Irritable.

I feel rather irritable today...

Ok, things that annoyed me is when patients are not managed properly...like someone is in congestive cardiac failure with only antibiotics for 3 days. I am aware patient not giving appropriate history, but a good clinical examination should reveals that, especially someone who is grossly oedematous and has a massive heart on CXR! Paling menyampah is a house officer yang banyak alasan buat keja, or do the job for the sake of it. Annoyed, annoyed, annoyed.

My meningitis man is better! Woohoo!! It feels rewarded. I mean, seriously, if he comes a couple days later, he would have turned up dead, leaving 4 children and a widow. Its a good thing his GP send him to the hospital despite his letter saying viral illness. This case holds a rather special place to me, since I managed him from clearking in, get CT brain done and did his lumbar puncture and sort out the public health side of it. How often is it you see a proper pneumococcal meningitis?

Meningitis

Let just I say, I truly not impressed with the public health registrar who has no medical training at all.

Had a definite case of bacterial meningitis today. Probably the longest time of lumbar puncture I ever done, had to swap mid-way whilst getting the cerebrospinal fluid sample cos my back is killing me. Ended up having to use the smallest gauge of needle cos all the black (can't remember the gauge) ones are gone; its either that or a big giant spinal needle. The cerebrospinal fluid is very turbid, very thick. 1 drop takes about a minute and a half to come out from the needle, no matter how much I adjust the spinal needle. 3 bottles collected. The result is typical textbook bacterial meningitis with at least 2.5 gram protein and 3100 white cells in it..

Yes, I knew the management is different between pneumococcal and meningicoccal. Yes, we can see gram positive, pictures looking more like pneumococcal but there is no way I can 100% rule out meningicoccal. Possible, probable, its all sound the same to me. Apparently possible and probable meant different things to public health, and it doesn't help this person has zero medical training.

Nothing is ever hundred percent in medicine. Doesn't make any easier for me whose job is to make some really important decision in many people life...sometimes the balance hang on what will kill the patient first. Awful, isn't it?

The worst winter in the last 28 years

Enough said.

The view is absolutely gorgeous.

Functionally doesn't work in real life though. School and offices shut down. We are severely affected in the health services; operations, clinics and angiogram cancelled. Doctors and nurses struggled to go to work; everyone snowed under. Manchester ambulance service has to declare major incidents.

I am damned tired from the traffics.

Couldn't really imagine on-call this weekend. I better brought spare clothes and food, in case having to sleep over!

Here to HOPING!

Ichi rittoru no namida

Berjurai-jurai air mata tengok citer ni.

Have to say, quite impressed with the way they potrayed the signs and symptoms of spinocerebellar degeneration.

The wide-based gait, the nystagmus, the past-pointing, dysdiadokinesia and gradual onset of bulbar signs.

Its a true story. She died at the age of 25. I couldn't even imagine being in her place, having the disease at the age of 15.

My consultant has Multiple Sclerosis. I can see his gait being affected to a degree. Truly amazing, and a kind person. He can still performed angiogram and inserting pacemaker. What a courageous person.

All these neurodegenerative and demyelinating diseases does make you questions certain things in life. 1 litre of tears...what an apt name for a personal diary.

On a more cheery notes, please don't bring me to Cheshire Oak (again). Udah2x la tu shopping time sales nak mampuih ni. Remember, you are skint. Exam.