150 practice ecgs

These days i am engrossed in this book.I want to become really good in interpreting ECGs by the time i finish my Internal Medicine rotation.I believe this book is one of the best i came across.
It's 150 Practice ECGs by George J Taylor.

Tom Cruise & Katy Holmes in my country??

Nice!!! I say no better place to spend your honey moon than Maldives, whether the sun is shining or whether its raining buckets.*Smiles

Clothes up,pull off,remove....or whatever!

The importance of having patients remove their street clothes and wear some sort of loose gown for physical examination is being ignored by most medical institutions in the third world countries.I can say about this country where i am in right now, that it is not something anyone ever heard of. Take your clothes off for your doctor? NO Sir! Or Ma'am!

But if you are a doctor, you will know how difficult it is for example, to auscultate (listen) to one's lungs & heart with tight fitting clothing on.Winter makes it worse because every patient comes with layers and layers of clothing on,and i will be asking several times to take up, pull off or something like that for each layer i encounter with.This becomes more or so a "struggle" on my part while i try to auscultate huge female patient's with pandulous breasts on a very narrow examining table.I guess examining tables were made with europeans size and built kept in mind.I usually end up fumbling and struggling to auscultate the apex of the heart with the constricting clothes half way up which won't go up just a few more inches so the patient's breast won't be blocking that exact spot i want to put my steth on.
I believe that IGMH and goverment hospitals in Maldives should start keeping gowns in the examining rooms, so doctors can provide patients with gowns when the need to be completely free of street clothes arise when the doctor and patient comes to an agreement to do so.

An unnecessary death

I dont know how to write about this.Its too mind boggling right now.The death of a patient on my on call last night.She was suffering from chronic renal failure and finally she had her second dialysis yesterday with a blood transfusion after which she started to complain of severe breathing difficulty.Anyone who knows about chronic renal failure will know that so many factors can be involved in that kind of breathing difficulty.But after i examined her i came to the conclusion that she was having impending pulmonary edema and the residents needed to take action right away.
But no one budged.It was an untimely death.She died after a few mins on her way to MICU which wasnt even 100 foot away from her bed.Her son and daughter beated down the ICU door and ran after the doctors to beat them up and the hospital security had to come up and control the fight and screaming.It was a very heart breaking death for me because as i believe it, it was an unnecessary death.A death that could have been prevented if the residents didn't ignore the complaint and my report on her.
It is unacceptable for patients to die because of doctors ignoring them.Death due to mistake is better than that.Last night, the residents responsible for her practically hid from the patient's relatives who were looking for them for help.There are patients who come at the middle of the night with nonsensical complaints but it is our job as doctors to varify them and explain and make them understand the situation and give comforting advise.
I dont know how to deal with this.It saddens me very much and i am very depressed today.

on call

Now,here's how my last 24hour on-call went on Medicine Floor.
-It began early morning with the congestive heart failure patient having severe breathing difficulties.*huff puff!!there i went prescribing nebulizers & ordering ABGs and running from my counter to his bedside every 5 mins.
-Afternoon visiting hours gave us a fist fight between two relatives who were visiting.Had to bring up hospital security for that and had to send down the injured to the ER.*arrghhhh!!! and i was busy seeing patients on the upper floor.
-The resident ordered a set of ABGs for so many patients and forced diuresis for that many and in the end no one collected the urine after the forced diuresis drips were over even after careful repeated instructions by me and the resident.*bangs my head in frustration!
-The resident realized that we have a patient who needs a change of dressing of her leg ulcer at 2am in the morning and wants to call the surgical department.*how inefficient!

Conversations with patients (1)

Taking history from an old demented patient is always a struggle.Sometimes it feels like that the accompanying relatives becomes as much demented as the patient.A normal history taking goes on like this..
Me: What's ur complaint?Are you having any pain anywhere?
Very old patient(VOP):I am sick. (groans)
Me:Tell me about it.What's the cause of your sickness?Are you in pain?
VOP:Doctor,i am sick
Me to the young demented relative:What's his complaint?
Young demented relative(YDR):He is sick doctor.
Me:What made you think that he is sick?
YDR:I don't know.He is just sick.
Me:**wishes i was on the moon in a thick suit bouncing around

Pheww!!

Phewww!!! I have been trying to sign in to my blog for the past few days and wasn't able to.Anyway,glad to be back again. :)