654. Best Practices from the SGH

can only type with left hand. on oct 4 2011 was operated by prof foo at sgh

admitted 7am
1. frontline asked me to scan my admission booklet barcode opposite near door and a machine will print q no. 1008. i scanned barcode on book cover. no response. she got up,open inside front cover. another barcode. got my slip paper no. 1008. good n0. not 1004 ("4" = death in chinese, ga death for me?)

2. TPR
young doc in blue v-top introduced himself, wrote lots on case sheet. had asked pre-op health qestions as what the anaesth doctor asked on sep 24. senior nurse took ear temp, doc machine pulse rate (50) bp 137/70, pr 50bpm

put finger on my l inner wrist - why when machine showed pr? i asked. pulse quality he said. well done

"where is the stethoscope?" the senior nurse fished it out from lower drawer. later i asked why hide it? they get lost she said. littmann brand over $100. i remembered mine (orange) at toa payoh vets being "lost" my assistant told me lately. not a trace. so sgh has similar problem too

"breathe in" doc placed scope on my back 3 spots, then front chest. he did not say breathe out as i held my breath. so when he reiterated, i was still holding my breath

drug allergy? medication? dentures? crown? no
"you must be exercising?" he asked. 61 year old, still working, bmi above normal must have some anti-cholesterol, high bp as is common. sgh does not screenor lipids on sep 24 blood test. chest x-ray ok
how come? the tired doc did not ask. his job was to check risk factors foe ga

senior nurse (SN) had to record on a form as she ask more questions. "Op theatre is chasing for you. i have to complete check list." very busy. one nurse does the job of 4 people. "why not ask union for help?" i asked. no use, she replied. SN carries more burden to teach procedures in all hospitals in medical n vet. they do get fed up but young doc need time to be familiar, like young vets.

"how much cash? handphone?"
$20, no phone"
Your change of clothes, blue first. green. gave me a bag which also had a paper panty

"did the doc mark arrow your thumb cyst?"
no
i will find him
a black arrow marker pen pointed to cyst

A younger nurse could not find slippers for me to change
the op was looking for me, it was nearly 8 am
"I'll go up to get the slippers," she wanted to go upstairs, pressed elevator, somebody called her away. the lift door closed. as soon as it opened, a covered bin inside was taken out.
when lift door opened again, i pressed button so she could do her job. i am a vet surgeon and dislike processes delaying start of any surgery. back-log. it gets tiring for the surgeon waiting for prep of patient as i am not the only one

nurse smiled n asked me not to hold lift open. she gave me slippers, might be inside the bin. a shower cap too.


lift with nurse upstairs to a big room with many beds. in another small room, i was on a trolley bed and saw more nurses. a young doctor introduced herself as anaesthetist. "You don't look like the anae who spoke to me" i said.

In her 30s' with sufficient years of maturity of experience and inspiring confidence in me. She had big black happy eyes, fair face and as you know, eyes to me, are windows to the soul. and her eyes were sunshine on a day i know i would unlikely to meet my maker (not die on the op table, this being my 4th ga). no doc can guarantee no heart failure, thrombotic shock into brain, drug reaction

"what u use for anae? propofol?"
Propofol is in the news as having killed michael jackson
"propofol, fetamine and ketamine"

Prof Foo in blue top n green shower cap came, tanned face and a personality that some doc naturally possess (as evident when I spoke to his nurses at various consultation times, greeted me and said in his best happy voice"take good care of my friend."

i asked for a mole on the right palm to be excised. it grew slowly bigger as i age over the 6 decades. he got me to sign a consent form. this is best practice for vets too. record proper surgical sites on consent form. a surgeon is now being sued for doctoring the consent form and the sadness I feel is for the nurse who helped him as she would lose her job. the private hospital admitted liability too. so nowadays, i pay more attention to my associate vets and intervene in vet matters as i do not want toa payoh vets to be in similar litigation. defensive medicine is ingrained into my vets as the society is now litigious.

anaest said "a local anaest" as she had put welcro strip tight on my elbows to distend blue wrist vein, slight pain as needle entered skin. 0.3 ml probably. a pink braun canula 20 went in at one go, no pain, taped. hartmann iv drip. efficient speed from experience i can tell n appreciate. no fumbling of rookies in locating the vein,

in op room, a nurse placed a nose mask onto me saying "breathe oxygen deeply"
i complied and looked at the anaes as i knew she would be injecting the pre med. "think of something nice" she said gently. i was surprised as previous anaes worked in deathly silence as the surgeon is the superstar. My life depends on the black-eyed anaest but I will never see her again or know her name. Patients cannot request for a particular favorite anaes I guess as the pre-op sep 24 anae was a different one and looked like a new doctor with 2 years of experience. shortall of doc in singapore nowadays.

i was asleep as i thought of sunshine and white sand beaches of Florida.

8.15 am op room. 11.15am i woke up. i heard and saw briefly twice running red lights on monitor. Impending heart failure? soon once briefly orange yellow lights. I am not in pain or in breathing difficulty. cannot understand. soon wheeled to blk 9 ward 63. grateful to be alive and to the anaesth.

I drank 2 warm cups of milo as I had not eaten breakfast. felt nauseated unlike in my past 3 ga recovery. I rushed to the bathroom to vomit out the milo. Over-drink? Very slight nausea. Not a bit of pain at operation site.
no pain too in the 2 op by Prof Foo 2 and 2 years ago respectively to remove skin lumps. I wonder why? Local anaet used? I don't do it for dogs,cats and hamsters as extra sc injections may introduce infections. Maybe this will be best practice.

Maybe it is fentamine and ketamine? There is a secret somewhere in the op theatre of sgh.



3.58am oct 5, 2011.