Tony’s Anatomy-#9: AAD, against advice discharge?

Patients come to a hospital in order to relieve their pain or cure their disease. But as patient right rises,  the more often patients refused to take the advice from medical staff(doctor, nurse…..). The term “AAD” means “Against advice discharge”.

It’s weid that people come here to seek helps from doctors and they refused the advice when diagnosis is made. This week, there’s a patient who was diagnosed as acute myocardial infarction (AMI) and admited to our ward. It’s really high risk of

deaths if not taking treatment emergently.In order to monitor the progress of AMI, it’s necessary to check cardiac enzyme and electrocardiograph(ECG,EKG) every 6 hours. After I finished the ECG and the nurse drawed the blood for cardiac enzyme tests at the midnight,

the patient’s wife ran out to the medical station and queried why we often interrupted the patient’s sleep and draw so much blood. She reported many unrelated medical storied to us and showed her angery.After repeat-and-repeat explantation, she turned back to the bedside. Then there’s a “click” sound poped out. She locked the door of the ward in order to prevent doctors and nurses to see the patient ANY MORE!  Fortunately, there’s a backup key of this ward. Unfortunately, we’ve to find a key to open his wife’s heart. To protect our medical staff from lawsuit, it’s common to discharge patiens when they decide to against advice.

 

In this story, I found we should take “AAD”as Anxiety, Agitation and Delirium  rather than against advice discharge. The family reported this woman(therir mom) didn’t have such weired response before and I was guessing it’s a delirium attack on this woman. Fortunately, there’re many

medications for delirium. Unfortunately, she is the family member and not the AMI patient who was admitted to our ward an lying on the bed now! Can we prescibe a medcation for her  ?? If we can’t control her temper and mood, the AMI patient may lose his life because she refused all of our treatement recommendation.

Well, I had to treat the couple , not only this old AMI man. It’s a tough on-duty night since I had to cope with the delirium and AMI simutaneously. When the sunlights shined into the ward from the window, this woman abruptly changed her attitute and responses ! She showed good manners to us and agreed any of our medications. What a delirium nihgt and the power of sunshine!

 

Tony

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Without Facebook-#3. New drug

This is a candy with drug function and it's made in German. The drug can fix and make up your hurted and broken relationship. And the most important is you don't need a doctor'prescription. A pill a day keeps the broken heart away.

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Without Facebook-#2 Merry Christmas

Being a volunteer really lights my passion!

In December, we are assigned to help the community in a rural area. We dissipate meals to self-living elders and help them measure blood pressure. In every Wednesday, we accompany children reading books and help them to correct their homeworks.These children come from poor family and the church help to take care of them in order to keep them not to become a ganster or have a bad behavior.When I  accompany children, I found them quite easily satisfied. Maybe just a candy or a game playing can fulfill their desire.In contrast, I found I was not a easily satisfied person. My mind is easily affected by the advertisement, TV show or others’ suggestions. Like Christmas, there’re many promotions and naturally you would like to have a better dinner or an expansive gift. It’s not a shame to have luxury stuff but it’d be better if we can adovocate ourselft or donate some money to help the world. I really found I became more easily satisfied and treasure what I already have after being a volunteer.

 

 

The mobile free bookstore

 

 

 

There’re many story and picture books.

 

 

A game playing between children

 

 

I planned to go home this weekend but my mother already went to a camp for young people. My mother doesn’t have a high education, high salary or reputation. But she does volunteering nearly everyday! More surprising, she refused my monthly money support and asked me to turn it to help poor family. As her wish, I donated much money every month.I think I gave up the chance to have a good watch, clothes or car (No doubt!, I donated more than a car’s price). As my mother, I am not looking for being memorized or having a good reputation. Except this diary, I don’t  ever talk or mention my donation with anyone.

It’s Christmas now and it’s time to make a wish.

Wish I can become more smart and have more power to help others.

 

Tony@2010 Christmas

 

 

 

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Without Facebook-#1

People say if God closes a door, he will open another door for you.  It’s the same reason why I choose to quit Facebook until my birthday of 2011.

There’re 6 months to go. Facebook is really useful and interesting tool for communication and sharing photos.But it takes me much time everyday. Some connections on Facebook are real and some are virtual. Although I already “unfriend”some people from list, there’s still someone you would press “like” on his photos or say “Happy birthday” but never hang out with. The longer I spend on Facebook and the lesser I spend on real connections with “real friends”. And as you see, it’s my first blog diary since I became a resident doctor. In the following 6 months, I will transform the time I spent on Facebook into working on my dream, making a real call to friends/family, updating blogs and travel.

 

Tony @ the era without Facebook

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Tony’s Anatomy-#8: Intern concerto!

Finally, the end of internship is coming. In review of this year as an intern doctor, it’s like a concerto, composed of 3 parts (fast, slow, and fast).  The first 4 months was like  a “Allergro”. Everything around you was fast! We came to a whole new medical center and tried to fit to new enviroment. Try to learn medical procedures we didn’t do befoe. Try to ask medical history of new patients who you never met before. And then at the same peroid, we were preparing for apply of next year’s resident doctors’ positions. Even you know you just came to a new beautiful city, no one had a mood to travel or fool around. Near December, most people will know where they would work as a resident doctor next year. Then the 5-8th months was like a “Lento”. Everything became slow!  As you know where you will go next year,  you’re starting to think when to leave and how long you have to wait especially if you were not in a hospital which you got a postion. And since you got adapted and familiar with mediccal procedures, every time you insert a Foley catheter you feel like doing a repetitive boring work. In the last 4 months, most people choose easy courses for their internship. However, life became very very fast as “Presto”!  Although our burden became less and easy, we felt we’re leaving in soon. We want to grasp more things like medical knowledge or procedure practice before we leave! We want to enjoy more happy moments with friends we meet here. We start to travel or gather together. Sometimes we even tried to talk with someone we never talk before. How do you feel if someone you just meet and found adorable and interesting is leaving soon ?   Quite sad, isn’t it? Iris shared a good movie story, “Harold and Maude”, to me. The 19-year-old boy loved and had dating with a 79-year-old woman in the story. When the woman’s life came to the end and the boy was panic of how to live without her, the woman said “ To love more!”.  Huge thanks to every friend and coleage ! Really hope our path will cross again in the furture.    

 

Tony @ Taichung

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Tony’s Anatomy-#7.Seeing is not believing!

Finally,my internship program came to the end course,Pediatic medicine.I pick up hematolgy department for my 1st rotation.In the grand round by all the staff,me included, I saw a little young girl who looks like 6 years old. However,her real age is 12 years old.How come? There must be something wrong! To everyone’s surprise, her family abandon her in the hospital and we can’t get contact with her family members to know any information about her disease history.Her kidney is going down due to the tumor obstruction. What a pity it is ! Finally we arranged a tube into her body to relieve the kidney obstruction and she was now transfered to ICU.We still don’t know why she had retarded growth.Through this true story, you can know the difference of the accompany between adults and childs. Without accompany or wife, we,doctors, still can take history of patients’ disease process. But in pediatric patients, it’s obvious that we can’t.Patients’ role is very important.  There’re some news about adoption and discard in recent days. I truely hope that every child will be well cared and accompanied.Children are so cute that many people like them.But you will know how much you love them until you have to face the problems and difficulty they made.Children are not toys that you can’t discard when you don’t need them. They are truely alive persons. Don’t discard any child,please.

Tony

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Tony’s Anatomy-#6:Unforced error and ACE

It’s at the last day of my internal medicine program. The emergency department(ER) transfered a man presented acute progressive back pain to our pulmonary medicine ward.Initialy,he was diagnosed as pnuomonia(lung infection) by ER doctors.However, after detail analysis, we suspected he may have a internal bleeding.We arrange a CT image scan for him which showed internal bleeding and colon PERFORATION! Oh~~~my god! Comparing to ER’s impression,it’s totatly different impression. This man was dyeing! Then we arranged endotracheal tube insertion and intra-venous(IV) line on the man. However, until one anesthesia doctor came , we found we forgot to insert a larger diameter IV tube(CVP) on this patient. Without this large IV tube, it’s quite impossible to infuse sufficient blood to compensate acute server internal bleeding.Thanks god.We did it before acute internal bleeding happened and arranged emergent surgery immediately. However, when I was writing medical summary note, I found my team member,the decision marker, was crying. Why? She felt guilty for making a unforced error( a term from Tennis). I told her it’s really a mistake but we also made an ACE  ball that we found the most life threatenng disease he got and fix the problem in time.A great docot bears strong resemblance to the great Tennis player like Roger Federer that they rarely makes double fault and learn from experience. I am not a great doctor yet.Hope I can make many ACE balls in the furture.

 

Tony

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