Tuesday, March 29, 2011

Lactobacillus acidophilus : a cautionary tale

that's the name of the good bacteria that's supposed to promote healthy bowels & is one of the "probiotics", a group of organisms used for medicinal purposes. this is commonly found in cultured drinks that's advertised extensively & is widely available in most supermarkets.

and kids just love them. i myself find it's just too sweet for good health but i digress.

today, we had a 4-year-old girl in hospital just from drinking that. no, the bacteria didn't cause her harm but the straw did. did you notice that the straws that come with these bottles of cultured milk are much stiffer, in order that they may pierce thru the foil-top? this poor girl was enjoying her drink when she tripped & fell, causing the straw (the blunt end) to pierce thru the inside of her mouth.

the puncture wound had to be surgically stitched up. & it will be the most expensive bottle of lactobacillus cultured drink anyone ever bought!

so, parents, warn your kids NEVER run, hop or skip, even with plastic utensils in their mouths!

Wednesday, March 23, 2011

here we go again.....

so, there're over 9000 top scorers with straight 10As for the 2010 SPM exam....(don't know about it? don't worry, the self-aggrandisation report will be splashed all over the media tomorrow)

so, that's many, many more than the 7000 plus top scorers the year before....

so, there'll be rush for scholarships....(& many students & their parents will be disappointed.)

so, i wonder how many will remain unemployed (or unemployable) after graduating?

same old, same old...

Tuesday, March 22, 2011

cheating time

for moment, i thought we were in different time zones.

when the patient was pushed out of OT, it was 4pm. i then went off to do some errands & when i checked on the patient again in the recovery bay later, i noted the nurse had timed the arrival at 4.15pm.


i asked her, how come it took 15 mins to move the patient a distance of only 10m. that's TEN METRES between the OT & recovery bay.

we looked at each other for a few tensed seconds before she broke silence : the clocks in the OT & recovery bay were set at different times. i checked & they were the same time.

after a few more uneasy seconds, she finally confessed, that the senior nurse had told to her to add 15mins. i've always known that something fishy invariably happens at 4pm. that's the starting time for claiming overtime. it happens all the time under our noses.

except that this time, i caught the sacrificial lamb culprit red-handed.

but don't we all cheat time ourselves? we cut queues to save time, we cut lanes & drive on the hard shoulder to reach our destinations earlier. we fix our appointments, then arrive late & make everyone else wait. how about we scratch out a later time when we put up our parking coupons?

in my mind now, the philosophical words of one of my ex-classmates* in secondary school ring true :

we are humans. we are basically dishonest!

*while i was still reading hardy boys & nancy drew, he was already on to john steinbeck.

Friday, March 18, 2011


bad mouth + bad heart + bad attitude = doctor from hell.

is there one in your neighbourhood clinic or hospital?

Wednesday, March 16, 2011

new nurses, old habits

i prescribed syrup panadol to a child recovering from surgery, using the accepted acronym QID, or "quater in die", which in Latin means 4 times a day.

the 1st dose was given at 8pm, soon after returning to the ward from OT.

the next morning, i checked on the child & was surprised that the 2nd dose was given at 2am. reading thru the nite shift notes, it mentioned that the child was not in pain, was not having a fever & was sleeping at that time.

so i questioned the morning shift nurse as to why the child was woken up at 2am to be served the panadol. she replied, defending her nite shift colleague, that i had written the QID dosing, implying 4 times a day or at 6-hourly intervals.

so i questioned again, whether there was a difference between a prescription written "QID" compared to one written "6-hourly." this nurse, with her colleagues now overhearing our conversation, almost replied in unison :


i asked again : you mean, there's no difference between QID and 6-hourly dosing? and the response again, almost in one voice :


that's when i got a little hot under the collar.

ok, so i created this scenario: they went to clinic for backache at 8pm & the doctor prescribed a painkiller with a QID dosing. if they took the 1st dose at 8pm, would they wake up at 2am to take the 2nd dose IF they didn't have pain at that time? 

instead of the concerted response i had come to expect, now they gave me a blank stare. & to drive the message home, i cynically asked : if they won't wake up at nite to take their medicine, why would they want to subject a sick child recovering from surgery, who was pain-free, not having a fever & sleeping peacefully, to a rude awakening at 2am?

all i ask is a little brain common sense. life-saving medicine like powerful antibiotics are often prescribed strictly round the clock at clearly stated  intervals, eg. 6-hourly, & often given intravenously without awaking the patient from sleep. other less critical ones are prescribed to be taken during the day, eg. QID, in which case, they may be served at 8am, 12 noon, 4pm & finally 8pm.

2 things are clear now:

1) with the mushrooming of nursing colleges, don't expect the standard of teaching to improve;

2) i won't be very popular in the children's ward from now on.

Friday, March 11, 2011

playing God

because doctors often deal with life-and-death decisions, we have sometimes been unceremoniously accused of playing God, as if dictating who should live & who should not. i occasionally have to encounter these circumstances myself but i'd like to think that i always have the patient & the family's interest at heart, although it may not be taken in positive light.

but i leave playing God to ..... God.

last nite, we had this particular difficult case in surgery. the patient had a huge pancreatic cyst which required removal together with a portion of the pancreas. pancreatic surgery is fraught with landmines as it is, so after 4 labourious hours, it was finally excised.

& right there & then, a small vessel started bleeding profusely. this was immediately dealt with, but not after 250ml of blood had been lost within minutes. (note: the excision of the cyst had resulted in a litre blood loss earlier)

this was when one of the doctors exclaimed : thank God,  it bled now & not later!

if the bleeding had occured later when the patient was in the ward, the outcome would have been catastrophic. the rapid blood loss would have cause immediate deterioration in the patient's condition & there might not be time to re-explore the abdomen in OT. most likely, it'll be a one-way trip to the morgue.

seriously, when we doctors have our heads firmly screwed unto the shoulders, we realise we are just pawns on the medical chessboard. God alone decides which piece will be moved.

i just pray there aren't too many checkmates on my watch.

Sunday, March 06, 2011

what i like about funerals

i attended a wake back in the hometown over the weekend. it was the passing of a church member. far from being a sombre occasion, everyone seemed to be in good spirits, including the family of the deceased.

met up with quite a few people from the days i 1st attended church & it felt like a reunion of sorts - the ex-student pastor who is now in management within the church body, the ex-door-to-door book salesman who is now a medical rep & the youths of yore who now have families of their own.

that's what i like about funerals & i don't mean any disrespect to the deceased nor the grieving family. i often catch up with a whole bunch of people that i will not be able to under other circumstances. in a way, i relish reliving my past life .

do you still remember your 1st love? of course, this doesn't apply if you married that person but many do not go through life that way. i didn't.

the wake happened to be for the beloved mother of my 1st love. as the projector flashed the life & times of the late mrs K, & as each family member paid tribute to the matriarch, i too recalled those care-free days of my youth & the start of my christian life in which she left a big impression. as it turned out, she remains a wonderful mother, grandmother AND mother-in-law in a world where two out of three is the norm.

it was indeed a remarkable trip down memory lane. almost like the green, green grass of home.

Thursday, March 03, 2011

a root of many kinds of evil?

the hospital organised an in-house badminton competition. a few of my colleagues who were taking part asked me to join as well - just for fun, they said.

i was reluctant for 2 main reasons. 1st, my joints creaked when they are stretched. and 2nd, nobody plays just for fun when cash prizes are involved.
besides, i was on-call that weekend. 

the day after the tournament ended, i found out that a few people had cried foul over the draw. well, actually it was over the re-draw. many questioned why the re-draw was necessary & why it wasn't done publicly. as it turned out, the re-draw had largely favoured a particular participant with a bye. the one who was given the bye in the original draw even withdrew from the competition in protest because of this lack of transparency.

in the end, justice was served & the favoured participant didn't win. i've always felt that when money is involved, all gloves would come off. nothing would be just for fun anymore.

the person organising this competition is a colleague, so i took a dig at him - told him the MACC are looking for him & i advised him to request for an interrogation room without windows or one on the ground floor.

we both then burst out laughing.