The Pacinian corpuscle

进入开工的第3个月第2个星期，我已经数不清我值了多少个夜班。经历了从非常疲累到无时无刻紧张的各种心理状态，我的身体及精神状态已逐渐适应于这种每四天就值夜班一天的工作规律。昨天的夜班里，护士柜台的电话一直在响。我尽可能让自己非常专注第工作，也让自己不要有任何一丝要埋怨的想法。患者一个接一个地“报到”，我保持平静的心情，按部就班地处理每一个案例。没有丝毫紧张与忧虑，也没有任何匆忙。另一个值夜的学长负责处理需要血检的患者。我们各司其职，没有很多交流，却如同心有灵犀。 从晚上10点上工，我便马不停蹄地在忙碌。当我在处理手上的最后一个案例时，早班的同事已经到岗了，我才发现原来已经隔天早上6点钟了。处理好手头的工作，我准备梳洗，再吃个早餐。早班同事询问后我才发现这个夜班里我已处理了10个新的案例。可是当下的我并毫不疲累。我心里有点沾沾自喜，因为在这个忙碌的夜班里，我们顺利地处理了所有病例，同时所有血检也完成了。对于护士们的无从配合我也自感欣慰。 在这个忙碌却平静的夜班里，我对自己有了新的认知。虽然要学的还有很多，但是我相信，随着时间的推移，我会逐渐成长，变得越发强大。

It's been a while since the last time I was on cloud nine. It felt like seventh heaven too. It would be such a shame if it's just a prodrome of a crash after being awake at odd hours (night shift). I'm happy because many things make me feel like I've achieved something. Not great things, but small, simple things that make my life better. To sum it up, I had a wonderful call. Only 1 admission. That's not the main point though. Having wonderful MOs to work with is superb. Dr. Jo was on call on my night duty, followed by Dr. Kl on my post night duty.  I never liked being in medical like how I do now. Although I'm still unsure if medical is the posting that will 'complete' me, quoting from one of my o' time lecturers, I am glad enough that I'm not reluctant to coming to work. The ward environment plays an extremely important part, as it indefinitely influences every working person in the ward. Next most important thing is to have nice ...

'Look at these people. It's been a while since the last time we did what 'normal people' do on a daily basis,' said Ruh, referring to other customers who were sipping their coffee, some silently doing their work while some chatting away with their friends. We both decided to spend some time together on our off days when we are well aware that it's not easy to have our off days on the same day. I told her I can't recall the last time I got to hang out at a cozy cafe. I begin to figure what are the essential things that will make my life more meaningful. After working for a month and a half, I realised I'm not the kind of person who is willing to occupy all my time with work. I have been reminded multiple times that work-life balance is more important than anything else as it will essentially decide how well I survive as a houseman in the long run. Ruh has been pretty aware of it so she's been engaging in a lot of activities during her free time. I...

这个星期心情起伏颇大。 我的一个工作循环只有6天。第4天值夜班，第5天post night，第6天Off。我像是渐渐习惯了每4天值夜班1天的作息。也习惯了夜班后那种没有睡意的疲惫。这样一个循环比一周还短，所以觉得时间过的很快。 过去这一周照顾的病人让人心很重很累很无助。 有个四十几岁的病人，心脏衰竭晚期。平时检查时要聆听她的肺部让她侧躺也会气喘吁吁不止。双脚也因为血液循环不好导致蜂窝组织炎。在我们病房有一个多星期了，给了高度 呋塞米 排水药，排了6公升的水，脚消肿了许多，可是肺部积水没有一丝消减。手脚冰冷，全身上下浮肿，有时连脉搏也很难感觉得到，更何况每天需要抽血，不断被扎针那种痛苦已经不在话下。 面对这位病人让人气愤。 我总是无法用平常心对待这位病人。 开始的时候，她总是要求很多。因为没办法自己坐起来，所以需要人过去扶她一把，想坐起来过了一会儿又想躺下。自己的药没了，让她老公带来她又苦着脸哭诉老公没来看她。每次经过她的病床她必定有所投诉，去问她怎么啦，说肚子很大很肿可不可以排掉肚里的水分。我心想我排不了什么东西呀，肚子没有ascites，我排什么呢。我每天检查她脚上感染恢复的进度，看着她看着自己的脚，一脸无助，我也苦脸。每次做早晨回顾报告的心情总是低落不已。心很重很累。不知道该怎么帮助他。四十几岁的女人，有血压高，糖尿病，急性肾衰竭，心脏衰竭，双脚蜂窝组织炎，还有呋塞米导致耳毒性。NYHA IIII 的病人，情况那么糟糕，这样的病人是不是该NAR了？ 自我开始有这个想法以来，我的心一直揪着。这样发一个NAR对于我们而言只是让病人签个字，听起来颇为简单。可是换个角度，签了字，这样代表这个病人更明确地知道自己很快将面临死亡。可是看着他每天吃饭大便睡觉如常，发个NAR感觉就是有点哪里不对。我每天看着她感觉上就没有任何改善。可是我的专科医生看的是排尿量，还有TWC，CRP。只要改善了，就代表药有效用。完成了一个星期的抗生素，我的直属上司说，她可以准备出院了。可是以整个个体来看，她只是在死亡边缘徘徊。我不知道她其实知不知道自己的实际状态如何。 面对像她这样的病人，我无法保持理性。我无法只看验血报告。我无法只看CXR。 她若回家了，还是每天气喘吁吁。她的老公必须替他更换尿布。可能没有人替她洗澡。脚上的伤口谁会替她洗呢。 说的白一点，因为心脏衰竭严重...

今天是第二个10点放工的工作天。 除了被骂之外，其实工作真的很简单。 被换来照顾病房后半段的病人后，每天只照顾一两个病人。工作量少得很，但是还是会被骂。 昨天是正式被骂的第一天。我如往常做am review，那个牟橹来到就发狂地问我们为什么还不赶快开始做round。然后刚好我顾的都是他看的病人，反正我想present的时候他就会打岔。拿起笔，我要写下他的review时，他却破口大骂问我为什么写的不对。后来，我很无奈，我反正没做什么。其实遇到他让我想起儿时的自己，以前妈妈就是这样教育我的。我有一段短暂的童年是在无奈中度过的。现在长大了，人变的有自尊心了，反而很耐不住这种无奈的感觉。让人无力。后来的细节我也没记起来，只是知道整个早上我一直被诋毁。在那个当下，我只是在内心很坚强地忍耐，让自己深呼吸，尽可能不要被影响。因为我知道，错不在我。我顶多只是还不熟悉工作所以做事不够有效率而已。他这样的态度对待我，我只能无语。 今天我只看了一个病人。一大早我就到病房了。不知道为什么过了1个多小时，我还没有看完病例。我的脑袋一片空白。在病例本上写了一些东西，后来发现做的不足，想重新再做，这时牟橹已经到了。我并没有害怕也没有担忧。我凭着平常心，预备挨骂。果真，他开始破口大骂，说我的review做得太烂，然后质疑我的能力，问我是不是不想在那个病房里工作，还质问我一个月了还什么都不懂。被大声质疑的时候，我挺难受的。我并没有把他说的每句话听进耳里，可是再怎么坚强，眼睛还是忍着泪水。我一直回想起儿时的自己，被妈妈责骂的时候绝不流一滴眼泪。那时的我怎么可以如此坚强。我自认没有做错，所以我不会浪费一滴泪水。可是为什么今天的我会那么想哭泣呢。强忍泪水的时候，其实喉咙会隐隐作痛。我一直深呼吸，让自己思绪转移到别处。 下午的时候，我回去看这位病人叔叔。在聊天的时候，他突然告诉我他心很难受。我急忙问他是什么事情。后来他说，他看见我被骂心里很难受。我告诉他，这是常见的事情，而且我已经习惯了。嘴巴上还是微微在笑，因为至少周围的人其实都为我难过。很庆幸，其实不是只有我一个人在难受。 我还是无法理解，为什么有些人可以用这种凶狠不讲理的态度对待像我这样的初学者。他不是我的母亲，他凭什么侮辱我呢？我的前辈们都不会被骂或是被质疑。但是我非常坚决，我绝对不会质疑自己的能力。我绝对不会允...

Managing 'troublesome' family members of patients Medical wards are almost always very busy. Housemen are always running out of time. Our day typically begins before 6.30am once we step into the ward. It doesn't stop till maybe 1pm on good days after most plans have been carried out after rounds done with the specialist. If we are slightly unlucky, we might still have a short break at around 4pm. It's usually the most quiet period between 4 and 7pm. By saying quiet it means fewer admissions. But this is also the time when visitors start to crowd the ward. SN will start calling for houseman because family members will want to know whatever going on with their family who got warded. It is essentially an important skill to deal with these laymen because if you're good at it, it makes your life easier. You get to take a little more breather before the next wave of admission hits the ward.  How should we deal with these people? First, we must understand that th...

Time's passing real quick.  I only couldn't keep track of the date of the day. Every morning during crucial times when MO and Specialist are doing rounds and I had to write down the date and time. I always spend 2 more seconds recalling the date of the day. It is such a paradox when you feel that there isn't enough time to get our work done all the time, yet you only feel that the time stopped ticking 3 days ago. I went to Radio again today. Made a couple of visits. I didn't have time to think through how I should present a case the best I could -- so I just had to do everything impromptu, hoping things will fall in the right place. The department always gives me a mysterious feeling. It is dark and cold and I always don't know whom I'm speaking too and I always have to ask around for their names for documentation. I only enjoyed the brief moment when the request is granted and I get to write down patient's details on the white board in the procedure ro...