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fitness goals next year posted by yee yen at 12 01 2019 01 56 00 pm 1 comment saturday february 16 miss little boss i was reading your blog you didn t tell me that you have been updating your blog i really enjoyed reading your thoughts i didn t know you are such a deep person you are not the easiest person to have an idle chat even on the most trivial subject you often end up becoming overly emotional by standard of a normal human when emotion dominates there is no way a reasoned conversation can continue and i would never grasp your actual thought process through the stories that you have shared i have come to realise that it has not been easy for you either some of the issues that you were talking about for example being excluded by a popular group of friends in upper high school were experiences of my past and many others and had been settled forgiven and forgotten a long time ago yes i did dismiss you when i shouldn t have why i don t want to admit it but yes it had to do with you being the youngest perhaps i thought such issues would become non issue with time and maturity just like it had been for me i did not understand what a torment it could be for a young person still figuring out i sense insecurity i see you are in constant need of external validation to assert your confidence is that so do you see that coming to an end do you want this to end hands down i cannot fathom this i have never felt i need to look or present myself a certain way for others to make me feel good if others are not happy with the way i want to be go ahead and shun me out i couldn t care less i only wish everyday to do my part to be as good a daughter and a doctor as i can be it is interesting that you do not feel you have accomplished enough if it has not been obvious enough to you let me reassure you that you are an outstanding young lady of your age you are extremely passionate in the cause you believe in you manage to get our family into environmental aware mode and trust me it is not easy to change something so fundamental among our family members although i cannot share your passion with animals i am allergic to dog dander i now have a new level of respect for them and their rights you are definitely a leader against all odds you have successfully organised the life of stray event day sure it wasn t perfect but it has definitely made an impact to all who were involved great job on the stage play cheng and i were super proud to have been the sisters of the heroine of the night i am sure mum and dad felt the same you have many talents and when you are working on something that you are not so gifted in you are diligent and persistent till you achieve your goal you are the sort of young people i want my children to aspire to be when i look at you i see a prominently figured and naturally confident person if i am looking for positive energy i would look to your direction you are kind and you value friendship and relationship something that i still do not think a priority perhaps i can offer a useful suggestion do you really want to be like the prime minister and change the world rethink your role in the world for me that was my turning point there after i was more or less calm and content seeing that both of us have this bipolar tendency ie when we are on a high we become extremely excited and energetic and when the inevitable anticlimax comes we are dragged into darkness and depression it is not healthy to have such swings i would say keep your feelings in check try not to become overly invested on the other hand a downfall is not the end of the world too extreme of anything is bad even if it is the best thing in the world because when the balance tips over you will be hit hard i have read this is in dharma books before why should we not laugh and sing out heart out over the pleasurable moments in life before i didn t understand now i do balance it out you are a clever girl you will figure it out do forgive me i have been one of those who have failed to give you acknowledgement when you needed it most i strive to be a better person each day this is important and i must thank you for the reminder posted by yee yen at 2 16 2019 01 06 00 pm no comments wednesday april 5 the dip this is the emotion i feared the most i was feeling over the moon over a month ago as i was finishing my phdw rotation i was performing well exceeding expectation and building reputation across the board ace ing the procedures having good relationship with the nurses and my bosses being aware of the bipolar tendency in me i knew that the feeling was too good to last i expected this to come the inevitable dip this is it i am in the hole i cannot perform one year and a half completely out of neonates and i have lost all the sharpness and sensitivities related to babies i know i used to be good using my past self as the standard that i should reach now which i am no where near i am my biggest critique i am disorganised slow and hesitant i doubt my own management plan i attempt procedures expecting to fail i let other people make myself feel inadequate i cannot get over every small mistakes that i make everyday it is dark over here but i hope other people are seeing the tough stoic face that i intended to put up it does not help that several babies have died under my care in the short one month that i have started the babies actually died not one but several that must tell something about myself as the doctor it does not help to feel i have to step up and impress at every occasion now that the bosses are aware that i have signed up for the clinical exam which would mean that i feel myself to be ready to perform as a specialist i hope this is transient i am trying to improve everyday it is just if this dark cloud goes away i can be a little more constructive in this arduous process posted by yee yen at 4 05 2017 05 17 00 pm no comments sunday july 10 pre empt in the business of child health a mentor once taught us that we must always be ahead of the babies and children from the moment they come in we should already be able to anticipate the course of the illness complication and recovery and pre emptively sort them out we do not wait until the problem arises then go into a panic mode and make rushed decisions in the district hospital that i used to work in this ethos is well understood by the whole team from the outset if the doctor or nurse who first saw the child have any concern whether it is a diagnostic dilemma or that the child did not look so good we would talk to each other about it we may alert the parents and the rest of the team about the concern or put on extra monitoring in a place easily noticed and make sure that a senior personnel is to see the child before nightfall when i first started in paediatrics i was an anxious ball and would become agitated over every tiny anomaly which i did not expect to find but i am grateful that even as a junior member of the team my concerns were usually taken seriously hence we are able to prevent lots of unanticipated problems this is very different in the adult wards especially the medical wards it is extremely common to have several deaths in a day more than half of those were unexpected resulting in several crash calls in a day or night crash call is a panic button that summons a team of doctors and nurses to come immediately and is to be pushed only when a patient deteriorates critically suddenly crash call in the uk hospitals are quite well run because the members of the team have been exposed to different scenarios simulated beforehand in training but over here it is more like a circus of confused people arriving no leader no effective communication only grumble and criticism at this most inappropriate timing needless to say the patient outcome is usually poor one of my colleague who used to work in the adult medical department had recently join paediatrics and was asked to present on a case of a child who deteriorated during the early hours in the morning during his oncall duty the child was admitted at 3pm with a chief complain of fever altered behaviour for 3 days and 1 episode of seizure which lasted for 20 minutes on arrival his gcs was 11 out of 15 but haemodynamically stable he was reviewed by the specialist at 5pm and started on antibiotic and anticonvulsive treatment night review was done at 7pm and the child s condition was the same at 4am the staff nurse was called by the mum as the child had suddenly became unresponsive on my review the gcs was 3 out of 15 hypotensive and bradycardic he was intubated and sent to icu the boss was clearly unhappy in medicine there is no such thing as suddenly collapsed suddenly deteriorated suddenly became unresponsive i do not want to ever hear those words again the child was last seen at 7pm what happened between 7pm and 4am the child was at the acute bed with continuous monitoring what did the observation show what was the level of consciousness in the interim my colleague were unable to answer gcs was not recorded and observations were not documented clearly during the interval 9 hours for the child to deteriorate to the point at 4am there would have been some signs that the body was compensating and all the members of staff on duty that night have failed to pick them up from this example we all got the message and went on to improve patient care by working on this very basic principle of medicine for every single child that came through the doors i requested for transfer to this tertiary referral centre to further my training in paediatrics to my dismay such basics are even more poorly done here there is a systemic problem of too many staff too many teams too many leaders too many egoistic heads as well as a system of office politics and culture that have been ingrained in this institute for many decades that are not easily corrected the paediatrics department is huge and the sub departments who are supposed to provide support are not always easy to talk to i see more of the bad habits of adult medicine surfacing for example kicking patients like a ball from one sub specialty to another or from one ward to another to avoid the responsibility of being the primary team every workplace has its strengths and weaknesses and it is working with the systemic limitation that upsets me because i cannot give the best to my patients however as another of my mentor who has worked in this dinosaur institute for many years said aim to save one patient at a time i am a tiny minion and i have conceded that i cannot change the system so i am using the principles of good practice that i have learnt to look after the few patients i see and so far i have been able to prevent a few patients from failling into the state of suddenly collapse by starting antibiotics early fluid resuscitating early starting inotropes early referring to icu early one of the parents once told me he would like his son to be admitted to icu because he felt the doctors there are better in his son s previous hospital stay he had experienced watching the icu doctors rushing to the ward in an emergency intubating the child performing chest compressions inserting various lines to save the child he felt that the ward doctors were inferior as these jobs are not their routine this is the trouble with people watching too many dramas on tv who sensationalises this heroic image of being a doctor please every doctor is able to help in any emergency situation but to what extent if only one can feel what a doctor feels during those surprise patient collapsed situation rushing to the scene internally your heart is palpitating away you feel a little dizzy from hyperventilating your hands become cold and your brain starts to freeze externally it is a havoc no one knows what is going on who is who in the team who is this patient where equipments are kept and who has done what besides once a patient succumbs to the point needing cpr much irreversible damage has been done the patient stands little chance being treated in this extremely uncontrolled environment it improves though the profession has started to realise the importance of teamwork and effective communication in such high stake scenarios but this awareness has yet arrive here i am afraid who you really want is a doctor who is able to prevent you from falling into that state problems are always easier to tackle when recognised earlier there is completely no need for 5 doctors rushing to stick huge needles all over the patient instituting invasive treatment when one injection of antibiotic given 5 hours ago could have prevented all these an unknown hero is the real hero but a good doctors do not care he or she just want to be able to sleep well at night do the basics well being able to pre empt problems is one of them posted by yee yen at 7 10 2016 07 15 00 am no comments saturday april 9 a disability is not a disability to a child one of the most amazing insights that i have gained working with child is seeing how this group of little creatures adapt to misfortune parents are often upset when they learn of a disability in their child a child born without his right arm a girl with a spinal deformity making her never being able to walk one who has hereditary cancer of the eyes that defines her blind even the doctors and the nurses cannot help feeling pitiful for the kid how is this child going to survive life in this cruel unforgiving world we foresee the mountains of difficulties the child would be looked at and treated differently kesian kesian this must have been the expression most commonly surround this child from the time he arrive in this world fortunately the child being born ignorant does not comprehend such expression he does not realise that how others see him matter he does not understand that it is a deficit to be born without a limb or a sense he simply go about exploring the world with whatever resource he has with him and make a sense of this world and he would find journey of exploration as enjoyable as his counterpart born perfect s was my first teacher he is now 18 years old the senior paediatric orthopaedic surgeon of the team had known him since he was born and keeps a photo record of his case from the time he was a neonate till now he showed us pictures of his legs auto amputated from the knees while he was still in the mother s womb as a result his leg prosthesis have been part and parcel of his life since yet there is nothing to feel sorry about for him he is as lively as any other boys who would sometimes test the patience of the the adults just to see where is the line drawn when i was attached to the team this boy was admitted for infected wounds on his knees he has been told to get off his prosthesis for a few months in order for the wounds to heal but how would he go about doing taekwondo a black belt holder going out with his girlfriends and training with his police cadet corp in school without his prosthesis so the wound deepened and ...