Thursday, May 10, 2007

Random Thoughts Post Barbeque

How I wish I could write down entries on the blog as soon as they occur to my mind. The one hour drive each morning to work is usually the time for bursts of inspiration but by the time I get home in the evening whatever impetus of idea I had would have disintegrated into fragments of incoherent thoughts.

Let me recall:

1. Post BBQ

The barbeque our team had had at Rutland Water has done wonders to our team's morale and congruity. We are now almost inseparable! As a friend most eloquently pointed out at our first lunch meet after the weekend: "It seems that after the BBQ we have stopped being colleagues - we are now officially friends".

I was oncall on the Tuesday we started work after the bank holiday weekend, and I was so surprised to find Abhishek there in the Medical Admissions Unit at tea time - he turned up just to invite me back to the ward for several minutes to join the rest of the team for our "journal club".

Aww - how nice.

At lunch, even though we were all working in different places due to oncalls, the whole Althorp team met up in the canteen to eat together. We are already planning our next outing ;) hopefully soon in the future.

2. The oncall

There's also something I wanted to share about my recent oncall. Partway through the day, we suddenly heard the dreaded sound of a cardiac arrest call. I ran to the surgical ward to find that the medical registrar was not present, and thus I had to lead the arrest call. Whenever I am called to a cardiac arrest, a sort-of "work flow" or algorithm would run through my head and it went like this at that time:
  • Arrived. Patient is unconscious but breathing spontaneously and has a pulse.
  • Blood pressure present: 120/60, heart rate 150.
  • I asked the nurse for the patient's history
  • Nurse: "80 year old, background of atrial fibrillation, hypertension and that's it. Found collapsed with a high pulse"
  • I tried to rouse the patient - no response but still breathing and confirmed pulse.
  • Asked for an ECG. ECG shows rate of 150, atrial fibrillation. No ST elevation to indicate MI.
  • Delegate task of taking full bloods and arterial blood gas to juniors.
  • Ask nurses to take blood glucose reading: blood glucose = 11 (darn, not hypoglycaemia!)
  • At that time I considered to slow the heart rate with IV digoxin or amiodarone.
  • IV access present
  • I asked the nurse to repeat BP: BP fell to 90/40.
  • Start IV colloid: (gelofusin) then recheck BP.
  • As soon as the gelofusin ran through, the BP immediately picked up to 120 systolic, and the pulse slowed down to 90.
  • I examined the patient: chest clear, heart sounds normal, abdomen ?!
  • ... abdomen was board rigid, with a pulsatile and expansile 6cm mass
  • Diagnosis: Query ruptured abdominal aortic aneurysm!!!
  • Surgeons oncall bleeped and arrived - agreed with diagnosis of AAA and patient was arranged to be transported to theatres.
  • Patient's blood pressure and pulse continued to improve with the IV gelofusin and fluids and the patient is starting to rouse.
  • Checklist (I said this all out loud): "IV access, IV fluids, ECG, bloods, arterial blood gasses, pulse, blood pressure, surgeons - all check. We've done all we can, I think".
A friend of mine said, "Yes, we've done all we can - that was a well led cardiac arrest." And then, suddenly everyone in the arrest team - nurses, anaesthetists, the medical doctors, surgeons - nodded in agreement and gave me a clap! A nurse even said, "you're a natural born leader" but my brain was too short-circuited at that time for me to come up with a reply and I just smiled meekly and gave a wave of dismissal (which in human language should be translated as "nah, it was really nothing").

I have to say though, the event did make me feel slightly proud and happy - even till today :)

3. My friends do not get me
Back on the wards the next day, I found out that a friend was oncall. So after work, I went to the Medical Assessment Unit to meet up with him before I went home. The timing was excellent, as he was starting a tea break with the rest of the oncall team, and I was invited to join in.

A (male) friend of mine was complaining of chest pain. Everyone else in the room was giving their diagnoses - the most popular and likely being musculoskeletal chest pain, of course. Trying to be cheeky & funny I said I thought it was breast cancer, "any discharge?", I asked - cheekily. To my surprise, my friend - not the one in pain - felt so strongly against the joke, that I felt slightly silly for making it in the first place.

It was at that time when for the first time I realised, "Even though I have been working with this guy for YEARS, he still doesn't get my jokes!"

I don't know whether this is true or not, but in Malaysia, especially when working amongst male colleagues, it's quite common-place to make (urm, how should I say it) off-colour jokes, right? By "off-colour" I mean jokes that are shifted towards the ultraviolet end of the colour spectrum, get what I mean?

After 3 years or so working here, I finally realised - jokes like that are not acceptable in this country! D'oh!

So from now on, my joke algorithms has to be squeaky clean. That reduces my joke repertoire by at least 50%!

4. Thoughts on Althorp team

Moving to less cheeky matters now, I just have to say - I am working with a great team in Althorp at the moment. I dare say, we are probably one of the most cohesive group in the whole hospital - emphasis on "probably". One friend from our team said, "Going to Althorp ward every day feels not like going to work, it feels more like going to Nursery to play." What he means by that statement is that because we have such great teamwork and friendship in Althorp ward, coming to work is such a pleasure that it doesn't feel like a chore and I feel so fortunate to be part of this wonderful crew. Here's hoping for more great times ahead.


dith said...

Mynn- Like you, I too get abundant flow of ideas to write whilst driving to work and the ideas sort of dry out once I am in front the pc, hehe

Ouch! I can feel your 'hurt' by the off-color joke incident. Guess, you better watch what you say next time, eh?

Btw, why is it called cardiac arrest when the patient is still breathing spontaneously, has a pulse and BP?

pycnogenol said...

It's good to know that you are around such talented and like-minded individuals.
Just the sense of camaderie among everyone, the competitive but team-oriented nature of the work done with fellow doctors and the whole team - must be a great experience you're not likely to forget!

hiyoshi said...


Yes, the human race is unfortunately predictable. At least one half of it is.

When in the company of male colleagues, it is not just common-place to make off-colour jokes - it is a rule. It doesn't matter how intellectual the original topic of discussion was, eventually the ever ingenious male mind will steer into the direction of more 'colourful' pastures.

Rats, now I've let the cat out of the bag.

mynn said...

I am the same - i always get brimfuls of ideas whenever I am not infront of the computer. sometimes I wish for a dictation machine where I can just voice the ideas and refer to them later (captain's log: stardate 203939 anyone??) <-- that's me starting my clean joke routine :D -- boring right??

another thing about me DITH is that, coming from a religious school and quite religious parents, I was quite a shy person (i know, i know - who would have thunk it?) - in fact, i still very much am. i had to WORK HARD to diminish my shyness - something i've been working at for past 3-5 years. i say "diminish" because a bit of shyness is good too right? and if you want to know why i am trying to remove a bit of shyness - it's prohibitive to "getting the job/things done".

yet another thing about making jokes DITH is, you have to be quick of mind. a way to be quick is to say what comes first. people say men think about something once every 9 seconds ... [i'll stop there]

DITH - i am also aware it wasn't techniquely a cardiac arrest - let's call it a peri-arrest shall we? (sheesh, nothing gets past you dith!)

it's excellent to be around such like-minded people, the team is like a well-lubricated machine*. and the "team" doesn't really stop at us doctors - it extends and include the nurses, physios, Health care assistants, pharmacists - everyone in the hospital really. all in the interests of the patients.

right??? it's a RULE. i think that rule is only confined to malaysia though hiyoshi. i made that joke in a mixed, international group - not at all appreciated.

*can't help myself

1. my friends like rosli and uncle de knows very well i tread at the very borders of what is appropriate for a joke :D hahaha....

2. i blame my father for this personality!

Mama Sarah said...

if you go to Nursery everyday, does that mean Sarah goes to WORK? Seems like it to me!

dith said...

You remind me of OK. He can make off-color jokes but balance it out by smiling his sheepish grin!

mynn said...

i was thinking of when i was writing about off colour jokes amongst male colleagues! O-K and my jokes are probably similar - we did come from similar backgrounds.

patutlah sarah selalu cakap nak beli kan i magazine, jam, pen etc2.

mynn said...

whoops correction
dith - I was thinking of O-K <- i left out "o-k" in the above reply

hiyoshi said...


Fact: Men have repetitions of a single thought every 9 seconds.

Given that, it should come as no surprise then how they have perfected the art of telling 'wonderful' jokes.

Tell you what Mynn. I find putting on a poker face will effectively help you out of a sticky situation (read: a joke not well taken)

mynn said...

yup, you could almost say that the onus is upon us for making these colourful jokes. as for me hiyoshi, i don't really have a poker face - people tell me i'm very transparent. how i cover up is i - like dith said above - smile blankly and hope for others to change the topic.
i forgot to add one thing to the story. My breast-pain-friend replied to my offended-friend: I know mynn sometimes make impulsive, inappropriate jokes but that is why i love this little guy and will miss him once he goes back to malaysia.

Aww - that's nice, despite my cruel joke! see yoshi, with my patented blank smile you can get away with anything :)

hiyoshi said...

(Notice how when the topic revolves around this particular subject matter, the boys suddenly become active?)

Well of course they'll miss you once you come back. Who's going to make all the impulsive, inappropriate jokes then?

Oh by the way, over here everyone is capable of telling such jokes, thus you won't be sticking out like a sore thumb as before *grin*

ikelah said...

congratulations in succeeding to bring the patient out. i know how it feels when we succeed especially with a good team. :)

in our emergency setup here we seldom use colloids as the first line when the BP crash. we'll usually run Hartman or just normal saline until we have established the probable cause and rule out bleeding. this is because colloids may impair fibrinogen polymerization thus coagulation. This will effect the peri and post operative management.

however some physicians here do use colloids as the first line as it has both pros and cons.

mynn said...

thanks for the info. over here, when the blood pressure crashes colloids (e.g. gelofusin and pentastarch, where available) are 1st line - even if we suspect bleeding. Reason being colloids are thought to stay in the blood vessels & are "plasma expanders". i think, one will need a larger amount of hartmans/saline in order to elevate the BP the same amount. whereas, with gelofusin sometimes only 500mls is sufficient.

i bet there'll be "more experienced" joke-tellers back in malaysia and I will be the one gasping at the inappropriate jokes. even though my jokes here are offensive, as i said it treads the very border of acceptability - true sometimes i fall to the opposite side but those are special cases ;) don't worry - i'm a fast learner.

raggedyanne said...

i'm pretty sure the Brits love 'off-colour' jokes once in a while. Maybe he was offended coz the joke is cancer-related... just a thought.

After watching too much medical dramas on TV, I don't think I get doctors at all :)