Please

Please don't go.

The one that slipped away

The 48 year old man was ill.

He was admitted with fever, cough and productive sputum.

Within 24 hours of ward admission, his condition deteriorated. At 45 breath per minute and dropping in conscious level, we knew he's not gonna make it without a ventilator (breathing support).

We had to intubate him before he deteriorated even further. By Friday nightfall he's already on triple heart-supporting (inotropic) drugs. The chest infection looked rampant at that stage. His prognosis was rather gloomy. I was on call that night, and by 5am we began the 4th inotrope.

"Shit, things doesn't look good. Nurse Maria, could you please call his wife and children, I need to break them the bad news"

Two hours later, as I was telling them his grave condition and that his likelihood for survival is looking thin, I saw his heart beat went flatline on the cardiac monitor.

"Damn!" I cursed silently.

I quickly asked the family to wait outside. We called the code and worked on him for 40 mins. Sounds of adrenaline ampoules broke the silence.

"Come on, stay with us... stay with us" I heard someone whispered those words to my ears... only to find that person was me.

A nurse recited the Shahadah to his ears while the rest of us working on him.

We couldn't revived him. At that point of time I like to believe that God loves him best.

As I told the family afterward, the wife broke into silent tears.

***

Update:

Yesterday we got our country's first case of positive H1N1 transmission.

22 cases.

A global pandemic.

We are at war with another microorganism.

The important thing is to remain calm.

(and yes avoid overcrowded place and sneeze into your tissue)

Observation

Learning medicine is similar like learning other disciplines - it's a lifelong process. An old axiom says "Learn one, do one and teach one". Much alike the master-apprenticeship style of learning. Having said that, you don't have much time when it comes to formal training in post-grad world. Only four years, and then you're on your own most of the time.

If you are lucky you could end up in a big tertiary hospital where you could do curbside consult on the way to cafeteria by asking your say... buddy cardiologist about some puzzling 'heart' case that came in last night.

Interesting cases mostly come in through clinic, where patients come in for follow up. The rarer the case is the more doctors will gather to observe and learn.

The trick however is not to stare, coz it is rude

... a simple observation will do :)

Old warrior

Good bye old friends.

You've been there for me through thick and thin.

Through those busy- busy on call nights (or those lonely nights too).

Now the time has come for you to retire.

Rest well.

A chocolaty affair

I was 10 minutes late for clinic that day. Instead of seeing patients, I found myself queuing up at the hospital convenient store buying a chocolate bar. Ever since London, I developed craving for chocolate bars. God knows why. As I grabbed a 90g Cadbury's Roasted Almond at the counter a whole lines of other chocolate bars fell onto the ground.

"Oh mak kau!! chocolate is good!" A lady of early 50's behind me melatah, loudly.

I smiled to myself and told her that it's okay and she can jump my queue because it's gonna take me a while to pick up those bars.

"It's okay I'll wait. So doctors also eat chocolate eh?" I supposed she wanted to be friendly by asking innocent questions.

"Yes but not always. Sometimes, it's not good for health y'know" I was kneeling on the floor while looking up and smiling at her. I thought this is just perfect all I need now is an engagement ring.

"So how often is considered as okay?" Gee.. this lady is persistent with her questions.

"Like everyday." I laughed out a bit while paying the cashier.

Then I realised that neither she nor the row of people who apparently had been listening to our conversation behind her get my joke. They were all looking at me with a semi-puzzled look blended with seriousness.

Suddenly I felt like being put on a spotlight - the crowd were waiting for my professional answer on how much is considered as a safe level chocolate consumption.

At that moment the only thing I can come up with was...

..."Actually my friend's is pregnant and this is for her.. err she's craving for chocolate. Bye!"

(gulp)