingatkan bahawa walaupun dia seorang boss, ada yang lagi boss dari boss2 dan big boss.
Dialah the Almighty Boss, dan kepadaNya lah kita berharap, kepadaNya lah kita berserah.
Di suatu pagi di hujung minggu, di kala boss sedang bercuti, boss terima khabar ada timbul masalah di tempat kerja. Masalah itu bukan masalah baru, kadang2 memang boleh berlaku. Tetapi selain dari itu, boss diberitahu ada juga masalah kedua yang telah timbul, yang berpunca akibat dari kecuaian anak2 buah boss.
Boss naik angin lah.
Boss mulalah membebel. "Aku dah cakap kat diorang ni berkali2, jangan buat begitu, jangan buat begini. Budak2 ni degil juga. Tak mahu dengar cakap aku. Tak percaya cakap aku. Sekarang dah jadi macam ni. Aku jugak kena pergi selesaikan."
Suami boss yang mendengar di rumah itu mengangguk2 saja melihat boss bersiap2.
"Awak bersiap ni nak ke tempat kerjakah?"
"Yelah, saya nak basuh diorang cukup2!" dengus boss penuh marah.
Selesai bersiap, boss seperti biasa mencium tangan suaminya sebelum keluar. Kemudian dia singgah di bilik mak mertuanya yang kebetulan datang melawat dari kampung. Niat nak beritahu mak, dia terpaksa keluar bekerja pula.
Boss selalu mengingatkan suaminya, orang boleh kata suami itu "boss" kepada isteri, (atau isteri itu boss kepada suami - sukahatilah) tetapi mak tetap big boss kepada kedua2nya.
Tiba di bilik, dilihatnya mak sedang bersolat. Masa itu pukul 10 pagi.
Mula2 boss pelik, tapi terus teringat. Oh, mak solat dhuha.
Tiba2 boss insaf.
Baik boss ambil wudhu dan solat dhuha dulu. Sudahlah pada waktu hari2 bekerja boss memang jarang dapat solat dhuha.
Selepas solat, hati boss automatik tenang.
Boss tukar niat. Baik dia pergi kerja untuk cuba selesaikan masalah yang timbul itu dulu. Kemudian baru dia akan tegur dan tangani isu kecuaian anak buahnya itu. Boss tanam azam akan cuba tangani dengan berhemah dan profesional, tapi tetap tegas. Marah2 sahaja tak ada gunanya. Jiwa boss juga yang bertambah stress.
Boss bersyukur sebelum keluar bekerja dia sempat diingatkan bahawa walaupun dia seorang boss, ada yang lagi boss dari boss2 dan big boss.
Dialah the Almighty Boss, dan kepadaNya lah kita berharap, kepadaNya lah kita berserah.
Tuesday, July 10, 2018
tak menjawab soalan (based on real-life events part 2)
More ward round scenarios.
Scene 1
HO : This baby is the one with the hypokalemia.
Pakar : What is the latest serum potassium level?
HO : Err.. (flips the pages of the patient's file)..there is a half gram potassium in the drip, Doctor.
Pakar : ?? (What'd I ask?)
Scene 2
Pakar : (on the phone) Hello, can you tell me how many empty beds we have in the ward today?
HO : Hello Doctor, yes lemme see..err..there are 26 patients right now in the ward, Doctor.
Pakar : ?? (What'd I ask?)
Scene 3
Pakar : How old is the baby today?
HO : Err...He was born on 23rd Feb, Doctor.
Pakar : ?? (What'd I ask?)
Scene 1
HO : This baby is the one with the hypokalemia.
Pakar : What is the latest serum potassium level?
HO : Err.. (flips the pages of the patient's file)..there is a half gram potassium in the drip, Doctor.
Pakar : ?? (What'd I ask?)
Scene 2
Pakar : (on the phone) Hello, can you tell me how many empty beds we have in the ward today?
HO : Hello Doctor, yes lemme see..err..there are 26 patients right now in the ward, Doctor.
Pakar : ?? (What'd I ask?)
Scene 3
Pakar : How old is the baby today?
HO : Err...He was born on 23rd Feb, Doctor.
Pakar : ?? (What'd I ask?)
gosh i'm old..and fat..and old(based on real-life events part 1)
Okay, I've posted these scenarios before in facebook in a visual comic formal.
Just reposting them here mainly to keep this blog "alive", but also to practice translating them into writing.
HO = house officer/junior doctor
Pakar = specialist (in these scenarios all me)
Scene 1
HO : Mother is geriatric, this is her 10th baby..
Pakar :Geriatric?? How old is the mother?
HO (who is 25yo) : 40yo, Doctor
Pakar (43yo, no kids): *cry*
Scene 2
HO : Mother is obese..
Pakar: Obese? How big is the mother??
HO : Well she's about your size, Doctor.
Pakar : *%^&**$#!*
Scene 3
HO : We sent FBC, LFT, RFT, CRP, ABF, IEM, TORCHs, xray, urine..
Pakar: So many investigations!! Who ordered them?!
HO : You did, Doctor.
Pakar: Oh, did I? *blush*
Just reposting them here mainly to keep this blog "alive", but also to practice translating them into writing.
HO = house officer/junior doctor
Pakar = specialist (in these scenarios all me)
Scene 1
HO : Mother is geriatric, this is her 10th baby..
Pakar :Geriatric?? How old is the mother?
HO (who is 25yo) : 40yo, Doctor
Pakar (43yo, no kids): *cry*
Scene 2
HO : Mother is obese..
Pakar: Obese? How big is the mother??
HO : Well she's about your size, Doctor.
Pakar : *%^&**$#!*
Scene 3
HO : We sent FBC, LFT, RFT, CRP, ABF, IEM, TORCHs, xray, urine..
Pakar: So many investigations!! Who ordered them?!
HO : You did, Doctor.
Pakar: Oh, did I? *blush*
Subscribe to:
Posts (Atom)