I got hit

Two days ago I was attacked by a psychotic patient for the second time throughout my short 1 and a half years of psychiatry experience. (the first time, I was slapped by a schizophrenic lady in a relapse)

The lady had eyes so big and angry. She was hollering at the staff nurses who tried to calm her down and when she saw me, she demanded that I let her out of the psychiatry ward. Knowing better than to provoke her, I told her yes and I have to go get the keys to the door but the next instant, she charged on to me, half grabbing my hair and banged me towards the wall. I managed to grab her hands together to stop her from punching me but she was stronger. Her legs were busy kicking my crotch and thighs. I thought I was gonna die.

Everyone was terrified and screaming. Luckily the nurses came to my aid by grabbing her four limbs which were moving aggressively. We managed to drag her to her bed and restrain her at four points while she then began to sob loudly and pleading for my help. “Doctor, help me!” She wailed. I wailed in my heart, “Actually I’m helping you. Who’s helping me?”

My head and face felt sore. My left arm that bumped into the wall felt like it was breaking. I’m glad she didn’t smashed my crotch – I’m glad I’m not a male or else there goes my hopes for the future generation.

My job is hazardous. That explains why I have 14 days of hazard leaves in a year. But I couldn’t take it despite the incident BECAUSE WORK IS TOO MUCH AND I HAD TO BE ON CALL THE NEXT DAY, and the day after the next, and the day after the next…

For a moment, I secretly wished that I was banged so hard to have a fracture so that I could be admitted and have the rest I needed so much… pathetic huh?

Because work is too much

I think we’ve reached our max.

Just yesterday, my colleague told me about her experience of panic rising from her heart to her throat when she was half way showering. There was a deep wave of nausea but she only coughed out air. Then she quickly sat herself down for fear of fainting only to find that both her hands were shaking. She thought she must had been really sick. Swallowing two paracetamols and an antiemetic wasn’t barely an answer to her brief, frightening woes. Despite a psychiatry medical officer herself, she was blinded that what she had gone through was most probably a panic attack. “Huh? Panic attack?” she exclaimed in shock. After a lengthy discussion about her symptoms, she finally admitted that she had been feeling off at work. BECAUSE WORK IS TOO MUCH.

Today, I was informed about a patient on clozapine who appeared very drowsy this morning was now running a temperature and having sinus tachycardia. I rushed into another colleague’s room to discuss about withholding her meds, give her IV drip and transfer her to the active medical ward. She’s most likely suffering from side effects of clozapine and I feared Neuroleptic Malignant Syndrome although the other parameters were negative for the time being. I was taken aback when I opened her door – the room was all dark and quiet, my colleague sat slouched over the consultation desk with her forehead resting on her forearms folded on top of the desk. She was taking a nap just as soon as the clinic ended at 1.15pm. She quickly sat up with half closed eyes and a face that had aged several years after those every-other-day calls we’ve been doing. “I’m sorry!” I squeaked. “Oh, no I’m sorry. I’m really too tired.” she said quietly. BECAUSE WORK IS TOO MUCH.

And I thought I was the weak one among the lot. Seems like we are all stressed out BECAUSE WORK IS TOO MUCH. May God bless us and see us through it all.

Can’t get out of bed

I related some words from a depressive patient the other day in another post.

Those expressions strongly suggested major depressive disorder. But my boss taught me more when he so aptly described a part of a depressed person’s routine…

When the alarm first rings early in the morning of a working day, you hit the snooze button and then go back to sleep. Five minutes later, it rings for the second time, all the louder and you slam it shut. The next instant, your second alarm clock screams at you and you are startled – just a little. You stretch your arm to shut it off and curse under your breath, then burrow deeper below the sheets. Your brain groggily repeats “I don’t want to go to work today”. By then, your third alarm clock jumps at the bedside table and its shrill sound beats all the previous others. You grab it with both hands and almost throw it across the room in anger. By now you’re officially awake but still lying in bed, wondering if you should go to work today. There’s this overwhelming fatigue in you although you slept early the night before. Fifteen minutes have passed, you’ll be terribly late for work if you procrastinate any longer and being late for work is not something your boss will accept. You seriously go through all the motions of you getting into trouble by being late to work. You then muster all the strength left in your body and hoist yourself up to the sitting position, your legs dangling at the side of the bed as you drop your head and support it with both your hands above the knees. “Should I take an emergency leave?” You are desperate. You think that maybe you should fake an MC this time. To do or not to do it. You go through that for about 10 times and is still undecided. Half an hour has passed. Spend another minute in confusion and you’ll be dead meat by the time you reach your workplace later (if that happens). At that point, you just feel like crying and dying in bed.

Have this same ritual repeats itself over and over again for almost all of your working days in a week (even on a Friday) and ta-da! my friends… you are most likely DEPRESSED.

I don’t know about you but that sounds scary to me.

No deadlines

When a doctor spends most of his life in a hospital caring for sick patients, he eats hospital food (tastes like cardboard), he drinks hospital water (sometimes he can see sediments in it), he showers from a hospital tap (if it works), he sleeps on a hospital bed (if he’s lucky he’s got clean sheets)…

And so I’m sure you totally agree with me how frustrating it is when some necessities become faulty, for example, the water heater (as shown above). Today’s date is 22nd October 2009 and apparently the management is still unable to find the spare parts of this faulty water heater. I guess it’s manufactured in Mars. So the notice sticks on like a sore thumb for ages, laughing at me when I shiver under the drizzle of cold water on a rainy/stormy day.

I think I should be happy that at least the air-conditioner in the doctor’s room was repaired after 3 months of me hollering at the ward sister to holler at the maintenance team to holler at the air-cond repair team to get their asses over to detect the problem, and then holler again to remind them that they had done nothing other than detecting the problem, and then to holler more to get them check the machine A FEW MORE TIMES till they get into their head what went wrong. Of course, I had to keep on hollering before they come for the 10th time to finally fix the problem-of-the-millennium and let me enjoy some cool air after months of baking in the oven of a room!!!

It’s common to see the bill “ROSAK” (faulty) on almost all the things available in this hospital. Sometimes, you holler and complain and curse so much you finally give up and decide it’s impossible to get certain people do their job decently. I could have pat myself and be glad that at least the rest of the hospital equipment we use to save lives are not faulty – but hell no, they have the “ROSAK” signs all over them too, while some are faulty yet neither labelled nor repaired. God, they are life saving equipment! It’s THAT BAD.

These are the times when all altruistic wishes get pushed out of your system and be replaced by resentment, disappointment and helplessness you just want to run away. Only that you can’t, coz you are not only leaving the stupid management that you don’t give a damn about… you are also leaving your patients in need. It’s a tough choice.

About to collapse

Been on call every other day for a week now I’m practically living in the hospital with my mentally sick patients.

Sob.

Can’t remember the good feeling of being at home. Or good food. Or a moment without phone calls!!!

Feel like quitting my job.

I’m really too exhausted. I don’t give a damn about the money I earn anymore. Come to think of it, I’d rather earn just enough to have a simple, NORMAL life.

Geez. I know this is bad.

As of now, ploughing through like a good bull…

Trapped in a deep, dark well

Depression in the words of the sufferer:

NA is a high school teacher who is diagnosed with Major Depressive Disorder with Psychotic Features. She came to the clinic about a week ago, sobbing in a wheelchair, well dressed in a baju kurung with her name tag pinned to the left chest and accompanied by two colleagues who had panic painted all over their faces. “She had a nervous breakdown in school. She just couldn’t stop crying!” said one of the ladies.

I approached NA gently, and asked her what bothered her. She was shaking, her tears streaming down like heavy rain. “I’m too exhausted, doctor. I’m just too exhausted. I can’t take it anymore!” She blurted out in between cries and hiccups.

I signed an admission form. The second day, she was fatigued by the excessive crying and laid in the hospital bed most of the time. By the third day, she could sit up but only stared into space in the moments when she was not sleeping. The fourth day, she spoke about her sadness. The fifth day, she could manage a fake smile. The sixth day, she began to tell her story.

“I was raped in 1997.” No police report was made because the offencer was a friend and someone from an influential family with political connections. “Even if you do go to the police, you won’t win because I have my way. There’s absolutely nothing you can do, he said to me”. And so NA did exactly that – nothing.

“He said I’ll never find someone who will truly love me or want me as a wife. His words stings my ears even after 12 years.”

She was pregnant by that cruel act. She was at a loss, not sure how to face the future with a child in tow. Abortion never did cross her mind as she would not hurt the life of an innocent. She was still studying for her masters degree and having a child at that time would mean more sacrifices.

“His family wanted the child but not me.” How could she stomach that? So she ran away and planned to give birth to the child and raise him/her with her very own hands. She couldn’t tell her own family for fear of disappointment and rejection.

“But when I reached the new town, blood was coming out. I went to the doctor and he said I’ve lost the baby.” The miscarriage followed NA up to today. She has dreams about the unborn child for the past 12 years. It’s a boy who’s both lovely and caring. “My boy gets older by the year, even in my dreams. Just yesterday, he waved to me at the hospital door, telling me to fight on and be strong.” In her heart, she yearned to be with him. By killing herself, she’s freed from her depression and near to her precious son.

“I’m a fighter. I fought for myself so strongly. I look fine to the others because I mask my emotions well. But deep inside, after all these years, I realised the painful truth that I’ve not gone any further. I’m running in circles. I’m still in pain and misery. There seems to be no future to look at, so I looked back. And yes, I’m still stuck in the past.”

“I’m angry at myself. And I bear a grudge at him. Why can’t I let go? I’m so useless, not worthy to live on. I’m tired. I’m exhausted. I’ve cried till I have no tears.”

“Every night I have dreams of me holding a shiny knife. I would stab him multiple times. It’s not a nightmare, but a dream because I feel comfortable when I see his blood flows.”

“How do I forgive him?”

“I’m not a good daughter. I’m not a good teacher. I’m dirty and worthless.”

She actually felt better and safer in the hospital ward because she knew the doctors and nurses were all around her, helping her, protecting her. She couldn’t imagine what she would do if she goes home, for she had hurt herself too in times of isolation. She banged her head on the mirror, hit on the wall, etc. Somehow, the physical pain cannot take away the pain she has in her heart.

“I’ve told my story many times, I feel comforted when I let it all out but in the end, I can still find no conclusion. What do I do to come out of this misery?”

And she just stared ahead of her, past the faces of the doctors and nurses. I’m sure all she could see was either blank or darkness. She’s trapped in a well so deep and dark no one can understand the helplessness and loneliness…

Blowing bubbles in the air

“Patience is waiting. Not passively waiting. That is laziness. But to keep going when the going is hard and slow – that is patience.”

On call again…

As I sit here expecting another call from the casualty referring a case of relapse schizophrenia, or a call from the ward staff complaining that one of them have gone beserk, or a call from a houseman wanting to tell me about a patient whom he needs to refer but could have been dealt with easily with simple show of concern instead of doses of sedation, or a call from a distant town hospital trying to convince me to accept an aggressive patient whom they have no idea how to handle… and many, many more calls for the day; (phew, what a long sentence) I try to blog a little to ease the tension.

My life has been kind of flat of recent. After a short week dealing with more news of deaths so close to home than I could imagine, I begin to sink into this dull state that could almost sum up to depersonalization. Everything outside me is moving fast forward while I just lay at the background, watching and feeding to very slow personal thoughts. It was as if life wasn’t even in me.

Besides that, I wonder if I’ll succeed in my application for the psychiatry masters program. I’ve tried my best to sound earnest in a separate letter attached to the application documents. I needed to write one because I was actually not eligible to apply – I’m underage. Why apply then, you’ll ask? Well, I feel useless sitting around doing mundane work day in day out. I need a goal, I need to do things that will bring me to a higher level. My boss and specialists have been supportive. One of them even wrote a support letter for me, praising me to the heavens I almost thought he could be lying that he thinks so highly of me. Anyway… now that all is done and sent, I just have to cross my fingers and hope that they’ll approve my application despite my age and short service.

Then, there’s this house that Ethan and I recently set up but rarely go to thanks to the number of calls I have per month – more than the figure 10! Which means that half the time I’m spending my life and youth in the hospital with my psychotic patients, answering their psychotic questions, facing their psychotic behaviour. The other half spent at home which is beautiful and wonderful – is just not enough.

I’m kinda burnt out. I need a rest. But I can’t take leave coz there’s only 3 of us now. And you’re asking if I really want to do psychiatry again? Yes I do. I’m burnt out not because of the demands of the specialty. I’m burnt out because the workload and working staff available just don’t match.

Please, God… grant us extra doctors before I’m totally burnt out and decide to become a housewife for the rest of my life…

Ignorance, is not bliss all the time

I didn’t realise what I had until I lost it. Such, is the ignorance of mankind.

Some time soon even the tears and cries will blow away. I don’t know about the pain but I’m sure the memories will stay…

Time to treasure all that I have and be contented and thankful.

Thank you, but can I say no?

Presents.

To think I’m reaching a point in my career where I’m beginning to be showered by well-wishing gifts from my patients. Actually, these presents give me a dilemma – to receive or not to receive the presents. I’ll give them a broad smile and thank them profusely, telling them that I’m merely doing what I must and can do as their doctor and I shouldn’t be accepting gifts at all. Several times I tried to explain how I’m not allowed to accept gifts no matter how I appreciate their kindness, but I failed terribly and then I totally give up.

In the book of law for the Malaysian civil servants, it is stated clearly in the pages of Perintah-perintah Am, Bab D: Peraturan-peraturan Pegawai Awam (Kelakuan dan Tatatertib) 1993, Bahagian II Tatakelakuan, Perkara 8(1): Tertakluk kepada peruntukan-peruntukan ini, seseorang pegawai tidak boleh menerima atau memberikan dan tidah boleh membenarkan isteri atau suaminya atau mana-mana orang lain untuk menerima atau memberikan bagi pihaknya apa-apa hadiah, sama ada dalam bentuk zahir atau selainnya, daripada atau kepada mana-mana orang, persatuan, badan atau kumpulan orang jika penerimaan atau pemberian hadiah itu dalam apa-apa segi mempunyai kaitan, sama ada secara langsung atau tidak langsung, dengan tugas rasminya.

In simple English, it means that we, civil servants must not accept or provide any form of gift, endowment or favour from or to anybody if it directly or indirectly involves one’s work. The book goes on to state that any gifts received should be reported first hand to the Head of Department, providing details about the gift including its monetary value and then awaits approval before its official reception.

How do I tell the cheery Chinese old lady who comes for her psychiatry appointment once in every 3 months, bringing me a jar of homemade preserved fruit that she grows in her garden? How do I reject candies from a young man with mental retardation who is just so happy his parents bought him a huge bag of candies he just thought of sharing them with his doctor? Once, a patient wanted to give me a red packet consisting money as a tradition during Chinese New Year… oh well, that was kind of dangerous to accept so I took great efforts to decline politely.

I can’t remember other things that my patients gave me out of pure gratitude that I was only being a little kinder to them. Some I accept, some I ponder if by doing so I’ll be severely breaking the rules, some I rejected with care.

Ethan is somehow skeptical whenever I bring back foodstuff given by my patients. “Are you sure you’re going to eat that?” He always said. To him, my psychiatric patients should be treated with caution. I agree, to certain degrees. But I can find no clue of homicide in that cute old grandmother who personally preserved the fruit harvested from her garden and so carefully packed them in a jar for me. I feel totally wrong to give them away without even trying, and worst to have them discarded. So I opened the cap and munched on the sweet-sour fruit, praying to God that my instincts were right and that Ethan was just being to paranoid.

So far, I’m still alive.

Anyway, if I do die of food poisoning one day after consuming foodstuff given to me by my very own patients or get penalized for breaking the civil servants law, kindly remind all other doctors how they should reject all patients’ good-willed gifts altogether.