Thursday, July 10, 2014

Hats off to Paediatricians

If you think parents who don't vaccinate their kids are terrible, I met worse parents yesterday. It wasn't a good day at all.

As I walked up the stairs leading to the Paediatric ward, a colleague of mine ran past me in hurry with an x-ray slip in her hand and said "welcome to work, things have been a bit flappy today". That's never a good start to an afternoon shift.

"A 32 week-er needs IV cannula"
"The 3 year-old-boy in ED with possible non-accidental injury needs IV cannula and bloods before his scan"
"Two patients for discharge"
"6 weeks old baby needs IV cannula and lumbar puncture"
"Preterm and breech delivered yesterday with mishapened head still waiting for review"
"Couple of admissions came to the ward and notes are not done"

My colleague seemed overwhelmed when she gave me the handover.

Then the registrar came. I thought I saw the word STRESS on her face. "Rachel, if you have time could you go down to ED to cannulate that boy because the bone scan is going to happen". Then she left in hurry to attend a birth.

I did all I could with the handover. It took me 2 hours before I arrived in the next destination, the special care nursery to finally deal with whatever messes there.

"Rachel, can you speak to the dad in cot 13? He refused any medical intervention for the baby with respiratory distress. We've paged the registrar and she hasn't come yet". A worried-looking nurse said.

Turned out it was the baby from the birth that the registrar attended: Conservative parents who wanted lotus birth but the umbilical cord had to be cut because the baby needed resuscitation given poor breathing effort and there was meconium liquor. Parents refused vitamin K and Hepatitis B vaccine. Baby is now in special care nursery with respiratory distress and parents have refused any sort of medical intervention. 

I introduced myself and they seemed nice people. The husband started talking and his wife stayed quiet. It became obvious of the dominant role in the house. I listened to his views then I explained my concern of the baby's deterioration, possible diagnosis and what needed to be done at the same time as I was pointing out the clinical signs and all the flashing numbers on the machine.

"Why don't we just let the baby breathes on his own? He was born just not long ago. Newborn always takes time to breathe up. Just give him some time and he will pick up. The number (oxygen saturation) is 85% and let's not do anything heroic until it is 70%. I don't want CPAP or needle or blood test or IV or antibiotics or anybody sticking anything into him. I won't let you start antibiotic just on the ground of presumed sepsis unless you can prove to me that my baby definitely has infection. Maybe he just aspirated little meconium and that's OK."

I gave my explanation for the second time, "Yes, newborn may not breathe normal straight away but they don't take such long time to establish breathing and this is not normal. The numbers are very concerning and I don't just look at numbers, I look at your baby too. He is breathing very fast and hard and he needs help. Babies don't talk and they can't tell you if they have fever or infection. I cannot prove to you that your baby definitely has sepsis because I don't have blood tests to show you. Your baby is literally throwing his hands up and trying to tell you 'mum, dad, look at me, I can't breathe, I need help, I think I have infection'. It is not normal to aspirate meconium as it belongs to the intestine and can increase the risk of infection if it ends up in the lungs. Babies are unlike adult and they have much lower reserve and can deteriorate rapidly and it can be too late if happens. CPAP is not intubation, they are prongs that we put on baby's nostrils to give pressure to deliver oxygen and help the baby to breathe. What was your concern regarding needle or IV or CPAP?"

I didn't dare to take my eyes off the baby and machine for long. My heart was pounding as I looked at the chest rise and fall of 80-100 per minute with the subcostal muscles absolutely sucked in with each inspiration. Listening to the lungs I felt pretty relief there was no pneumothorax heard but the hard work of breathing kept me on guard and made me so wanted to push some oxygen into this little one more than just 40% of cot air. Then the dad spoke.

"Look, I just want as minimal intervention as possible. Let's just give him his mum's breast milk. If she expresses now will get the colostrum for antibodies to fight off infection. He doesn't need antibiotics. Just leave him alone and let him breathes up. He won't deteriorate suddenly. If he gets worse then you start doing things and it won't be too late."

Talking to him really sucked all my energy but I kept in mind that my patient is the baby, not the dad. Like a primary school teacher, I taught him colostrum and breast milk and how it has no role in acute infection. I ended by saying his baby is now deteriorating and just like any babies he can deteriorate suddenly and die. Yes, I pulled out the Ace card --- DIE. "I am extremely concern about your baby and minimal intervention is not possible now".

He finally allowed me to start CPAP but not the rest. I informed the consultant and she wanted everything to be done and told me to explain to the dad again the importance of getting the blood tests, despite my futile effort for the last 45 minutes. 

Miracles do happen. After my conversation ended with the consultant, baby's dad looked for me and said "If you really need to do CPAP, IV, blood tests and CXR, that's fine. But no antibiotics. I just want to make you and myself happy". 

That's when it struck me. "This is not about making you happy or me happy. It's about making this baby happy." I cannot believe my 2-hour old patient had become an object of bargain for the ignorant dad. 

The next thing he asked "Is there any way that the baby can go on boobs now?" It was a clear and loud NO from me and the nursing staff. Looking at the floppy baby and MAP of 37, the baby scored a fluid bolus and I assured the dad that the baby won't be on boobs for a while until he recovers. 

I spent 4 hours in the special care nursery and admitted two other premature babies to the nursery before the consultant made a decision to transfer that sick baby to a tertiary hospital with neonatal ICU as he deteriorated despite maximum ventilatory support in our Level 2 nursery.

I finally went back to the Paediatric ward at 9:30PM and was inundated by parents of three patients wanting to know their test results. So I went to those rooms to explain the results to these three parents that I had not even met their child. Then a nurse informed me a patient's mum called and she was unhappy when she was told that the doctors were busy with a very sick baby and couldn't answer her call. The nurse quoted what the mum said "the doctors are obviously too busy to even pick up a phone to call me back with my baby's result!"

I left the hospital at 11PM. I took my packed dinner that I left in the ward fridge from 2 nights ago that I didn't get to eat. 

Tuesday, March 6, 2012

Mornington Peninsula

I notice I'm getting lazier to write. Not just writing the blog, but also writing in the hospital. My handwriting now sucks and ugly because I'm always pushed by time in the hospital. Each stroke is done so quickly, simply and I'm not pushing my pen deep enough onto the paper. We call this 'cincai' in Hokkien. Sad but true, time is running after me. My birthday passed not long ago and I'm getting older. After two years of working, I finally decided (sort of) that I want to do obstetric and gynaecology. I'll apply to do DipObs (Diploma of Obsetrics) for 2013 and if I'm not put off by it (i.e. stress and midwives) by the end of DipObs, I shall apply to get into the training for 2014/5. It's going to be a long way and some of my seniors have been trying for 3 or 4 years but still failed to be accepted into the training progam. Some people dropped out after being accepted into the program because it was too stressful. Once being accepted into the program, the training takes another 7 years. I don't know how far I would try, I may give up after 3 years of trying or I may even drop out if I find that I cannot stand the stress anymore.

Pictures from Mornington Peninsula:

My second visit to Sunny Ridge Strawberry Farm (December 2011)

Strawberry picking ($8 per adult i.e. a box of 500grams strawberries). Lovely day.

Hey mister :D

Sunny Ridge Strawberry Temptation (strawberry ice cream and sorbet topped with whipped cream and strawberry syrup)

 Quick visit to Tuck's Ridge Cafe/Vineyard where we bought a bottle of good red wine.

The vineyard

A nice sunny day to spend at the beach. Can't remember the name of this place.

We went to another beach, which was nicer, more beautiful and less secluded. Sorrento Beach.

 Sunny weather but it was quite cold! :)

Friday, February 3, 2012

Happy Chinese New Year

I just took a nap and am still feeling tired and sleepy. Blame the number of hours I worked and the fact that I worked two man's job on Wednesday because of someone resigning. The new batch of residents are going to learn a lot because there will finally be a registrar next week, and he is a senior registrar who had passed the exam. Lucky people. 

This is going to be a photo entry because I have a lot of photos in my iPhone to be offloaded to somewhere. I don't know why I took some of these pictures, but anyway at least my family can see some of my recent pictures here.

After coming home from Queen Victoria night market.

CNY's eve dinner before leaving for night shift

Steamed fish (the fastest and simplest CNY dish - 5 minutes cooking time)

Love this dress from Lipsy London

Yummy glutinuous rice. This time I did soak the rice in water for overnight, and it's a successful dish.

This was a message Kevin sent to me on one of my busy days at work:
"Today's dinner will be parsley pesto tagliatelle with cherry tomatoes and pan fried kabana. Will start serving at 21:45. Love, Kev"

Prepared by Kevin, with lots of love :)

Dinner at Shira Nui


Sushi and sashimi, my favourite

Tuesday, January 17, 2012

Congratulations to Pik Lay and Wee Liem

First of all, happy birthday to my newborn nephew. I wish I were there in Penang to accompany my sister when she gave birth. She did a great job!

Secondly, I want to post photos of my victorious baking history. My sisters in Malaysia bake very well, and my youngest sister in US also can bake! I decided I must bake something to keep up with their pace. Furthermore, Kevin got a food processor + mixer which he exchanged from his credit card points. That gives me a better reason to bake now!

Lamington berry roll

Not the best looking lamington roll. But it tastes great. I'm proud :D

Coriander roasted chicken

Some kind of Vietnamese/Laos dish. Very complex flavour (more than just coriander). Love this recipe and would cook it again!

Wednesday, January 4, 2012

So, I have a day off...

Having a day off like this sitting in front of the computer the whole morning, is AWESOME and BLISSFUL. It's sunny day looking outside the window next to me :) 

I've been busy. I didn't have the chance to celebrate Christmas or New Year. I worked on Christmas day (I wasn't paid the public holiday rate!), and I worked till late on the new year's eve. By the time I finished work, I was too tired to drag myself out for celebration. I counted down the new year with my soft toy, sitting on the couch watching fireworks on TV; and I received a warm message at midnight from Kevin who just started his night shift in the emergency department. He is so lovely.

Yesterday was a stormy shift for me in the obstetric ward. I had less than 10 minutes to review a pregnant woman presented with abdominal pain, in between two emergency caesarean cases. In the morning was antenatal clinic, and I met a pregnant girl who gave me so much headache. She is 17 years old, slim (yes, she is 33 weeks pregnant and she still looks slim), pretty, and has thick cosmetic put on her face like a doll. Before pregnancy, she used cannabis, 'ice', cigarettes and maybe more. Came along with her was the father of her baby. He is also a teenager, with the voice of Justin Bieber, and he is literally a boy. The whole scene reminded me of the film Juno

Out of nowhere, the girl pulled out a sandwich and ate in front of me, before I saw her fasting blood slip dated 8/12/2011. She said she didn't do the blood test because her boyfriend went to Adelaide and she wasn't given a blood slip during that time???!!! (don't ask me, I don't know what has her boyfriend got to do with that, and I don't know why she lied about the blood slip too). So I asked "why are you eating the sandwich now? Are you not going to have the blood test later?" She said she was told by 'a lady at the front desk' that she had missed the fasting blood test, and didn't need it anymore *_* (maybe she should have asked me before she started eating?). Then she told me everything has been good and she had some bleeding recently (seriously?!). She didn't think she had to see a doctor because she read on the internet that 'it was normal'. And she smiled (and I felt like punching her tummy). As I pulled the curtain to examine her, she said "I think my boyfriend has the right to see this too, he is the father of the baby". So, the whole scene was like a school boy watching his science teacher dissecting a frog. Before she left, she said she didn't like her previous doctor, because the doctor said that she was naive. I agree with the doctor.

Friday, December 2, 2011

My Job

It's been a while!

I AM EXHAUSTED from work...

I am rostered to work 13.5 hours most days of the week.
I face angry, screaming women everyday.
I work night shifts.
I deal with dumb women everyday.
I work under the territory of midwives.
I hate midwives.
I feel scare to assist in one of the bosses' surgeries because I can't seem to predict her next move.
I don't have a registrar.

Having said that, I learn the most from this rotation.

Thursday, September 22, 2011

Tik Tok...

Scary thought that I'm ageing. When I smile, couple of wrinkles appear next to my eyes. I doubt my waist size is the same anymore. Also, I have a feeling that my boobs and my facial skin are drooping.

Couples I know are getting married. Lovely people tell me to get married. Time flies and soon, I'll be 30. But I don't want to be married. The fact is it has to be done one day. Just like having kids - I don't want to have any kid, but it has to happen eventually. Because it has to happen, it better happens before the ageing process speeds up and my ovum becomes defective. Worst thought of all is I wouldn't know what sort of kids they would end up becoming. Having kids is expensive and is a huge bet, just like getting married. Thinking all these is enough to cause me sleepless nights...

The reason I'm ruminating is not because someone pops the question. But because I notice I'm getting old and I feel sad seeing my body changes and therefore I have to start planning. It's unfair seeing Kevin becoming more attractive while I'm going downhill... I've given deep thoughts and came up with some ultimate beauty plans. There's no way I can go back to 18, but at least I can try to preserve 26 and slow down the ageing :)

I'll keep the beauty plans to myself. Maybe couple of years down the track I'll tell you if they work :) And whether I'll get married, who knows?

 I'm a wiser woman, more mature and confident!