Thursday, November 7, 2013

On Societal Excrement and Tertiary Educated Toilet Paper

Yieha !! I'm back !

After several months of writer's block, a period of social life stagnation, weeks of longing for home and a heart break, I am back. Yay for you ! Yay for me ! *applause PRN*

For those who have forgotten, I am a medical intern at the present time- 11 weeks of assorted rotations away from becoming a resident medical officer (whatever that means- the thought of needing to go back to med school bugs me more these days than it ever has).

I have survived 11 weeks of the emergency department- full of patients emerging from the cracks on the streets and of life. Work in an Australian ED, you'll understand what I mean- hey you intern! Pick up after these societal excrement and make them fragrant again ! Fix their problems ! I don't care if its a vague pain present for 10 years now- I want it fixed tonight ! I don't care if its a morose old migrant woman not getting any attention from her family members save her crippled old dog, I want you to understand what she's saying, and fix her abandonment tonight ! I want all these patients to be transferred to a non existent ephemeral ward bed within 4 hours of them presenting to this packed emergency department. I don't care if you haven't sat down to gather your thoughts, or had anything down your throat other than airborne microbes from your patients, work ! work ! work ! (ok this is unfair to my bosses- they were very very kind- despite their kindness- it was really stressful. Again, my bosses were really nice and helpful- heheh)

 "I donno, maybe you can teach me deep breathing techniques" said my shaking, sweating, agitated young male patient, who appears like he stuffs boulders under his skin in his free time and probably has no functioning gonads- hours after taking Ice and coccaine; and possibly years after injecting steroids. Hell was in my heart that night. *flushes down M&Ms with lemon pop*

It reminds me of this case of severe epigastric abdominal pain- complete with the pale face, sweating, tummy clenching, rolling around middle aged migrant male who is married to a GP. Enough to make one with experience as abundant (no) as myself rush to his boss- "this guy has an acute abdomen ! ". To which my boss- also my supervisor replied "right....~hold're a doctor now, tell me your differentials"- to which my panicked self  was unable to answer fluently. Which is bad news for yourself- all non english speaking background, all flustered, with hair all over the place and possibly cracked lips from not having had anything to drink all day- the appearance, both of your panicked self and your panicked presentation- not great for your supervisor to remember you by.

My boss then went around- pressed around his tummy (with the patient just saying "ouch" all the time- and then saying it's not painful where he was being palpated- it was an ouch for his general pain) and the patient, all frustrated that he was being poked around and wanting to be seen "soon ! this may be appendicitis..right?" just said yes "it hurts there" when he was palpated in the right iliac fossa (which he didn't mention before- i suspect his wife has been educating him while I was away- curses! ).

My boss then called the surgeon and told him that this patient has appendicitis. Patient sold !

Severe epigastric colicky pain with tenderness on palpation in the right iliac fossa - diagnosis ?

If you answered appendicitis- congratulations ! You are fit to become an emergency physician !

If you answered - "i don't think this is appendicitis- sorry" then you are like me when the surgeon asked me "do you think this is an appendicitis ? Seriously? "

I saw on facebook today an ode by our much beloved modern age Malay Prima Donna- Siti Nurhaliza to another much admired Malaysian character Tok Guru Nik Aziz. A man well worth the praise and adoration of Malaysians- well known for his iron grip on principles and honesty- a gem amongst rocks.

It reminds me of a critique made by a Malaysian historical and cultural pundit- Farish A Noor on the Malaysian society; how we long to cling on to our ancestral practices of feudalism and dependence on demigods and kings and heroes to make life better for ourselves. A hero bringing salvation and answers to our plight. A hero to carry the burden of our sloth, our ignorance, our apathy, our impulsivities- a hero to be perfect; who will carry us across our oceans- as Moses did for the Israelites.

We make up our people- our rotten society is a reflection of our individual traits. Sure, that's a blanket claim- but isn't it true? Our societal negativities are all our apathy, recklessness, narcissism, pride - jumbled into one big mess. Fixing it must be by the hero of our collective narrative- our own selves.  

Dig out our principles- hold on to them, spread it to others. Practice it in life- God knows our society craves for some diamond age old principles.

I guess it's no wonder that it felt good when I told the surgeon what I thought (or didn't think) the problem was - how I wanted to say to my boss

I'd love to help myself and the ED out- and get this patient seen by the surgeon with a good and firm diagnosis within 3 hours of his presentation to ED- ridiculous the diagnosis may be.

But please let me keep for myself some integrity.

Yours sincerely

p.s.: So how is my story related to all these ED presentations, my steroid laden patient, my boss, Siti's song and Nik Aziz ?

p.p.s: I wanted to say that, but of course I didn't say it- I'm not your hero.

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