Sometimes They Don't Survive

Statistics is very much part of our training in medicine. The graph above is known as a survival curve and every step signifies a death. Whilst a million death is a statistic, each death is to a doctor a powerful if not sometimes painful reflection.

For we may try our utmost and do whatever we can but sometimes, some will slip through our hands. With each death and with the bias of hindsight, there is always that nudging, albeit transient, feeling of guilt. The feeling that I could have perhaps done things better or that I could have done more, if I can do it all over again.

Or perhaps it is with the knowledge that with each death, we are ourselves one step closer, that is the origin for this wishful thinking of saving our patient's life, such that ours may one day be saved.

But alas, sometimes, and oftentimes, they don't survive.

The Avengers

Those who have not watched the Avengers must go and watch la! Especially lokuns. Not only was it very shiok to see Ironman fly here fly there, Hulk jumping around, Cap American cheonging aimlessly, the Avengers actually delivers a  very important message. Like in our Lokun Choo, Avengers is all about team work!

In a medical / surgical team, you always need the goodie two shoe like Captain America who does not care about pay or fame. A also stands for Altruism and he is always ready to throw the A card in your face. If you tio smack by him, its almost like kennah Cap's shield. Sure faint big time!

You will also always have the maverick like Ironman, narcissistic because his lao pek wu liu and he drives a Porsche to work. But no worries, Cap will keep him in check! Only problem is he will get all the girls la... (just accept it ok.... you drive Chery QQ, he drive Porsche...)

In every team, there will be a Hulk. Forever angry with everything and bashing around. You dunno why he is jumping in anger but he complains incessantly about everything including canteen food no good, weekend rounds too many, pay too low (which is true) and changes too many. Most of the time, Cap has to come in to damage control for him. Others may hate him but Cap will tell you he has a nice side to him known as Bruce Banner and is harmless la.

Thor is my fave character in the Avengers. Who don't like a pretty boy who thinks he is God? Unfortunately narcissism may cause conflicts in the team and Ironman will fight it out with Thor for that one chiobu nurse! Thor will lose as he is actually in love with himself (something only Gods can do) and is too busy playing with his own loin lock. Thor's greatest weakness is his hammer. It behaves like a boomerang; dunno how many times he tio whack by his own hammer liao!

Most teams will have a Hawkeye but some teams may have a lesser version, the Cockeye. Hawkeye is the most hated member of the team. Problem is that he likes to shoot arrows at people. If you tio his rapid fire, good luck. Cockeye abit better, coz he shoot arrows but everytime buay tio!

But hor, the most important member of the team is Black Widow! There must always be a sweet young thing in the team to make all the difficult blue letters to the hum sup senior doctors. Any unwarranted urgent radiology scans that your Consultant ask for, ask her to settle, sure can! However, she must be zhai enough like in the movie so that Ironman, Thor, Cap America and Hulk not matter how horny won't dare to touch her coz she is thorny.

It is important to remember that like the Avengers, we need to work together as a team to repel any possible Alien invasion. Good luck!

打点滴

Ok, if you guys are expecting daily updates, please don't. Just happen that I read this news I buay tahan must share my experience:

Patient: 医生，为什么不帮我打点滴！
Loctor: You have tension headache, iv drip will not help. Your blood counts are normal. No infection, no need for iv antibiotics.
Patient: 不行！我在国内每次头痛都打点滴！打了马上好！
Loctor: I'm telling you there is no indication. You are not dehydrated. No need iv.
Patient: 你是怎么當医生的呀! 我头痛就是要打点滴! 痛死了!
Loctor (in broken Mandarin ((I know, this loctor damn jialat, English Chinese all broken))): Tamade dian di ni de tou!! Chi wang yao ma shang hwei jia! (Google Translate: Madam, you can go home after having your pain killers.)

In some countries, strange as it may be, it is a cultural norm for patient to get an i/v drip for any condition or complaint. In Singapore, we like to do things for a rational reason. 不爽你又能怎样?

48 Men

The ongoing saga of the 48 men (and counting) reminds me of the times when we take a sexual history for our patients...

Loctor: Uncle, you got visit commercial sex worker or not?
Ah pek: Huh simi lai er?
Loctor: I mean prostitute la.
Ah pek: Huh? simi prostitute??
Loctor: Aiyah, chicken la...chicken...
Ah pek: Orrrhhh, Gwer! Got la. But tell you ar, I call chicken and then only talk la. I never do it...
Loctor (puzzled): Huh, talk only?? Never have sex??
Ah pek: Yah lah, no piak piak. But talk I also pay...

It is not uncommon (really) that (male) patients tell us that they have gone to CSWs but ended up only having conversations. The possibilities are:

a. Uncle cannot stand
b. Uncle forgot to take his Sildenafil (if you dunno what that is, click on the link, brand names not provided here as Dr Og is impartial!)
c. Uncle bought Sildenafil from JB and kennah counterfeit.
d. Uncle depressed, just need someone to talk to (unlikely because visiting a gahmen psychiatrist is cheaper and most Vietnamese don't speak local dialects)
e. Uncle tok cock (literally)

It is strange that not one of the 48 men brought up the defence of "I only talked to her niah!" in Court. Best still if the victims (48 men) can prove that they have some sort of erectile dysfunction or premature ejaculation and could not have penetrated the victim (under age CWS). Whatever the case, it will be impossible to prove that sexual intercourse actually took place though I am not sure if that has any legal impact. Maybe just having the intent and having made payment is bad enough to land you in jail.

So the next time you try to get a sexual history from uncles, don't forget to remind them to check the i/c or passport of the CSW. And if they really just need to talk, refer them to the appropriate people like counsellors, psychologists... (don't bother referring to psychiatrists, they don't generally talk to patients). Beats spending nine weeks at the wrong side of Changi!

5 Types of Medical Colleagues You Love to Hate

Dr Og tries to be positive but sometimes the serotonin receptors in the brain gets a little short circuited and you can't help but can't stand some of your fellow colleagues.

1. The Pseudo-Researcher

This dude was basically a chow mugger in school. When people were chasing skirts, he was chasing paper. So when he became a lokun and has gotten his name on as many degree as he can, he tries to get his names on journals. He does not care if he has any right to any database and will bulldoze his way to generating papers for journals even if he offended the rest of the world. Most of his papers would be case reports of no scientific value as he will not spend too much time doing good solid studies. After all he just gian to see his name on paper.

2. The Sneaky Bastard

Remember that JC classmate that told you he never finished studying for the exams and still topped the class? Remember the time he said he did really badly in the exams and ended up with an A when the results came out. That classmate of yours is probably a doctor now! Instead of being sneaky about his studies, he is now sneaky about his work. He doesn't share his notes for the MRC(Whatever) or M.Med Exams. He will borrow all of the senior's notes and tell you he lost it. He will chope exam leave before the posting even starts. He pretends to go for evening rounds but ends up assisting the HOD in the operation of the decade while you slough like hell in the ward. As he get more senior, he keeps news of research grants, training programmes, overseas conferences and any other opportunities to himself, even if he does not need them. He will suck up to the boss, get an A* for his TPM and tells you he got a B. He is sneaky because he is selfish. Just like back in JC days.

3. The Learned Colleague

Some say that learning is a lifelong process. But this people take it too literally (may be due to some frontal lobe lesions). They seem to be forever away for courses and training. However, they are never able to apply what they have learnt in real clinical practice in that few days you see them in the wards or the clinics. Your Boss may however be quite impressed with their insatiable quest for knowledge. Unbeknownst to him, these people will suck up the department training fund, make absolutely no contribution and bring their knowledge to their grave.

4. The BCC Char Bor

This is a bit of a sad case. Call it uglism but you cannot bin chow chow (face black black) if you are not bin swee swee (face pretty pretty). Typically, the BCC colleague is a female who just have to black face everyone. It may be that she steps on shit every morning or that she had some very traumatic experience during childhood. But whatever it is, she puts up that "you owe me money" kind of facies day in day out, to juniors, to peers and to seniors. The whole team cannot stand her but she does not seem to care. The only time she will smile at you is when she needs a really big favour from you. Sometimes, some idiot may defend her in the department and induce guilt in you by saying that if she is pretty, you would not be so upset with her. Do not feel guilty about it! This is real life, if you ain't pretty or handsome, then be nice. Prolonged PMS is not your birthright.

5. The Super Duper Bastard

Some people have it all! Its probably in the genes. Every decade or so, the stars align and the super duper bastard is spawned. He is the pseudo researcher who chases every paper qualification and writes stupid papers regardless of the scientific value (of which you sometimes have to review if he submits to the local journals). He is the sneaky bastard who uses rejected submissions to journal and sends them for overseas conferences as posters. He uses up all the department training fund to go for these overseas conferences and is thick skin enough to buay paiseh still go for lots of local courses. He may be a she and if back in the department for that few days annually from her long sponsored trips and courses,  she will show you her BCC!!