Good days

Can't seem to believe my luck. I am not deeply religious but I really believe someone's listening. I had three whole days off! Just for myself and family. Kids, wife and I went trekking up a waterfall, hiking up a hill, to a park in Taman Tun and to a movie. I also managed to catch up with old friends who I had not seen for 18 years! The world is really a smaller place thanks to facebook.

I did not forget about my patients though and called ICU often to find out how their doing! Unhealthy obsession? Perhaps. But there is something to learned. They ( the patients) did well without me fussing about them 24/7. Hmmm.....

Of course life wont be like this all time, but its a welcome break. I suppose we all need to take things in our stride. Books and studies during these happy times? Well, we cant everything all the time.....

The ICU and family

At times, work in the ICU does take its toll. I can't seem to leave my patients and my screw ups at the workplace. More than once, after my 24 hour call, I call my friend who is on call the next day to find out about my patients.
At home, especially after a bad call when some of them turned bad or unexpectedly died, I tend to brood. My wife takes it the wrong way at times.
Our calls can be bad, I don't have the energy I used to possess. I sleep most of the day and bury myself in my books at night.
Six on calls. Six post calls when my family doesn't see much of me. That's close to half a month. Some days, I get stuck in a traffic jam an arrive home in the late evening.
I also try to hit the books whenever possible.
As a result my contribution at home is nothing to shout about. My son misses playing with me. My wife has to care for a problematic baby on her own most of the time. Her understanding and patience only go so far.
Being a gym rat and an outdoor freak doesn't help. I yearn for a trek in the jungle but I have to deny myself. It doesn't seem good to be spending what little free time I have away from the family. That leaves me a little frustrated.
I had a whole day free day today and it was a good day. Good family time.
Rare days like these make me think and count my blessings.
I had my fun in the past. I did many exciting and thrilling things. Many people will never get to do the things I did, many who try wont even survive! Those were good times.
I suppose there is a time and place for everything. Now I need to grit my teeth and go through these tough times. Once I am done with the major exam, there will be good times again, just like a close friend of my is enjoying now!
Tough times don't last, tough people do.

Honestly speaking.......

Its about 2am now and I am sitting opposite a 58 year old who was ill, well on the way to get better, then unfortunately on my call, he took a turn for the worse. His blood pressure dropped, needing powerful vasopressors and his kidneys shut down for a second time.

I just told his family he was on the road to recovery prior to that.To say I was embarrassed is putting it mildly.

There is this so called rule in ICU. You are never supposed to give patients relative any glimmer of hope that their loved ones will ever get better. In case they dont, then to relatives wont jump on you. We and our silly precious asses we are so bent on protecting.

Like many things in my life, I do this differently. I tell them that their relative/loved is ill but whenever I think so, I tell them he has every hope and chance of getting better. The truth and nothing but the truth. If he is a no hoper, I tell them so. If there is a small chance he will get better, I tell them so.

Many times, many times I have been wrong. 'Your dad is dangerously ill, but with our interventions he has a fair chance of getting better' or 'Your dad has certainly improved and I think he is going to be OK'.

I dont know much yet, but I need to commit. And using what little knowledge I have I will commit when pressed for information.

Like today, I have often been met with 'Didnt you just say....." or 'what went wrong.." sometimes meaning 'what did you do wrong...'

I dont really care. I said it and I meant it now they are upset and I dont blame them. Sometimes things happen.

I just hope and I become I will have a bit more right than wrong most of the time. But I hope I wont change

Sakit hati 2

He did appear to be improving. Slowly, gingerly, with him wide awake, I extubated him, liberating him from the ventilator and free to breath entirely on his own. The first 24 hours, everything looks OK. Hope it will stay that way.....

The whole country is once again shaken by a similar tragedy in a similar are with similar reactions from politicians. My deepest condolances to the victims and families affected. My close friend is one of them. Is extremely difficult for a family of five to be evacuated without many belongings.

Instead of playing the blame game, lets all as Malaysians not buy houses on hillslopes, built in water catchment areas or in previous forest reserves. Developers will get the message. There is enough flat land in the country to cater for all our needs. Land to cater for our greed? I don't think there's enough in the world.

I have become cynical with age. With regards to the words of politicians promising to stop indiscriminate development, we all know it has happened before with similar effects.

Medical Racism

We doctors are a bunch of racial stereotyping, racist, group of individuals who can put politicians to shame.
"This Indian man had been ill for......"
"This Chinese man need an urgent operation........"
"This Malay lady needs dialysis....."
We always mention the patients race when we present the case, or when we make referrals. And we have for always been doing it. We do it very important and specific reasons. Its just that I don't know what they are.
Everybody else is free to do what they want, I am going to try to stop with this silly practice.

sakit hati

A 60 year old gentleman was unfortunate enough to fall very ill from a bad foot infection, had a heart attack in hospital and nearly died. he needed close to 15 minutes of CPR, cardiopulmonary resuscitation and by all the books, he should have died.
He defied the odds and now he alive. He's wide awake and hooked on to a ventilator. he's blood pressure is just holding with a ton of inotropes.( drugs that are infused to support heart rate and blood pressure in ill patients are called inotropes. Stop infusing them in people who still need them and they can die
His kidneys have failed to function and he needs dialysis.
The problem is he has a very sick heart. his ejection fraction is only 10%. a mere 10% of blood that enters his heart is being pumped out-ejected. that's barely compatible with life....most patients with similar heart function wouldn't be alive. but he is.
and he is awake and aware.
He cant breath very well on his own but that's not really the problem, our ventilator is connected to his lungs via an endotracheal tube and it does a good job helping him breath.
An ejection fraction of 10% isn't enough for the heart to pump blood at adequate pressure to reach all his organ.no matter, our inotropes are helping. Like super turbocharged amphetamines, grade A rocket fuel for his heart, they are being infused into his blood stream 24/7.
Now his kidneys have failed him and he cant produce urine to remove excess fluid and waste water. No matter, we have a super gentle and efficient dialysis machine that sucks and filters blood and returns it clean.
through it all he remains awake and aware.
the problem is how long do we continue? his family has been told but did i do a good enough job in explaining to them the gravity of the situation? did i paint the full picture clearly? its really not easy to tell people looking for any bit of hope that there's only a small chance of him getting well.
Small but possible. He is alive so far. I really hope he gets well.......

Intensive Care Unit

This is my second day in the ICU. For me, its a really cool place. Very few doctors have a ward all to themselves where they can actually snatch patients from the brink of death, take over most of their vital signs and wait for them to get better.

An ICU doctor is given the an impressive array of tools and human resources that is seldom available to regular doctors to help their patients. We can order the most expensive antibiotics at the stroke of a pen, ventilate our patients with machines worth as much a a brand new car, and get at least three well trained health care professionals to take care of our patients in day.

There's tons to learn. Each and every patient is different and a template management seldom fits everyone, if anyone at all.

Hope I have an educational posting