Tuesday, March 24, 2009

Ukrainian CPR, Russian Life Support and the Boris Yeltsin Classification of Heart Failure II: The Reign of Chaos


I resuscitated another corpse today. By the grace of God, old Pak Abu was revived.

More than a successful resuscitation effort, it was a failed murder attempt.


The perpetrators behind the latest assassination plot were none other than our Malaysian medical graduates from Russia.

I was only a nonchalant passer-by.

Drama and blood and gore were the last things on my mind.

Yet the sight of a soul in distress was inescapable.

Some people have an uncanny the ability of selective vision to ignore that which is unpleasant to the eyes.

I unfortunately do not possess such a gift.

If I come across a man (or woman) gasping for breath trying to remain alive with the little air they can inhale, I can’t turn around and pretend I see no evil.

Now Pak Abu was obviously struggling to breathe, so much so that he was already unconscious and cyanosed with no heart beat.

I caught the first house officer and made a very quick enquiry about Pak Abu.

“Oh, he’s just sleeping,” was her reply.

It was then that I flipped and threw a fit – a memorable, record-breaking grand mal seizure even by my own standards.

“THE PATIENT IS NOT SLEEPING! HE IS DYING!” I snapped, throwing the house officer into a state of panic and disarray.

Any human being with a minimal amount of common sense could have come to the conclusion that Pak Abu was in critical condition.

I supposed that was why his Filipino caretaker stood by and did budge not an inch away from Pak Abu.

While the staff nurses and doctors left Pak Abu to die miserably, Aminah the Filipino illegal immigrant with no skilled training or formal education did the most sensible thing she could think of.

It was also the only thing she could do in the absence of assistance and professional help.

She pumped precious oxygen into his failing lungs while the Russia graduates left Pak Abu to rot.

Aminah is paid RM 60 per day. That’s RM 2.50 per hour for twenty four hours of cleaning and feeding and diaper-changing with no designated lunch time or off-days in between.

In contrast, a house officer educated for six years in a Russian medical school earns RM 4800 per month, excluding food and on-call allowances.

In the process of a rowdy resuscitation – somewhere in between 1 m of adrenaline and 360 Joules of defibrillation, I grilled the three irresponsible and blatantly negligent house officers one by one.

They did not know the basic A, B, Cs of resuscitation.

They have no inkling what an oxygen face mask is.

They have never performed chest physiotherapy and suction before.

They couldn’t tell a Ryle’s tube from an endotracheal airway or even plaster the latter decently in place.

Sometimes these Russia and Ukraine graduates give answers that can really leave one stumped in disbelief and a locked open jaw.

Do Russians turn blue and stiff and icy cold with no heart activity in sweet slumber?

Do Ukrainians have a normal blood pH of 7.28?

The list goes on.

Very bluntly, it’s a serious issue of aptitude and attitude or rather, the lack of both.

They are a living testimony to the rotten state the Malaysian Medical Council has put us all in.

How many more must suffer and die before they put in place a mechanism of evaluating the competency of trainee doctors?

As it is already, irresponsible and dubious doctors are commonplace in the system.

The disciplinary action and remedial steps however are few and far in between.

The end-of-posting assessments, log books, annual SKT appraisal and incident reporting are nothing but an exercise in vanity.

Anyway, I visited Pak Abu today.

He gave me a reassuring nod of wellness.

Here is one soul that successfully slipped away from the Russians.

How many failed to?

30 comments:

Anonymous said...

All i can say is i think u should be our PM, if not, at least Health Minister since u revealed so many unseen shortcomings of our national healthcare...so, don't curled up your hands and watch or just write a blog with not even your real name. If u wanna set things right, at least stand out and do something. Don't just sit in the corner somewhere and pointing fingers at ppl's nose. Time is running, more ppl will still be victims while you're pouring out your anger in your little corner...I just wanna say to u 'U R NOT HELPING MUCH EITHER'...

DI said...

And just what are you doing to improve the situation in the country Mr 'Anonymous'? Shouldn't one who insists that others reveal their names do the same...sheesh.

tazkirah_88 said...

Do you think that all of Russian graduates r like that?If so, I think it's unfair....share your experience n skills with those HO;s, it will be nice I guess...

DI said...

Were these the same bunch who managed...or rather mismanaged the previous patient? If so, does your hospital typically take any remedial action, e.g. send them for courses in basic life support?

In Malaysia, HO's are sometimes graduated from a department even if their skills are below par. I wonder what would happen if the 3 HO's u mentioned were sent to the rural districts of Sabah and Sarawak and started practising independenty...

Russian student said...

I am a Russian medical student. And i don't deny that there are black sheeps among us. But at the end of the day ( up to now) ,all of us will be absorbed into the system. There are alot of us who willing to learn, and wish to be guided by senior doctors. Hopefully they will put aside prejudice against us , and guide us to be better doctors. Afterall, it's the rakyat gonna benefit from better health care.

Anonymous said...

actually what's your problem with ukraine/russia graduates.. why do you choose to specify them in your blog? and what were you doing when you saw pak abu was dying? nothing right?

Anonymous said...

I got no complaints, so y bother to know who am I? Just think that if u have so many ideas, y not stand out and make some improvement? If u cant and obviously u know u cant, stop whining and just do what u can to help others. Even if it's 1 person, there's difference...

Anonymous said...

racist, lonely, never had a serious rship, sucks in the field, thinks that having fun is just a waste of time, study a lot, parents were pushy, sad childhood, father never understand, mother too nice, never had appraisal, jealous of rich people, blames others for self insufficiency, thinks self so smart but wonder y nobody ever approve, curse the world every morning, fake smile, hates job, think some ppl r just so dumb, expects ppl to understand feeling, never smile to a waiter or cashier, sum it all up - you are just a plain loser pots

Anonymous said...

first of all, if u think u r better than the russian and ukranian grads, help them, guide them and teach them to be a better doc. it's no help/benefit to anyone criticizing how bad they were. do ur part, go help those who need it and being a prick trying to stab those poor kids. whether u like it or not, more grads from ukr and rus are coming back. as the wise one would say, 'if u can't beat them, join them.'
Hoe u will look into the mirror and ask urself, how much of a help to the country with u writing this blog? help out those poor docs, like giving them tips, and tuition if u r free and wanna help out the country.

msian said...

What you wrote is an outsider's view of russian graduates. Why not read up the insider's point of view. Shocking revelation at http://efenem.wordpress.com/2008/05/22/the-competence-of-graduates-from-russia/

efavirenz said...

"Pot calling a kettle black"

There couldn't be a more apt description to what Anonymous has said.

sojourner said...

POTS for PM? or Health Minister? that would be a miracle...one that we need so badly in our state of disaster...this blog may be just a 'little corner'...but i believe in the theory of 'ripple effect' or 'butterfly effect'...you're creating more awareness in more ppl with your blog than the government will ever achieve, POTS..all the best...

90120 said...

That stupid anonymous!!!!
If it's not because of POTS, nobody will know about the HQE crisis.
If it's not because of POTS, nobody will know about the incompetent Russian/Ukraine grads.
That stupid anonymous!!!!
Don't just sit there konon!
Very stupid!! Never use the brains before saying anything.

People like you (anonymous) are just trying to fork out information in the wrong way. Reveal name konon... Ceh! People like you (anonymous) should just go and die.

Anonymous said...

I'm not saying that what you are wrong...But what you are saying do not imply to every russian student...don't you even have that slightest courtesy to think about the some good ones that are still studying and the effect of people like you on their future reputation.everyone have to learn before they become someone.Thats why there are housemanship programmes so that people will tend to gain information more through the practical method..do you think that the people who created it are stupid enough to just create it for fun after all the student being so intelligent directly after med school???..think first..please don't just talk according to your wrong foolish preset mindset that russian doctors are non qualified which many malaysian have.i personally have seen many malaysian doctors even after finishing houseman and the best part sometimes from malaysian university itself fail to even draw blood...which is supposed to be the first thing to learn...to my personal experience,my grandfather wuz "murdered' by a malaysian educated doctor if i put it in the same way as you did.This dun mean i am supporting the non genuine doctors from russia which i believe to exist..if the adminstration agrees with these facts..please be more then welcomed to create a test on the students..we are pleased to do the test and to prove that we are the genuine students from the same university..remember that it is we malaysians that destroy the university and make use of all the bad oppurtunities such as bribes.........it is not the uni that is spoiled.......a russian medical student......

Seiken said...

To all the readers out there, I dun think POTS did anything wrong. I don't think he has grudges against Russian/Ukrainian graduates. Read all his previous posts about his working experiences for God's sake.

Don't forget the Part I of this post. Already 2 students, one from MMA and one from CSMU telling their stories. Aren't you all convinced? I'm not saying that local graduates are perfect, but as a medical student in a local university, I can tell you that the situation is not as bad as what's happening in Russia.

Also, if all of bothered to read his previous posts, he critised the local graduates as well...even those from the "prestigious UM". I believe that POTS is a competent doctor himself. He couldn't have intervened in every mistakes these ignorant H.Os made.

Last but not least, I think POTS has the rights not to reveal his identity. You should know why. The good old ISA.

Chao.

LP said...

well said Seiken ;)

i also actually found POTS blog entries as major eye opener.
thanks to doctors like him who care enough to blog about it, share with the readers and probably something good will come out if it.. like for example, probably the russian and ukrainian medical students would improve themselves and try to clear up the current stigma. try proving it !

Anonymous said...

To 90120, all the shouting and claiming ppl stupid and etc will not make u sound any smarter than me, right?

Anonymous said...

Applause to comment #8! But don't think POTS a loser, he is just a SADDIST Doctor who once also screwed by his MO and was looking for any chance to do the same to others...

Fenny said...

Dear Anonymous,

You are so not teachable...

By the way, did you read other older posts?

Adam lah! said...

dang i just love your blog.

i was doing my house man stint as pharmacist in tawau and when i got back to selangor there was MAJOR DIFFERENCE.

thank you for putting the words in my mouth cos i myself dont really know what to say about the state of Health Dept in Sabah. its a sad blardy case!

nway, i would like to say 'who has the bloody time teaching HO's in QE'? what were they doing all that time in Ukraine/Russia??! honestly! in a perfect world the MO's would someone 'guide' the HO's but when ur in QE nothing is PERFECT!

seriously, im on this fella side! QE is falling apart and with that it does break staff spirits with all these nonsense of to and fro from 3 diff places (QE/Luyang/Likas).

Gosh i wish someone does somthing about Sabah!

I MISS U SABAH!
:)

Yun said...

Seriously it sounds like you have a grudge on medical students who graduated from Russia and Ukraine.

Seriously it sounds like that all you doing is complaining, but are you contributing to the solution?

Seriously you need anger management classes.

Anonymous said...

Dear all, the matters brought up by POTS should remind us that, we are the product of our uni. Our incompetence and ignorance will bring down our uni. As a future teacher of medicine, i've printed out all the post and laminated it for future readings of my student on day one of lesson. So that, these students of mine will remember that, DON BRING SHAME TO YOUR UNI AND TEACHER........

I Know My ABCs said...

POTS writes in a neutral tone.

I don't think anyone should take his writings negatively. Perhaps he has yet to witness a outstanding Russian medical graduate?

Fresh graduates have little or no experience at all. The old birds are the ones who should be more alert and willing to give extra attention to guide them.

I think that's only fair.

Dr.Big said...

so this looser GA in hospital queen,KK,thinks all russian/ukranian grads are damn terrible,killers etc etc n etc. So what? u know what,... this guy is such a looser n has no life at all i suppose.....nyanyuk like an 80 yr old guy .........such a pathetic looser with damn girly mouth. i am a HO in queen too n i am so called killer russian grad too, happenned to have achieved something that my bosses are proud of me.......its about a young man's life who is 22 only has a wife n kid.......not even the specialist nor any GA(other GA r nice people except for this asshole) could find a molar tooth in this young man's chest x-ray for one bloody week. this patient was a polytrauma patient with le fort 2 fracture,(facio-maxillary tauma),bilateral heamopneumothorax n lung contusion. this pt was kept in ICU for one whole week n had chest tube bilaterally. so on 9th day after admission, post trachestomy and dental surgery day 2.........i was asked by my specialist to remove both the chest tube n i went n remove them, ordered a chest x-ray post chest tube removal.and to my horror,shocked by the surprise, i noticed there is a molar tooth stuck in the bronchus,n it is so obvious n no one noticed since the beginning not even the radiologist...........all have failed!( i reviewed one by one all the dozens of x-rays and discussed with the dental team to verify my findings) pt admitted on 24th n the tooth is at the right bronchus, on 29th march the tooth broken into two, leaving one root behind at the right bronchus n the big part of molar tooth migrated with another root still intact in the left bronchus. So i am asking u back .......why u all failed? lucky this poor guy i happenned to be there n turn out to be his savior n informed my bosses...bronchoscopy done,respi team rushed and.....n according to u how on earth a looser russian grad like me can save this young man's life n not a local grad or UK/India grad like u and my specialst failed to have noticed a well noticeable foreign body(well defined tooth)in simple chest x-rays? i demand an explaination STAT!Not one doctor or two.....multiple teams of doctors and specialists somemore......ENT/dental/surgical/Anaest GA/opthalmo/Respi ALL HAVE FAILED! THIS IS UNACCEPTABLE AND SIMPLY UNBEARABLE! so now shall we include these specialist icluding your own bosses who happens to be non pathetic russian/ukranian grad in your list of killer doctors? now i am challenging you......if u are man enough you may stop all this childish behaviour of yours and act as a responsible and a professional doctor. you think u r so great is it?I know u have many skills but i think u r not at all a professional by all means and not fit to be a doctor.....u know only how to find fault n instead of screwing them why dont you teach them,force them to learn, motivate them,show some respect, become a mentor and by dooing that, do u know u may save alot more life more than u bitching about like a bad girl.........they say if you give a fish to a poor man u will only satisfy his hunger for a day but if u teach him how to fish he will never be hungry forever. and by the way i am not going to apologise to this looser GA for my harsh words because his mind is already fixed and obsessed in finding people's fault and whichever his agenda is.....he has already been targetting russian/ukranian doctors......but for me i am doing great n i know my stuff ...not to a specialist level but to a level what i suppose to know and still learning ......i havent kill anyone yet but i have witnessed many local grad mistakes which leads to patient's death. a lady died bcs one local grad houseman didnt bother to check the casenote,after heamodylysis half way stop because leakage of femoral line bywhich the dialysis people already mentioned clear cut to change the cap........the patient bleed to death...the end......PURE NEGLIGENCE by LOCAL GRAD!!! there are many instances but too bad this looser GA only targets russian/ukrainian grad..........may god blesses this looser with good thinking,and washes away his idiocy,do something good to the doctors community and not further tarnishing it or create hatreship among doctors.

Product of the System said...

Dr. BIG,

So sorry to burst your BIG, BIG ego now but um, LOSER is spelt L-O-S-E-R.

Cheers macha.

Anonymous said...

Dear Dr Big,
Please think twice before you post. You are mentioning very specific details of your patient's care and is totally irresponsible and unprofessional.

Anonymous said...

i think dr big is just letting out his frustration as a young doctor. everybody wants to be a good doctor. underestimating and downgrading ppl won't make anything better. the stigma should stop. better to help, rather than create havoc and propagandas.

to pots, don't throw rocks at others if you have a house made out of glass.

Anonymous said...

To the author, the more i read ur post and ur comments, the less intelligent u seem to me. First impression can be wrong I guess.

God's kid said...

Dear author, you sound almost 100% like my Dr friend/ Christian/ loves to give comments, stubborn at times. But.. very smart and intelligent, knowledgeble, almost always right.

Re: Russian graduates, I have heard many stories about their blunders. But I guess not all of them are as what you've seen, but I do agree some of them are pretty lost and confused. I was told many more Russian Medical Schools have been discreditted.

Well, it's good if you could, by the grace and patience of God, teach and guide the Russian newbies. Afterall, they were trained from a different country, system,and language. They too, had a dream, of becoming a doctor.

Seriously, I would still vote you as PM, if that ever happens, if it'll ever be possible in Malaysia.

Sudhakar said...
This comment has been removed by a blog administrator.