Let me recall:
1. Post BBQ
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
- 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".
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
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