One week of rotation in QEH Pediatrics and I already missed QEH MED so much.  Shouldn't be saying this but I don't think I'm going to like Pedi. On the first briefing session, the supervisor already labelled us (me and another HO from QEH MED) as "reckless" because of where we came from.  Sure we had seen a lot of emergencies and are confident in handling a lot of things by ourselves, but we do know our limits. It is not necessary to warn us to restrain ourselves, as if we're some untamed animals. Even it may have been a joke, but what does that suppose to mean?

Anyway, apart from this, there's litter satisfaction in daily work in Pedi. First, the nurses are always rushing you to do things, even there's only one thing lying on the houseman workstation - while you're trying to attend ward rounds. In addition, they are unhelpful and rude so I'm starting to solve problems by myself. 

Apart from poor working environment, we are not involved most of the patient care, except taking blood. Every night, if you're calling infant wards, you'll have to take blood from the start of your duty until the next day.  Sometiimes during the night it is not uncommon to have thoughts of child abuse.  Blood taking is all a Pedi houseman is required from.  Even if you admitted patients and wrote down some simple management, it is often disregarded and the nurse will wait until the MO has given the order. For me it is hard to imagine how one can learn about Pedi if he wants to work there in the future when all you can do is spooning blood from a neonate's bleeding heel.

Still 11 more weeks to go.

First rotation is coming to an end. So far I've done multiple bone marrows, some lumbar punctures and abdominal taps, a few pleural tap, 1 central line insertion and 1 chest drain. (and countless CPR and many tedious blood cultures WITH ASEPTIC TECHNIQUE, which have to be done 3 times if the patient has a Hickman line...).  

No matter how expirenced I am in doing procedures (in fact I'm not the expert), I don't think the seniors will take this into consideration when they are hiring people.  But my tutors were either not senior enough or too cool to approach...how can I get a reference letter from them??

Trying to write a CV...so far it's still blank...what am I supposed to put in?? 

A 70-something lady with hepatocellular carcinoma, not for resuscitation.  She has a son who is a medical officer.  Her condition had become critical, with low hemoglobin requiring blood transfusion and fluid and ionotropic support to maintain her blood pressure.  Then, more than 500ml of coffee-ground aspirate came out from the Ryle's tube, she must had had more bleeding.  More blood-taking would only show further drop in hemoglobin, which was already very hard to do since the patient's blood pressure was dropping, and with the poor clotthing profile, femoral blood taking was not allowed. Is there a need for more transfusion?  The medical officer is standing right by her side, knowing all about this. What was going on in his mind? He had had this experience every day in his career. He knew about doing more is just causing more suffering to his mother. If this were his patient he would not hesitate in making a decision, but this was his mother...

"Do not resuscitate" - this is a decision all medical officers have to make when they think that a patient's prognosis is dismal and aggressive resuscitation will only cause more trauma to the patient's body. But can they make and accept this decision if it was for their love ones?

At the end, the medical officer agreed not to take more blood samples. He just stood by his mother's side, watching her last gasps for air, until there was no more effort of breathing...

He must have had considered this situation some time ago since he entered medical school.  He understands that medicine has its limits. But can he still be rational when it happens to his close ones?  Isn't it ironic that he, being a doctor himself, was not able to treat his mother, and watched her died in front of his eyes?

What will I do when this happens to me?

Something learned from recent days - when you've completed most of the work during on-call nights, be sure to get some rest instead of feeling like being helpful.  Or else this is what you might get: needle stick injury, cardiac arrest requiring CPR, skipping important image or lab result findings which you thought was unimportant in the first place, then later being scolded by the medical officer the next day. Some I've experienced and some I've heard of.  This may sound irresponsible, but sometimes it will be much safer for oneself and  the patients if we only mind our own business.

Recently there is much pressure in daily ward duties, mainly due to the widely reported medical incidents. "Urgent" cases need to be attended quickly, especially when the patient is accompanied by concerned relatives. K+ need to be corrected carefully and on each lab result form the value, electrolyte, name of the patient have to be underlined, and sodium level have to be written down before correcting K+. Each blood taking is takes longer than before for the fear of taking blood from the wrong patient or printing out wrong labels.

One of the most satisfying things is that the management you have ordered for a new patient had not been changed after assessment by the medical officer who comes in later.  Although that was only a minor case of fever, at least now I know how to admit a case of fever in the future.

QEH is undoubtedly a place that can really drain all the juice out of you, but the team spirit in the medical department really impresses me, and within us interns this is developing too.  Thanks for those who have helped out during the times of collapse.  Can't believe a month have passed already.  Really wish to come back and work here a year later.

Life as a houseman in QEH

Have always known that QEH would be hell, but the first day was really overwhelming.  On the first day, with nothing in my head, already had to manage a lot of problems: drop in blood pressure, desaturation, raised Troponin I with chest pain, fast atrail fibrillation...it was too much and too sudden for someone like me, for I used to take on problems slowly... But in the hospital patients like to have problems together, and they like to do it at night when you have that least support from seniors and other staff.

The first night oncall was a long night.  Complaints and ugly-looking lab results kept pouring in from 10+ wards from night until dawn.  There was no time for a drink, not to mention to sleep or even a short nap.  Feeling of loneliness and helplessness flushed in as I saw the sunrise during that night.  Luckily I could still hold on.

Procedures I've done so far: >10 bone marrow aspirations, 2 lumbar punctures, 2 abdominal tapping, 1 venesection .  Sounds like I've done a lot, but the price of doing a pricedure is a mountain (or several mountains) of work piled up in other wards.

So far, I haven't the chance to sleep during my oncall nights like the others did.  I guess I really have to work on my effiency.  But have to admit I'm quite happy working here, even I worked my ass off.  I have very nice and supportive colleagues and  I can feel a team spirit is emerging within us.