Friday, November 28, 2014

20141128 K14N Vascular Bedside - AAA post-op (EVA) VF cardiac arrest :(

人生 第一次 目擊 真正 的 ventricular fibrillation.
Cardiac arrest.
Code blue.
搶救了 很久 很久 終于 宣告 病人 不治。

病房裏 一切 都 正常。安詳。
其他病人 也沒有察覺 有什麽 異常事情發生。
但是 對於 9號床 的 伯伯 意想不到 今天就是 他 最後 的 一天。

今天的我來了瑪麗醫院 K14N 病房上課。就是K座14樓北部病房。屬於乳房、血管、和内分泌外科病房。K座的病房比 Main Block (ABCDEF)的病房舒服、空曠、多私人空間。原本醫生吩咐我們 "clerk" 4號床的伯伯,就是要向他問症(take history)跟做身體檢查(physical examination)。這些主要都模仿考試的環境和方式,除了在上課時我們可以一組同學一起做,到醫生來到抽書(其實只是小組討論而已,但是我們作爲三年班醫科生剛剛進入 clinical year 什麽都不曉 ...)時也可以互相幫忙答問題。

一切都非常正常,跟平時在其他病房上課時大致上一模一樣,我們也快快完成了跟4號床病人談話和檢查。

醫科生,medical students,特別是三年班醫科生,在病房裏常常被視爲 "SOL" - space occupying lesions,佔據了很大的空間,卻實際上什麽用都沒有,更加製造不必要的麻煩,妨礙地球轉。在入讀醫學院前一早已經知道三年班醫科生就是醫院裏地位最低的人。食物鏈最底層。就連清潔和病房文員姐姐也比我們更加有權威。常常聽見同學被護士罵,被醫生趕出病房,被 HCA(health care assistants)投訴我們阻止他們工作。所以一向喜歡低調,等醫生來教書時往往會尋找暗角位置躲避,盡量避免做太大的SOL。幸好本身也身形嬌小。

回到正題。
在等醫生來教書時,突然聽見9號床的一個儀器(後來才知道是cardiac monitor, 心臟監察儀器)響起來。不是很明顯,不是很大聲,不是引起注意的聲音。應該要在病床範圍50米内才會聽到,而且覺得不妥。

然後,HCA突然叫護士,護士便一聲喂!緊張招攬更多醫生護士到9號床幫忙。如果沒記錯,應該連 "cardiac arrest", "code blue", "shock", "asystole/arrhythmia/VF" 這些搶救病人專用字眼也沒聽到。他們已經熟悉,已經懂得那緊張高調的聲音,就指不妙,並且關乎生死。迫切性的求救。

10秒内,已經有3-4個護士和一個資深大醫生(我想應該是head of department or 起碼consultant吧,但是已忘記那醫生的名字了)趕到病人身旁。他們動作爽快,非常冷靜,淡定,純熟。換了是我應該會雞手鴨腳不知所措亂七八糟一塌糊塗什麽也干不了。

再過多10秒,他們已經開始急救程序。Chest compressions 心外壓。Bag - oxygen 二氧化碳。Adrenaline 腎上腺素。

多30秒,有其他病房的houseman實習醫生和resident駐院醫生(就是實習醫生之後,但是還沒升到AC Associate Consultant副顧問醫生一職)。

這個時候我的視線轉移往心臟監察儀器。它從一開始已經一直低調地響起來,一波又一波奇異的聲音,在沒有心跳的一聲長的 beeeep 中間裏夾雜了一組不同音調的,有點像乘搭交通工具用兒童或學生八達通那鈴聲。不敢走過去望,眼睛又開始朦朧沒看清楚。後來有同場的五年級師兄師姐告訴我們,原來是VF,a shockable rhythm。Only two rhythms are shockable - VF, and pulseless VT。

大醫生問了很多關於病人之前狀況的問題,然後當機立斷作了決定。"Defibrillator",還是 "paddles"?忘記了。他說的那一刻,仿佛有一秒整個醫療團隊都停頓了。在電視電影裏看得多,亦知道他們常常因爲要戲劇性所以很stereotypically incorrect。想不到今天,此時此刻,即將就要第一次見證了。Paddles的確跟之前fictional的一樣,但是不用 "CLEAR!",亦不用團隊彈開三米,病人亦不會跳動,或突然睜開眼睛醒起來。就像之前急救證書課程用的AED差不多,要在left lateral & right anterior chest wall貼兩塊patches,然後paddles就輕放在paddles上面,一下電擊,然後立刻恢復心外壓。

再過30秒,開始緊急抽血。事後看看病人記錄,是要驗CBC,CK Creatine Kinase,LF(RT) Liver/Renal,TnI (cardiac) Troponin-I,electrolytes,ABG Arterial Blood Gas。一切都是書本裏念過的東西,卻是現實中第一次在自己眼前親自看到。是很震撼的經驗。一針又一針的鮮紅色的血。在醫生口中得知ABG非常疼痛、痛苦。不知道那是病人還有沒有知覺。:'(

或許 最心痛的一幕 是見到 病人家屬,應該是女兒,衝進病房的那一刻
無法形容
很痛 很痛
仿佛感覺到她的痛
不知 從哪裏來的 但已經感到 眼淚 在眼角裏 急不及待 湧出來
知道作爲 醫科生的我
作爲未來醫生的我
要專業
振作
不能過度感情用事
如果我也崩潰倒塌了,讓病人,讓家屬知道 我也很無助
那 他們 又如何面對 如何接受 殘酷的現實 呢
以爲自己很堅強 能夠面對生死
但是 今天告訴我 我還是 非常脆弱
到頭來 也只是一個 無名小卒 一個人類。human being。
再次反思 選擇讀醫科 的意義。做醫生 不是什麽 偉大 強大 厲害 的事情
而是 要用 專業 知識
更重要是 跟 病人 家屬 建立 patient-doctor relationship,互相尊重
最重要是 愛 agape 還有 empathy。
多聰明的醫生 也比不上 一個 懂得 聆聽虛弱的心靈 伸出溫暖的helping hand
願意花多一點點時間 借出 一對耳朵 一個肩膊 一顆 善良的心 的 人類

Working diagnosis of post-op AAA EVA repair VF: post-op MI.

或許今天失救的那位我從沒見面的伯伯,或許他的床位 已經 讓新的病人躺著
但是
我一世都不會忘記
2014年11月28日
下午12點(大概吧)
瑪麗醫院 K14N病房 9號床
的您。
May you rest in peace. God bless you.
--

Warm summer sun, shine kindly here.
Warm Southern wind, blow softly here.
Green sod above, lie light, lie light.
Good night, dear heart. Good night, good night.

(Mark Twain, Robert Richardson)
@ Dan Forrest "Good Night, Dear Heart"

Sunday, September 28, 2014

20140929 忍無可忍

20140929 1305

忍無可忍

要出去了。M17 First-Aiders let's go.

20140929 Outcry of Injustice

20140929 0514.

#HKboycott
#HKStudentStrike
#OccupyHK
#hk926

it is in the early hours of the morning. Occupy Central (OCLP) has been launched for a full day and more now, on top of HKFS's student strike and original week-long class boycott. Tensions are rising by the second and mere hours ago Hong Kong witnessed its darkest day. Police used brute force and inhumane brutality on our poor defenseless people, many of whom are students younger than me - university and high school students alike. Out came pepper spray at point blank range (aiming for the face and eyes specifically) and police truncheons/batons, which quickly escalated into ruthless waves of tear gas (which is xx times more toxic than pepper spray) and guns loaded with rubber bullets.

i must say, again and again, ever since my post 3 months ago in response to the 613 東北事件 and the foreshadowing of the 7.1 Democracy March and 7.2 公民抗命, my blood has started to boil at such injustice in the society, and my voice is finally coming out.

20140629: http://lifeinrc.blogspot.hk/2014/06/20.html

三個月前我只是一個無知的少年。很服從,一向只會聽父母一切的話——不要去示威,危險。不要罷課,因爲老師不會罷教。(當然,他們兩都在大學教書,自己又不會罷教,當然也嚴禁自己子女罷課)

但是三個月前突然醒覺,自己長大了,有權利,有能力自己為自己著想,自己有自己的想法,更加思想越來越成熟,要為社會的各種各樣不公義詳細了解,決定自己的立場,發聲。

20140613 東北,看見跟我在教會裏長大的 Sunny Leung 哥哥(應該是跟我同年吧。。。?)作爲前綫人員,衝破立法會。究竟他是暴民嗎?絕對不是。

20140702 遊行后公民抗命,看見哥哥(自己親生啊哥 lol)的女朋友 Athena 因爲參與靜坐而被警察拘捕。究竟她是暴民嗎?絕對不是。

其實此時此刻,仍然對自己的政治立場有所保留。不是完全反對,但是原本就是不支持。但是到了現在,已經不只是對於佔中的立場,面前一張又一張的臉孔,被警察的胡椒噴霧和催淚彈擊中的傷痕,的悲哀,不屈服的精神。。。我忍無可忍了。

常常聼別人說,你不喜歡政治,對政治冷感,躲避不了的,因爲關乎所有人。今天,到我了。罷課大行動和全港不合作行動。

儘管一早已知道父母不會讓我這樣做,我也必須做。不是因爲 peer pressure, 不是因爲恐懼,不是因爲對佔中立場有所改變。但是因爲情況已到了危險關頭,全香港都在奮鬥、在抗命、在支持聲緩學生。這香港已經變了。這幾年已經開始了,只是自己沒有好好留心周圍現實殘酷畫面。

不站出來,也覺得慚愧,總會覺得自己沒有實現公民責任,但是也要告訴自己不要感到迷茫和無助。別人也可能會譴責我只做鍵盤戰士,更加只是 Twitter 的卑微 share photos and retweets 。。。但是起碼我有良知、有想法,不是盲目,不原意被洗腦。

還在成熟的階段中,還有漫長的路途要走。請不要放棄,支持有很多种方法,包括默默在電腦后打句祝福話語。

多麽想出去跟醫療團隊學習,獻上自己卑微的力量去幫手。那爲什麽不去吧,少年。這些機會。。。

不要再説了。更不想用父母做擋箭牌,始終還是過不了自己那關。

今晚過後(現在已清早0607,太陽已升),香港從此不一樣。我們踏進了新的抗命時代,不要為自己沒有盡的所謂 “責任” 跟外出的戰士們道歉,最緊要是自己知道自己在做什麽。

思想的確很重要。

繼續努力。

再吸取經驗(什麽經驗?鍵盤戰士???)和教訓。

願香港能回復平安,能夠再歸于香港公民。

Valiant warriors fighting to safeguard our future generation, take care and be safe. Salute to you all.

Friday, September 5, 2014

ECU Chamber Singers - Good Night, Dear Heart





There's a magic here that didn't exist yesterday when I first clicked on it.



But something about it has caught my attention and I can't push it to the back of my mind when I search for other potential songs RC may sing this year.



Yet this magic has been accumulating bit by bit, slowly, softly, unknowingly. And now when I look at the score properly ... wow. There's just such a powerfully poignant air to it.



RC is still immature. And this song is not particularly difficult in terms of the words or music notes or even structure.



It's the music - the phrases - the message - that's overflowing from this clip of the ECU Chamber Singers - an outburst of emotion - of tears and love, of ages gone, of hope despite sorrow, of faith despite grief and pain, of warm sunny skies despite the darkness and empty vortex of losing a dear dear friend.



Good Night, Dear Heart.



Hope we shall do you justice.



No matter what may happen this year, I will find a way to make it work and make you prouder than ever before, beyond your wildest imagination. :')

Thursday, September 4, 2014

CVS Bedside, 20140904

Bedside with Dr KMM Ma today. Late for 20 minutes, so all the "good" cardiovascular cases were already snagged by other groups. The reserve cases all vanished too - either discharged or no longer existed. :(

Finally chanced upon a CVS case. A very nice elderly gentleman with ESM @ LSB - ejection systolic murmur at the (left) lateral sternal border - barely audible, but I could faintly locate it.

A poorly patient in the bed behind me caught my attention. The nurse was here for blood-taking and other minor procedures, presumably taking the blood sugar (finger-prick) and adjusting the IV cannula. Something about him made me linger in mid air, my focus drifted away from my case and my eyes darted sideways. He couldn't talk - possibly a stroke patient, with multiple co-morbidities. His slurred speech and indecipherable sounds and yelps of pain made me tear up behind my glasses and mask.

I was still recovering from my cold, with a hint of a sniffle and already watery eyes and clogged throat partly filled with thick mucus. I had to put much effort into suppressing my emotions.

Today I finally understood what they meant, when they said "don't get attached to your patients. Keep a certain distance and make the relationship clear - a professional one. Doctor and patient, no more, no less." :(

Having served as a hospital volunteer in the past, and placed in a geriatric ward @ Shatin Hospital, it's not the first time I've seen such cases. Hell, I've even spent days sitting with and holding the hand of a severely affected stroke patient with hemiplegia - couldn't move, couldn't feel, couldn't talk, couldn't eat, couldn't swallow - and required intensive speech therapy every day.

But I couldn't put it past me today.

I knew that I wouldn't be able to specialise in geriatric medicine in the future. Even last year, I knew. The most depressing thing about old people is that most of them do not recover. Though you may improve their quality of life, accompany them, listen to their stories as a kid, "in their days" ... but ultimately it's never a happy ending. With their endless chronic illnesses, masses of co-morbidities, often only able to receive palliative and supportive care ... it gets too much to bear, even for just a day. Not that I don't want to serve them, just that somebody's gotta get the job done, but I just feel that my calling is somewhere else (you will know it if you know me).

My heart weeps for you, good gentleman.

I wish you peace, and a hope for recovery. For relief from suffering, whatever form it may take. That every day may be filled with hidden blessings, that you may discover them, and smile once again.

Though you may never know me, I will keep you etched in the back of my memory, as part of my bedside adventures.

Farewell.

Wednesday, July 23, 2014

Peaches and Cherries

Peaches and cherries are my favourite fruits in the world. Gawsh. I just cant resist them. Even through these icky days when my body just refuses to take in any proper food. Havent had a proper meal for the past three days. Haven't had dinner for the past two days.

Mom keeps apologising, saying she's sorry she can't help with my study (she's been saying that ever since junior high...) ... it just breaks my heart. Her soft smile and unspoken support is already a huge confidence booster to me. Her presence next to me on the dining table every single night, her peculiar 喃喃自語, her random squeals of "aiya!", just being there - a human presence - whilst everyone else is hidden in their own rooms, and as I slave away to my notes on the other end of the dining table.

So, she says, I'll buy you food you like. And like a hyperactive kid out on a field trip, she hops down to the supermarket and scavenges all over the place, returning with three full bags of food we could never finish in a week.

To clear things up a little, I dont have nasty eating habits. I'm not a picky eater, I dont leave leftovers in my bowl (not even a grain of rice, unlike my messy brother -_-), and I dont pick things out that I don't like. I eat what I'm given and my mom has taken that as a sign that whatever she gives me, I enjoy eating that food. So she buys me all sorts of foods, but secretly my favourites are just peaches and cherries :') Don't tell her that please.

I've heard all moms do that, but when it's your mom, it's kinda that much extra sweeter. And it's why I enjoy staying home. Almost everyone else has asked me at least once - why do you go home so often? Why are you always at home during the weekends or holidays? When are you coming back to hall?

And that's another reason. Hall life is absolutely wonderful - without it I would be far worse off than I am right now. But every single day (particularly now that we've hit the deep end of summer) is jam-packed with all sorts of activities. The peer pressure gets too much sometimes, even though I know I don't have to conform. And, I don't want news to spread out to the whole hall that I have to take the supplementary exam. I've only told six people in the whole hall I think - Anthony and Jackie (classmates), Yeungwing & Ode & Bobo & Seung (who told Rita, but it's okay). It's great having the extra support, but I just wanna keep it closed. As I've always said, it's my own damn problem and i'll damn right get it fixed myself. It's a lesson I have to learn the hard way - unfortunate but necessary.

But anyway. Peaches and cherries. I've never bought them myself when I go shopping for my own cooking at hall. They're quite expensive to be on my budget shopping list (don't even try to guess how much money I spend on food when I'm at hall lol), so I usually just grab a bunch of bananas or a few apples as my fruit of the day (or fruit of the week, as I only pop in the supermarket once a week or less.

So, it's wonderful to be back at home for the summer. I really feel like I missed out on a lot during term time - my brother's spending more time at home, my sister's having lots of precious alone time with my parents without me in the way (you're welcome Diane!), and in general as I can feel myself transforming over these two short years (so far), I feel I have a need to portray this transformation to my parents, so that they can witness my growth and maturation too. They will always be part of my journey :')

So had my first supplementary paper today - Minicases. The most dreaded, the beast, the monster - I could use a hundred adjectives to describe its monstrosity, how petrifying it is, it sends shivers down my spine just picturing it in my mind. But I got through it alive. It wasn't my best attempt, but I really hope I have enough in the bag to hit a pass mark. (Touch wood).

Second and my final supplementary paper is on Friday before I fly out to Taipei for TICF. It's MCQ and EMQ, surprisingly a weakness of mine, since SAQ is deemed to be the harder paper, which I passed (barely, but still, ultimately, a pass).

I must take his personal space to thank everyone who has boosted me and egged me on when I felt like the whole world was gonna come crushing down on me. If anyone ever comes across this, you guys really inspired me to take my wings and continue soaring upwards once again. The skies are opening up~