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Medical Officer Lunch

Ni District version.

Sure I had my lunch when  I became medical officer(MO) myself.  Posted in District,  there must be a hell lot of time to spare.  Or is it. 

Now my blackberry era is over.  My HTC One alarm clock bell rang.  Already snooze it for a few times.  Why is is so hard to wake up in the morning.  It's 6.30 am.  Had my shower,  cold shower.  My house's heater broke.  This old government house build for doctors are poorly maintained.  Perhaps no one stay here before me for quite sometime. That's what they said. 

I'm fully prepared for work by 7.30am.  Life much better now.  I'm staying alone in this lonely house,  my wife will join me here in a few weeks time.  If she came,  maybe she can make me some breakfast. 

I am on call so breakfast would not be a problem.  There will be breakfast prepared by kitchen hospital for oncall MO.  In a few minutes time,  I will arrived in hospital and I will enjoy my breakfast.  A thing that is rare during house officer era. 

Breakfast usually simple,  same as what patient in the ward get.  A naked dinner loaf with hard boiled eggs and a sweet tea or milo,  or fried rice. Literally fried rice,  with no other ingredients inside it except maybe garlic,  salt and pepper.  Who says you will be getting nice food in hospital?  No one.   It's healthy,  edible, but not tasty. 

Had to eat quick.  20 patient waiting for me in my ward.  Yes, 20 patients.  Rub that in your face me in my house officer time.  Work pretty much the same. Reviewing patient is still the same as what HO did but now I have to make decision myself.   The responsibility is mine. Something goes wrong,  I will bare it myself.  None will help to protect me now.  Who ever had been call to state meeting because you fuck up someone's life know what I  talking about.  They will make you cry and regret your life as a doctor. 

So this 20 patient of mine,  I will make sure they are alive no matter what.  We don't have specialist in my small district hospital so I am pretty much the boss when I do my round.  My follower,  is my nurse and occasionally a pharmacist.  I love them hanging around because they were like a walking dictionary of drugs.  If I'm rushing for clinic they even calculate the drug doses for me.  A nurse basically just..  I don't know how to describe it.  You know what a nurse do.  They help me a lot. 

If there is a case that I think need to be refer to specialist,  I will pick up a phone and ask specialist opinion.  This is where I get my 'breakfast' occasionally.  Who said you are mo and nobody scold you anymore? You will be scolded,  but in my place scolded by phone as my specialist is 200km away from my hospital. This is when you realize,  the skill of presenting cases is matter.  When two person talking in phone,  the way you present will determine whether you will be scold or not.   Sometimes I get scolded for no reason.  Because for me that patient condition is that bad but the guy at the other side convince me that it was not that bad.  I am the one who see the patient! Shit happen. 

Wait,  I don't have that much time to drag my round for 1 hour.  I start working at 8am and I have clinic by 9 am.  So i have only 1 hour to see all this patient and document everything inside their case note.  And when there is discharge,  I am still the one who will be doing all the paper work.  Work basically the same as in big hospital but here in my place,  I am the MO,  I am the specialist and I am myself the HO.  No one to bully me and no one for me to bully. 

By 9am no matter what,  as ordered by my director of hospital,  I must run the clinic.  Clinic is the boring part of becoming a doctor.  Basically you are seeing mostly 'healthy'  patient.  They came because it's their appointment date.  They want or not,  they still have to come.,  and I still have to see them.  Basically he don't want to see doctor and I don't want to see him but we will end up in clinic room somehow,  and work goes on. 

A good patient will come and say "doctor I'm feeling well just prescribe my lipitor.  If can,  prescribe longer so I  do not need to come to hospital that frequently".

A bad patient will says " I'm having back pain,  sometime dizzy,  only sometime.  Not now.  Sometime fever,  but rarely....." and the story goes on.  " I think that metformin not good for me so I didn't take it".  Face palm.  Her blood sugar is 23mmol.

A terrible patient will come and says " doctor,  I need Mc."  enough said. 

This classification of patient only valid for my own purpose.  But you can't actually distinguish patient like this.  A talkative patient might be the good one because we can find her illness much easier compare to the one who always claimed he is well and compliance but his diastolic blood pressure is 120mmhg.

Patient who ask for MC,  always be a terrible patient. 

Clinic usually drag until 1 o'clock,  and for a person who is oncall,  it's my bad day.  I can't go out for lunch because at 1pm until 2pm, I have to cover the whole hospital so that non oncall mo can go eat their lunch.  Lunch usually provided for me,  consist of,  not again,  hospital food.  Not tasty, not tasty. 

Now at 1 pm, I have to sit down in casualty and see green zone patient.  Most of the time,  I think people really abusing emergency department.  I am available in my clinic with 2 other mo to see all this common cold and viral fever case and yet at 1 pm,  when other mo go for lunch and only one mo stay in hospital,  they will come to casualty department seeking treatment.  To ask them to wait until 2 pm is out of the question. 

"I cannot wait,  I am busy doctor.  I have to go somewhere after this"

" I'm not well and you ask me to wait in outpatient department? "

" insect went into my ear, you call this not emergency? What kind of Doctor are you? "

There is actually one uncle in acute exacerbation of chronic airway disease inside red zone,  fracture case,  stroke,  and this guy want me to pull out insect from his ear right now?!  Is that thing biting inside your ear?  No.  When does it occur? Last night!  He have like 12 hours to wait to come exactly at 1 pm during lunch time?  What  a sick world we living this day?

So if you are damn fast,  everything will be settle by 2 pm when the primary team arrive back from lunch or if you don't perhaps primary team will come and help you at 2pm. That is rare.  You see,  as a doctor,  everyone is holding so much responsibility for a person life.  No one in the world are doing the same thing in my opinion.  You become an army and you think you are protecting life?  The whole country life?  Yes you are.  You become  pilot,  likely you will have to keep 100 lives inside your plane.  Yes you are. 

Doctors however is not the same like these other job (add other job if you want).  Life and death is really (REALLY!) in our hand.  We are playing God and we always fail.  No other job give you a position to see people dying in front of you and you can't do anything about it but still optimist that you can keep them alive.  Really!  People that are sick will die somehow someway.  A soldier will regret of not killing the enemy who later kill his team mate.  A pilot will regret, if not die together with his passenger.  A doctor, playing God as I mentioned, regret of not saving that patient who have multiple diseases,  a heavy smoker,  and he is 90 years old.  We are fighting God.  The battle that we surely will lose. 

Anyway,  I do believe other occupation have their own stress and responsibility but I cod not think of others   that does what we do every day.

So when the primary team back at 2 pm,  most likely all patients from 1 o'clock have 'tattoo of your name  on their forehead' .  That patient is yours and you better settle it before you go finish other thing such as lunch. 

By 2 pm you already have patient waiting for you in ward for that peritoneal tapping you promised in the morning. Perhaps, an acute appendicitis patient need to be cut, or that case that you need to call radiologist 200km away to get CT scan,  and clinic patient as usual.  And you need to settle that patient with an insect stuck for 12 hours in his ear before hand.

If you are damn lucky,  you will have your lunch at 3pm.  If not so lucky,  you will be eating  a cold nasty dinner at 5 pm,  hospital food,  usually serve at 5-6 pm.  Your lunch already eaten by your medical assistant (MA).

And at 5 pm before you can even take a shower,  you need to start your oncall.  And as usual casualty is your primary base.  As usual,  all those cold cases will come straight to emergency department after 5pm. Common complains are common cold.  Your emergency department will become outpatient starting from 5pm-10pm at night.  Plus the real emergency cases. 

A bad oncall is when a midwife call you telling that this CTG or fetal heart is no good.  Then, trouble begin.  An emergency cesarean is a damn medicolegal case potential.  You don't want to play with it.  So forget that dying young man who involved in car accident,  I need to save a baby first

Your second call will be like a superhero,  always came in the end.  When patient already prep to operating room,  he or she will come and you can settle down a bit, back to saving that car accident guy.  If he still alive. Please God let him SURVIVE!  I don't have time to do post mortem tomorrow.

At night,  weird cases happen.  Husband punch wife,  wife go to hospital,  doctor need to write detail report due to possibility of court case.  A young girl complain dizziness and urine pregnancy test turn out to be positive when she 'never'  had sex with anyone.  She must be damn holy! Finger amputated by chainsaw,  what the hell are you chainsaw-ing at midnight? Horror movie.  A guy who cannot sleep at night,  too much coffee? A youngster brought by friend because he fainted after drinking too much alcohol.  Great,  what alcohol actually do for you by the way? Make you awake and energetic? And lots and lots of illegal immigrants who didn't dare to come at daytime because police might arrest them.  I guess police sleep at night nowadays.  Crime only happen during day time.  No police at night.

As I scan a denying pregnant mother at 4 am,  I was damn tired.  I do get my sleep on and off but that pattern of sleep always gave me a throbbing headache.  Luckily I am a doctor so painkiller like ibuprofen,  aspirin,  would be available for me to ease the pain.  Paracetamol won't work anymore. After explaining to that mother that we need to observe her due to her per vaginal bleeding,  I grab a clerking sheet and start writing her clerking admission when I suddenly realize that she is too, a non resident,  an illegal immigrants.  One thing about them,  they really don't have money to pay for hospital bill.  If i am a billionaire, I would sponsor her so I do not need to counsel her for 1 and half hour to be admitted.  In the end,  I sent her home,  sign  form to go home at her own risk,  and maybe now I can get some sleep. 

It's already 5.30 am.  The cold and quiet dawn.  And again, my MA woke me up,  "someone brought a dead baby to casualty". Great!

It was until 7 am before I get my sleep. Cases after that, hopefully will be referred to 8am MO.  I want to sleep.  I don't care if I woke up at 10 AM.  I need sleep.  I am damn tired of oncall and I want to have some sleep!

Then i started thinking of all patient that is eagerly waiting for me to see.  In their head,  maybe that doctor will sent me home today.  Clinic will be already filling up at 8am.  All patient impatiently waiting for their number to be called.  I can't sleep thinking of this.  No matter how much I hate seeing patient,  I still choose this professional line of work.  I already took an oath to put patient first above anything else.

Do I get lunch as a medical officer?  Yes I do occasionally.  Life is not that bad,  or maybe it is bad but the life before, is worse. The training of constantly hungry and scolded all the time during house officer creates a person who don't care about anything else anymore other than his work treating patient. Those little thing such as having a normal lunch even in rush bring a feeling of accomplishment. 

Life as I said will keep getting better, even better for any other person is not the same as what I feel right now. 

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