Jason’s Blog

Tuesday, 27th March 2007

Was feeling rather sleepy last night cause stayed up quite late to revise Complimentary Medicine class test the night before. Though my eyes were really droopy, I forced myself to read PSDs 1 - 4 just in case the pharmacist-in-charge would question us in Seremban later today. Read until around 11+ till I could no longer fight the fatigue and turned in for the night, praying that I wouldn’t humiliate myself or IMU the next morning. :>

Woke up at 6 a.m. so that I’d be able to meet the gang by 7 a.m. As expected, the road was slightly congested but unlike other days, it wasn’t so clogged up because we left 10 minutes earlier than usual. Reached the station, boarded the train and slept all the way till Sri Petaling. Walked to Vista C to find Kok Pun waiting by the gate. A little while later, Laura drove out with Kong. We waited for Po Leen and when she came, we left around 7.15 a.m.

The journey was uneventful; just that it ’s really, really, really far to travel to and fro everyday. Plus, the toll was a litle on the high side, costing us RM7.70 one journey! Our plan was to leave by 7.15 a.m., reach Seremban by 8 a.m. and go for breakfast before reporting for work. So, I didn’t have anything to eat since dinner last night at 8 p.m. We reached the hospital around 8.05 a.m. and hunted for a place to park. There simply are too many cars there converging in a tiny place like Seremban Hospital!!! We turned left, right, downhill, uphill, cornering every few metres but still couldn’t find a spot suitable to park Laura’s MyVi. Eventually, we found an empty space which was facing the front door of some office building. Ignoring it, we parked and proceeded to find our pharmacist-in-charge, Puan Basariah.

We took around 15 minutes hunting for a stupid parking space and by the time we entered the hospital’s main hallway, it was already 8.30a.m. We wanted to report to Puan Basariah and maybe to head to the cafetaria to grab a bite. Who knows, after reporting to her, she took us to the OPD straightaway and left us with the head there, Pn Kamilah. She proceeded to split us into 2 groups: Kong and Po Leen would be based in OPD today while me, Laura and Kok Pun based in the sattelite pharmacies. First she explained to us the various steps involved in ordering drugs and the various channels and government agencies that a pharmacist can request for a drug. She also explained about the Blue Book and how certain psychotropic drugs have to be kept locked up and the key is kept with the head of the department. She took us to the drug cabinets where they keep all the drugs and showed us how the movement of drugs have to be recorded. Interestingly, some drugs are only meant for certain patients and they’re given based on a first come first serve basis (e.g. only 50 patients can be given the drugs in a cabinet). I was shocked to find out that royalies are given a special cabinet and best of all, the logo was labelled "Royal" printed in Yellow paper!!! Talk about equity for Malaysians…

Kong and Po Leen stayed behind while we were herded by a PRP Kak Ida to the satellitle pharmacy on the 5th floor. From there we were transferred to another PRP, Kak Munirah (I think). She explained to us that the 5th floor satellite pharmacy was meant to serve discharged patients from the 5th fllor till 8th floor while the one at the 3rd floor for 4th floor and below. After explaining about the drugs and the functions at the 5th floor, she took us down to the 3rd floor and did the same there. After that, she "dropped" us there with another PRP. She asked her what was she supposed to do with us but Kak Munirah didn’t know either. Somehow we feel like being treated like cattles, transported from one dealer to another. We "sibuk-ed" there for a while till we could no longer learn anything there and proceeded to head back to the 5th floor instead (the air con there was much, much cooler). Along the way, we walked into a Second Class Ward to use the washroom. I saw a group of IMU Medical students crowding around a lady, listening attentively while the doctor explained the method of diagnosing the patient.

We went up to the 5th floor to find another PRP talking to the personnel there. She was helping her pack bags of medicine and solution to be dispensed to the patients in the maternity ward. Out of boredom, we asked her whether we can follow her to see how she dispenses medicine to the patients. Being a nice person she is, she agreed. Her name was Kee Kiat but we found out that her colleagues call her Kit Kat, which we did as well (:>).  Along the way, we met another of her colleague (Woei Tatt) who offered to help her dispense since she had about 20+ in her basket. We actually offered to help her dispense but she was worried that the patients there might complain, so we just followed her and her colleague around while they counselled the new moms on how to take the pills and apply the solutions given. What we observed was so very different from what we usually do in PSD. You don’t get to spend more than a minute for each patient, what more 5 minutes like we normally do during PSD.

After that we went back up to the 5th floor again. According to Kee Kiat, the lift are always fully packed at ALL times so we walked up a few flights of steps instead. There, she explained to us the various roles that are played by pharmacists in Seremban Hospital including TDM and CDR. Since we still had a good 1 1/2 hours still lunch at 1 p.m., we asked her whether it was possible for us to visit TDM and CDR departments. She made a few calls and took us down again. This time, we took the lift down. We entered from the 5th floor and the lift proceeded down slowly, stopping at each floor with the ever hot stuffy air circulating in the lift. When the lift reached the 3rd floor, there was a brief moment when the lights went out. Just as suddenly as it went black, light came up again and the lift proceeded UPSTAIRS by itself!!! We went up floor by floor again, stopping at 4th, 5th, 6th, 7th, 8th and repeated the  process right down to the ground floor. When we finally reached safe ground, my head was already throbbing and I had a good mine to grab my medicated oil (but I didn’t want to face the prospect of taking the lift back to the 5th floor again).

Along the way to TPM, we asked her whether she was busy that day. She was kinda busy but was willing to sacrifice her time for us. At TPM, we met her first colleague (Woei Tatt) and a few other fellas (Lee and Intan). Intan was our MPharm senior from P103 batch (if I remember correctly). Woei Tatt took us around the area, pointing to CDR and TPN areas as well as where they normally store their drugs. It was quite brief since there wasn’t much to see, so we headed back to the office and chatted with Intan instead. She told us that we could actually visit the 3rd class wards at the 5th and 6th floors if we would like it. Somehow, they always compare us with our B104 seniors (who were more talkative and friendly, I think) who just came last week to do TDM and CDR. After a while, we left and decided to disturb Kong and Po Leen instead a OPD.

When we went to OPD, they were sitting behind a PRP, watching him dispense medicines. His lane was the Express Lane and had many young, old and special patients. He worked very fast, spending on average about 7-8 seconds per patient, but he was very professional and direct to the point. According to Puan Kamilah, he had just started at the OPD a month ago and was full of praises for him. We watched him for an hour, then we headed for lunch at the newe cafetaria nearby. The food was mediocre, yet expensive. Perhaps we’ll try at IMU’s Clinical School cafe tomorrow instead :>

After lunch, we went up to the 5th floor again and looked at the various drugs in store. Kee Kiat came in a while later and informed us that she would be clerking patients in the wards. We followed her into the ward on the 5th floor and took us to a small discussion area. This 5th floor was meant for getriatics (patients above the age of 65 years). According to her, a PRP has to clerk at least 15 new patients every month and follow up on their progress until they are finally discharged. While she was writing down patient’s details into a green form, we busied ourselves with other files and tried to decipher the doctors horrendous and illegible writing. We chatted with Kee Kiat and found out that a new PRP could earn up to RM2500 gross and in a few years time, the starting pay would be around RM2700 to RM2800!!! I walked around the ward (which was really humid and stuffy) to get some fresh air. The windows were left open and warm gushes of air hit my face every now and then. Walking along the aisle, I saw many patients who were invaild and most of them had a urinary catheter inserted into their bladder, draining out dark orange urine into a polystrene bag. A few of them had tubes stucked right into their throat from their nose and there was a particular sucking sound as the nurses proceeded to suck up the patient’s mucus. I can only imagine their agony as the tubes were pushed in then out again. As I walked further along, I saw an old man lifting his left leg up from the ground towards his bed, but just that there wasn’t any leg!!! It was already amputated and what should had been a calf with a foot and 5 toes were replaced with soft tissue mass crumpled around the stump area.

A while later, Laura and Kok Pun joined me and we went up to the 6th floor to another ward for the general public. Walking down the aisle, I nudged Laura and pointed to a student wearing IMU name tag. I asked her whether we can observe her while she diagnoses her patient. Luckily for us, she was really nice and agreed. Her patient was an old woman. She was anemic, really pale, her skin had lost its turgor and based on case notes, had some sort of respiratory infection. Before we started, this trainee doctor (Miss Teo) asked us whether we could speak Chinese since she a little of a banana. Luckily Laura was there and helped to translate certain stuffs that Miss Teo told us to the kind old lady. Miss Teo taught her how to diagnose some congestive heart problem by looking at the large vein on the right neck of the patient. Since the patient was so very thin, we could actually see her veins throbbing with a characteristic double throb, followed by a singular throb everytime. She listened to her heart and passed the stethoscope to Laura to listen to her murmur. True enough, a kinda weird sound could be heard!!! She then palpated and tapped her spleen and liver, teaching us how to differentiate the different sounds to roughly judge the positions of the organs. If a sharp sound was heard, this shows the edge of the organ but if a dull sound was obtained, a solid mass lay beneath and the tapping was continued until another sharp sound was reobtained. She measured the liver and spleen of the old lady and found out they were both larger than 15cm (vs the normal about 7cm). According to Miss Teo, the patient had some chronic blood disorder, which leads to her anaemia. But since her RBCs were actively destroyed by her spleen, this causes her splenomegaly. She even allowed me to press both her spleen and liver which were very hard. After that, she pressed the patient’s veins and found some abnormality. When pressure was applied to a vein, blood flowed away from that area; but when the pressure was removed, it flowed back into the vein. Miss Teo said this is called blanching, indicating some vascular disorder. The patient was also quite dehydrated since her skin didn’t have enough elasticity to retun to original after being pinched. We asked the old lady how much she drank and she drew an imaginary 500ml bottle size for us and said she drank 2 bottles of that for the past 3 days. We advised her to drink more water to saty rehydrated. Her fingernails also showed slight clubbing. All in all, we spent nearly 45 minutes with her and I could see that she was enjoying the attention she was receiving from a doctor and "3 fake doctors". Hehe…Poor thing. She must have felt so lonely there. But the good news is that she would be discharged tomorrow back to her 2 grandsons. We thanked her for her kind "hospitality" - literally and went down to OPD again. Just before we left, she told the trainee doctor in English "Aiyah, don’t worry la, you sure can pass your exams wan".

They were busy helping the pharmacists there packing, cutting and reading presriptions so we waited by a corner and chatted. We left around 4.40 p.m. and hurried to the car as we were afriad that the KL-Seremban would be congested. Luckily for us, we were well ahead of the mad rush back. Along the way, I chatted with Laura and Po Leen while Kong and Kok Pun both tired out, napped. Though tired, it was a really interesting and educational trip!!! :>