Random thoughts.. again

Hello world, greetings from the airport! :)

Today, I have some encounters in the wards. Perhaps it's accumulative, and today happened to be the peak.

I think I like patient care.

Few days back, there was this 67 years old uncle got transferred to my ward. You wouldn't miss him. He's just so prominent. I find him very adorable in fact. He is severely obese, always in a drowsy state, and fall asleep easily even when sitting at the TV room.

And then i took a look at his IMR.

TB meds. Empiric treatment.

On warfarin, admist tonnes of other meds.


Sigh. He weighed 96 kg.


Reason I used "weighed" past tense is because he lost 5 kg over a span of 3-4 days. My anticoagulation pharmacist oversaw this uncle for his warfarin. It was through him that I learnt many valuable lessons. Lessons about managing multiple complicated drugs on a single patient who has so so many co-morbidities. Lessons about treating patient is just not about seeing the recommeneded numbers but really, to treat the patient rather than the numbers. And also, he reminded me of my dad.


Uncle is to continue 6 months of anti-TB meds, on top of his 9 other existing meds.


Typical anti-TB meds - 5 drugs - and because of his size, the max of all are used. Uncle has to eat 13 tablets of anti-TB meds half an hour before food. After food, eat his other meds (around another 10-13 tabs). Can you imagine such a pill burden on such an uncle.



Sometimes we always ask patients to be compliant to meds. We know every reason why they should be compliant, and we know it's for their own good. Yet, when you put yourself into their shoes, if you were them, could you even imagine youself taking 26-30 tablets a day. And they are at least of panadol size.


Yet, this uncle is so adorable. I felt like giving him a hug when I dispensed at bedside just now.


Uncle spoke Hokkien. But I can only speak 90% teochew 10% hokkien. Yet he understands.


He really has all of my heart - because through interactions with him, i know that he will be compliant. He's illiterate yet he will adhere to the numbers written on the drug labels. Everytime when I pat on his back, he will nod his head and signals me that he appreciates. Uncle cannot read, yet he knows some meds are for diabetes, some are for hypertension, and new ones are for TB. He even knows that rifampicin causes orangle discoloration of his urine and sweats because he noticed it during his stay in the hospital. Do you know how encounraging it is to find out that your patient actually take charge of his own health and know what's happening to himself, and to embrace the reality with courage?

Pardon me for the incoherent thoughts. Just suddenly have too much gushing through my brain. I am so gonna have a brain infarct.

Today, there's this good son whom I encountered that took all of my heart too. His father was warded for breakthrough seizures, and other diseases included dementia with behavioral disorders. Because of his illness, this malay uncle looked very irritable, and sometimes he will stick out his tongue to you. He is just so flustered, yet demented. He's like a kid most times.

And his son came to bring him home upon discharge. This son is a 30 years old obese man who's sweating very heavily because it's very warm in the ward. Yet the love and care he showers on his dad really touches me. He is a full time caregiver because of his dad. Unlike other people who don't care what the meds are for, he carefully tells me what are the meds and how he has been serving his dad the meds and these and that.

All these things meant a lot to me. They showed me that there are many people out there worth every of your time and effort.

Admist many nasty people, there will always be people out there who appreciates you. And I soon realize that what God said to me is true - Giving is always better than receiving.

Got my 2nd marathon medal last Sunday :) Yep! went for New Balance X-Terrain Run and it was quite a good experience. Signed up for 15 km with hui ling and despite having to wake up early for it, it surely was a good run and I didn't regret it. I didn't stop until 13th km when the final 2 km runway was superhot and unbearable dehydrating. Could have clocked a 15 km non-stop run but nevermind, try harder next time. The terrain and beach run were fine, and they were not as scary as I had imagined. Certain part of the route reminded me of Adelaide's Barossa Valley though... oh man, I so wanna have a getaway :)

This is my 4th week in inpatient. On Tuesday while I was reviewing my patients' medication record, I saw the staff pushing something rectangular in shape out of the cubicle. My heart skipped a beat then. Auntie passed away. Sigh. Did a few interventions this week and I was truly satisfied. Asked doctor to change certain doses in certain patients because of their kidney malfunction, suggested an alternative which can give better result etc etc... Learning curve is steep every day, and I am loving the role which God has given me :)

God has brought me to the Heart of Worship :)

Today has been another good day. Met up with Mindy for breakfast before the lecture - we have not been spending time together for a long time! Can see that she has her own problems and worries, life has given her much weariness too. Somehow, I feel so relieved that we are still making time for each other, listening to each other's problems, and cheering each other on. She has been a good supportive friend while we were in NUS, and i hope that I can be her support when she needs one too, when it comes to work and strength.

Met up with my buddy Eric in the evening and we had our dinner at Mykii @Holland Village. It is a nice restaurant with nice ambience and good food. Enjoyed the dinner and chat. He's still the best in what he's doing even in Deutsche. Haha. He's buying a house next year - a condo man! So proud of you friend! :) Perhaps fenru has to go over more often to help tidy up the house tho :P

How have you been? :)

Screaming.... and Waiting.

Today, old grandma at ward 3 kept screaming.

Today, old grandpa at ward 3 kept screaming for help.

Today, I feel like screaming too. :(

Lord, when I have trouble standing strong in certain

difficult situations, help me to not lose heart and fall into

discouragement. Infuse me with Your everlasting love and courage.

Enable me to be strong and whole in my mind, body, and soul

as I wait on You to move on my behalf.

To be or not to be?

Hello world, how have you been?

I have been well I guess. Mid-way through my pre-reg already, if you are me how would you feel? Time flies I always say, and I have to say it once again. Time flies, and I am going to fly too haha!

Spent more time thinking lately. Not that I've not been thinking, but lately the thread of thoughts have taken another path, a new path I have to say. Will let you know once it's confirmed.

It's my inpatient rotation now - inpatient means wards. So I am now dealing with patients in the wards already. Have you ever wondered what a pharmacist do?

Many people ask why am I so busy when all that you do is to tell patient 'This is panadol. Eat 2 tablets four times a day for fever and headache."

At times I felt insulted when I heard these.

But very quickly, my heart immediately feel at peace because I know that I do not care much about what people think or say about me or my profession, my greatest consolation is that God knows.

Perhaps it's this indifference that makes me more hesitant in commenting on stuff.

Perhaps it's this indifference that makes me want to do more for patients if it's within my capability, albeit nobody thinks highly of pharmacist.

I am glad, for God maintains this serenity in me. I still go to bed every day with a tired physical body but I always wake up with a soul full of passion and adrenaline to do what I should. I finally learn to live with grace alone.

Inpatient pharmacy is like a battle.

Doctor writes orders for medication --> medication orders sent to pharmacy --> pharmacy staff have to check if the medications prescribed are appropriate --> sometimes we call up doctors to discuss about better alternatives --> process orders and supply.

In the afternoon pharmacists have to review all patients' medication profile in the ward. If you think reviewing is easy then you're quite wrong.

Do you know what it means by an appropriate therapeutic option?

A drug can be an option for a particular treatment yet it can be unsuitable for patient. Do you know how appropriate a drug is to a patient depends on patient's renal, liver condition, his age, his intake, his output, his illness, how sick is he, is he able to take medicine orally etc etc.

Do you know how much considerations one has to go through before deciding to go forth with a particular drug? And do you know drugs interact with one another too?

And if 1 ward has 30 beds, do you know how long it takes to review a ward?

And if there are 2 wards to review and you only have 2 hours, it feels so awful?

But I must say I like inpatient. Although it's a mad rush during discharge time, but it's then that I appreciate the role of a pharmacist more. As a guardian of rationale drug therapy, like what doreen always advocates, I do agree we have to intervene until the best is given to patients.

I am in S3. Ward 3 is a geriatric ward. Ward 2&3 feel like a mini-IMH most of the times. You see very old people. You see quite a number of patients sent from IMH for critical treatment. You see a lot of old people lying down and letting you do all that you want. You see very pathetic scenes. Sometimes you will hear people screaming.

The world is so real. SO is a hospital. I have much consolidation of thoughts throughout my rotation in geriatric wards. All they need is not medical treatment, but rather, a healthy consistent dosing of loving tender care. They need love.

If one day I am an old and frail 80 year old lady, please let the doctor know I've signed DNR. Please also don't poke me with needles and tubes and catheters and pumping me with potent antibiotics etc etc. Let me go.

Sad things aside, lately I have quite a number of encounters with patient. Yesterday, this 74 year old Eurasian lady sitting on a wheel-chair wrapped her hands around my waist and said thank you for nothing to grave to thank about.

You might feel like vomiting if you hear this but I feel like crying then.

She said "You're like a flower. Are you married? You are always smiling, you look so loving and caring." - when all that I did was to explain the importance of lactulose in her condition and told her not to miss that anymore.

She held my hands and gave me a gentle kiss and said God bless. I felt like crying. I felt as if God has been looking at what I've been doing and am doing. I just felt so trembled within.

And I thank God for giving me this consistent bolus of passion to serve. For without Him I am nothing, yet through Him I already have everything.

It is also because of His consistent guidance that I know that my life has a greater purpose and I am walking towards it.

Pray for me :)