Unexpected Friday

Alhamdulillah, started the morning with good breakfast. Gastritis resolved.

23 patients in the ward. The day before, I left the ward with only 13 patients. It seems that my on called colleague just had a good business. Non stop admissions since midnight. He, as usual, will clerk patients one by one slowly, takes his own sweet time, gives the basic management and leaves the rests to other people. Such a lucky guy. Despite his never-serious character, he always survived. His patients were always okay, or a bit unstable but saved by us.

I reviewed a neonate of day3 of life with the intention of helping him. Such a young baby with fever secondary to dehydration. Increased urea, creatinine and sodium. Mother admitted that she stopped feeding the baby the day before due to too tired. Despite explaination and simple management plans, the mother already started asking on discharge. That is not a good sign. I emphasized on supplementary feeding as a form of rehydration, plus mother's breast milk.

Another patient that worried me is another new case in isolation room, treated as pharyngitis. When I told my colleague about the low platelet count, he seemed not worry at all. He is post call, what he thought was only about going back and sleep. Patient is suspected dengue fever. Only 9 months old, clinically quite well. Another FBC was ordered in the afternoon, together with FBP and dengue serology.

Another review of the baby. Mother seemed not keen for the supplementary feeding. I was told that she threw away the feeding. She wanted only her milk. Understandable. Yet, do you think the 46mls formula milk that I ordered was freely available? Do not waste, my dear, just tell us that you do not want it, so we do not have to prepare for your baby. Husband came. Also very keen on discharge. He suggested for discharged today and return the next day for check up. Okay, now parents have become the paediatrician. I told them to continue feeding first and we will discuss this matter with the paediatrician when she comes later in the afternoon. They agreeed and thanked me.

I checked a patient with simple febrile fit, but with very low grade fever. Not warmed. No temperature spike. No abnormal behaviour. It seems that I did not have a good day with febrile fit patient lately. So I better be more careful. The patient next bed is also a febrile fit patient. He looks better, not fretful.

We had an early lunch as we expected to do rounds with specialist during lunch time. Big treats by our staff nurse who is going to other hospital for transfer. She must be very happy. Alhamdulillah, happy for her too. She stays too far away from our hospital and already involved in MVA twice. Such a lucky hospital to have her, a dedicated and hardworking nurse.

I managed to rest and closed my eyes for a while before Zuhur prayer. I came out to the ward right after prayer. Specialist came at 2.45pm and straight away came to me. She scolded me for not completing the MRI parental consent. Boss, did you know that I wasn't the one who took the consent? I just accepted the scolding. No point answering to someone who won't listen.

Rounds started. Dehydrated baby first. She explained about the current condition and blood results, exactly like what I did. The father came quickly. Then they started their own theory and plan. This time, specialist spoke in a very strict tone. Discharge at your own risk, it is a high risk discharge, baby's kidney might stop working, baby might stop breathing. Mother said if any problem arise, she will bring the baby immediately to the hospital. Specialist replied in strict voice, "you need to be informed that if baby is brought in a bad condition, there is nothing much we could do about it anymore." And she repeated it at least twice. Maybe thrice. Wow! I was surprised too that those words came out from a paediatrician. Of course that she was right but its just sounded a bit "loud". Yes, the parents need to know this, they can't just simply make decision for their baby like they are the doctors, at least listen and respect to the knowledge and experince that we have. Oh ya, they did ask the nurse whether I was a houseman or a medical officer. I wished to answer, oh I am just a medical student <sarcastic>. AOR discharge was allowed. I am sure they won't come back anymore. Hopefully we won't get referral from KK for jaundice. Take care of your baby well please.

The second child with febrile fit was very fretful. Non stop crying.Suspected meningitis. Septic work out stat, IV Rocephine and prepare for transfer!
One patient diagnosed as measles. Another wow. From penicillin allergy, to dengue fever, to measles. Patient needs to be isolated stat!

Day 40 of life, admitted early morning, diagnosed as bronchiolitis. He was reviewed in the morning by my colleague ,patient well, tolerated BFOD, no fever, lungs clear. Neb was off, IVD off, diagnosis changed to acute pharyngitis. I didn't see him in the morning until that afternoon rounds. Child was pale, tachypnoiec, laboured breathing, no feeding since morning, SPO2 not picking up. Child in shocked! Child was brought to NICU room for resus. Bolus given.Intubated for airway protection. Someone was so impatient, everything wants as fast as the blink of eyes. It should be a team work, boss, and please be more cool.Very warm room, the air conditioner seemed not working at the wrong hour. Loaded with midazolam, antibiotic and IVD maintenance. One team left to HSJ for the suspected meningitis child.

Results came back. Mild respiratory acidosis. Hb was only 7.4. Bleeding somewhere. Child was pale.Treated as septic shock secondary to pneumonia, TRO meningitis. I was nauseated even before sending the patient. Luckily my colleague came back from HSJ. We "forced" him to accompany this child to HPP. Both patients were reviewed by him in the morning, he should at least be responsible. I'll be on call the next day, so at least I should rest today.

Continued with rounds. My thrombocytopenic patient now treat as dengue. Why I never send her out? She appears okay clinically, vital signs stable. Already sent out so many patients. Like specialist never exists. Patient on close monitoring with repeat FBC coming morning.

Did discharges and notification. Left the ward at 6.45pm. A bit worried about tomorrow. Yet I believe that He will never test me with something that I couldn't handle. Everything happens for a reason. Just do my job with sincerity. InsyaAllah He will guide me along the way. Bismillah, may tomorrow's on call be peaceful.

p/s I wonder everyday, why since we have this permanent boss, many of our cases are very bad, many intubation cases and unstable patients? Is there an outbreak of meningitis? Are the patients over treated or under treated? And I realised that I  have become more dependent, I use my brain less since I have someone to refer to. We'll see how is it gonna happen when she is not around soon.