After I successfully bleed my patient for a renal profile stat that afternoon, I sent it for lab. My boss ordered me to "Refer Medical for CKD. Amik RP stat."
It was 12 plus. The result will be ready close to 1pm. As a courtesy to fellow doctors, I don't feel right referring non urgent cases during 1-2 pm. At 2 pm my boss will start PM round and the first question for me will be
"Dah refer Medical belum?"
And at this point, I would be answering truthfully "Belum-" and boss's face will change...
Logically we should refer once all data ready, but.. I don't know.
Nasri happened to be sitting beside me while I was contemplating. As pleased I was at having his company and not be confined to one "Hai Nash" greeting per day, I felt scrutinised. I knew he would be listening and I would be queried.
So I decided to call Medical anyway despite the current RP result in progress and inform the oncall MO as to why we're concerned of this patient's kidney profile. And as expected, she scolded me and told me to call her back once the result was ready. I happily thanked her because that was exactly the words I wanted to hear.
"Medical nak result dulu?" His tone was stating the obvious. I was grateful he regarded me intelligent enough to not tell me what I should have done instead.
"Yep. At least dah refer," while I documented "spoken to Dr. N (Medical), she requested an update on RP result once ready" in the patient's BHT.
When I think about it, that was a "asal lepas" kind of answer. I wasn't proud of that answer, but I really needed to have something to answer to my bosses. You haven't meet the Red bosses yet. Some of them would shoot me "awak tak menjawab soalan saya" if I answer "tunggu result RP keluar baru nak refer". I just wanted to answer with "Dah" followed by whatever buts in the world.
Anyway, I called her back at 2 pm just to inform her that the blood urea and creatinine were normal, which I bet from her tone and choice of words when I called her earlier would shot me again for not waiting for the result before calling her in the first place, basically saving us from having to deal with each other today. But it went to voicemail. I called later at 2.20 pm and again went to voicemail.
I felt God was totally on my side then because immediately after that my round started and I was lucky enough to have an answer of "Dah refer Medical, she asked for an update when result ready. Result dah siap. Urea creat normal, tapi patient hypokalemia 2.9." Lol.
Had I wait till 2 pm to refer, I wouldn't have referred the case at all before round and would have been at the receiving end of "dik saya suruh awak refer Medical kan!" should the urea creat results were abnormal.
I wish Nasri will read this, haha.
Back home I discussed my situation with dad and he said;
(A) yes I should have waited for the result before referring, but next time I should just say "the result is still in progress, but we would appreciate it very much if you could still take a look at this patient."
(B) dad understood my dilemma of having to please my bosses and everyone else around me. He said I should try to balance this. How, he didn't say. I guess some things are to be figured out by experience.
(C) as a medical-based consultant, dad had more problems with surgical than they ever had with him. "They're always late." One time ago dad had a suspected case of intestinal obstruction. His team referred to Surgical and the MO said he will come review later. I don't know how late was later but when dad was doing round and Surgical had yet to review the patient, dad called the then HOD and said "your surgeons are lazy."
The then HOD scolded his MO and said MO came to review the case on the spot. And subsequently the surgeons all were angry at dad. "Kami bergaduh masa tu."
And I thought, maybe being targetted as Dr. Hanifah's kid was a result of their feud back then. Dear God.
---
The same medical MO I referred her for an updated management for one of our patient under their care for HAP diagnosed on the 17th who we wanted to discharge. I told her patient had been afebrile for the past few days, comfortable under room air, no cough nor SOB, tolerating orally well, lungs minimal crept at left lower zone...
"Platelet?"
"Last result was 19th-"
She scolded me because the latest FBC was 19th and no one cared to repeat FBC after that. "Macam mana awak tahu patient dah okay?! FBC pun tak repeat!"
I had no answer for that. We only repeated daily calcium haha FML.
"Calcium je jaga! Kalau nak discharge sangat, tukar la jadi tab cefuroxime! HAP pun tak reti manage ke?!"
Truthfully I wanted to answer "Saya tak tahu, sorry first poster noob. Kalau saya tahu pun boleh ke saya tukar je management Medical? Boss Surgical saya pun tak buat camtu." But she was obviously having a bad day and as a wiseass I know when to be wise and when to be an ass.
I replied her with a bright smile instead. "Okay, terima kasih doktor. Nak bagi berapa lama ya?" She answered curtly and hung up.
Then I realised; what dose?! What dose?! Gaaa what dose?! Why these people think I know everything!
---
For another patient with diverticulitis keen for discharge, I don't know what to change IV Cefobid 1gm BD to oral. So I searched in the Blue Book. In vain. So I asked Wong as he was nearest but his answer was so fast and I sort of heard-not-heard what he said. I then asked my teammates but no one replied. Should I call my MO to ask about drugs- nah, no way, nuh uh.
So I messaged the best MO in the world, Bawarouq. Haha manja gile... I was ashamed of myself but felt very grateful. He even wished me "ganbatte!"
Sigh. I need to work harder and study smarter.
---
Speaking of branulas, Arif inserted one on Cik Mala this morning. It was pink and Arif inserted it (to me) in a weird angle of her dorsum. Patient complained of pain later in the evening and boss ordered the branula be changed.
It would have been the fourth branula for Cik Mala. K tried and failed twice, so I was up next because I was the only other Red in the ward who hasn't try yet. Arif and K are my senior HOs and I was sort of amused at the third trier be the less experienced of all.
So I sat next to Cik Mala, assured her, searched for a vein while K observed and Arif behind me telling me to hurry up because he was standby in case I failed. I got the branula in in one go, no bunk. Nicely done.
Arif complimented me hehehehehehe. I felt proud. And for the sake of Cik Mala I hope the branula stays good.
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I saw Dr. Adham in the morning and greeted him. I last saw him during my oncall Sunday last week. Later near afternoon I was at the counter doing paperworks and he had some other case with his team HO near me. I merely greeted him. As he finished the discussion, he passed beside me and asked,
"Okey dik? Beres?"
"Beres," I replied. I wasn't sure what that was about, I half thought he was going to viva me the surface anatomy of liver right there and then. It felt weird to be asked that so suddenly, did I look grim?
But I appreciate the gesture. Hehehe. And I forgot to wish him Selamat Hari Raya.
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We started with 15 patients for Red team and ended with 5 patients. Haha 10 dischargessssssss!
Granted post Eid will be a feast of work for us, but I'll be happy while I can.
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