Glory in Hell~

Ahh, so we meet again! Let me see where I last left. Oh yes, it was in the month of April 2012 when I thought the worst was over as a major part of my attachment in the In-Patient Department (IPD) was completed. I've gotta admit that I disliked IPD very much compared to the Out-Patient Department (OPD). Though I hate the Aseptic Unit more than IPD, I still cannot come to terms to be in love with IPD.

When I last wrote in this familiar site, I just went into the Galenical Unit. Life in Galenical was serene but at times, boring. It was as if I was baking cakes, bancuh-ing syrups and coloured drinks, and packing icings. Nonetheless, it was definitely a place to relax and to have a break from the idiotic IPD lifestyle. Wait, what's happening in Galenical? Oh my, new family members. They're so cute!!

However, time in Galenical was short. More terrifying units awaited me. Come end of April, it was scheduled that I should be in the Drug Information Service (DIS) Unit. Initially it was a little tough to get through as the Unit Head was stern and at times came with fiery anger. Rarely had people ever escaped her web of rage. Even I got entangled in her web despite trying my best to evade. Atrocious it seemed she might had been, but it came with balance. She was one of the best Leaders around that is worthy of genuine respect. Her works were excellent, incomparable, and I guess it is safe to say that they were second to none; and if I were wrong, then at par with others.

Initially it was tough for me to go through DIS, but as the days went by, I began to learn how things were and should be. I came to understand her better too. She believed in good management and self-discipline. She was one of the bosses that would actually allow her subordinates to take leave or time off NO MATTER HOW BUSY the unit may be if the applicant has an ACCEPTABLE reason (acceptable, not necessarily be good or desperate). Hence, with her excellent management skills, the outcome of her works or the unit's works were always good if not, better.

In DIS, the amount of knowledge I gained about drugs was the most compared to other units. Other units were just focused on perfection of work, less of education and knowledge. Oh well, more preparation for me to face Clinical I suppose. One of the best thing I felt being in this unit is appreciation and understanding. Unlike leaders from other units, no matter how much you've done, no appreciation came from them; some gave you more problems. I was quite happy with what I did for this unit, even though my output wasn't at its best - i.e. re-organising the drug catalogue, assisting in the preparation of MERS talk, and compiling/editing the pharmacy bulletin. A little self credit I should have for myself maybe (OMG, I'm so into self-indulgence suddenly xD) since this bulletin was the first to be sent out to other hospitals after some time (perhaps, a year maybe?).

After a month in the much feared DIS unit, came one of the most terrifying unit of all - TDM!! Therapeutic Drug Monitoring, or Clinical Pharmacokinetics. I had to admit that I suck in TDM during my Uni years. Who would had known that I would fall in love with Clinical Pharmacokinetics when I'm actually practicing it. I did not have exposure to all drugs but at least I'd experienced one of the least common cases in my hospital - phenytoin, valproate, theophylline, aminophylline, and digoxin; all together in one concise case. During my time, there was not much of vancomycin cases, so I was stronger in aminoglycosides instead. But attachment in this unit was fun, especially when you get a fun partner. With her, my secret life is revealed.

Clinical Pharmacokinetics wasn't smooth all the time. Ajaran sesats are always around and idiots always come with them. Once there was a house officer who showed zer0 respect for us. Mother eff!! Everybody makes mistakes, so please, we never disrespect you, for what reason should you look down on us? Another idiot is a traitor of our own kind. Well, she must be better than everyone else. In this context, she is always correct, even though she is wrong, she is still correct.

Sometimes it is very sick to get trapped between two Sesaters. Alright, I may not be as experienced nor talented as any of you out there but at least I did my homework. I called up a few other hospitals to get datas on aminoglycoside monitoring. I am aware that different indications had different target levels. There was once an evil day when my rival gave me a gentamicin initiation case for infective endocarditis. I wasn't happy about what my rival did to me but I had to do it since at that time, it was my teammate's first day, and she wasn't accustomed to the calculations.

The case was from a medical ward, and I was told by my rival that the clinical pharmacist estimated that the dose of gentamicin for this patient should be 160 mg BD. Of course, I called up the ward to ask for the patient's body weight, and it was only 46 kg. For infective endocarditis, the peak level for gentamicin in synergism with C-pen, should be between 3 to 5 μg/ml, and it should be a TDS dosing. Using the patient's body weight, no matter how I adjusted, I couldn't get 160 mg BD, not even targeting 10 μg/ml could I get it. From the clinical pharmacist's recommended dosing, I realise that she wanted a BD dosing for convenience and accuracy of gentamicin administration, but I had no idea why would she target 10 μg/ml. Nevertheless, I adjusted the dose to 100 mg BD. When I got back to my rival, I told him that I suggested 100 mg BD. My rival playfully hit me on my tummy and mocked me whether I had already discussed with the clinical pharmacist or not. I got angry and shouted at my rival and stormed to see the clinical pharmacist in charge of that ward.

"I've done the calculations, and I found that 100 mg BD is enough," I told the clinical pharmacist.

"Why 100 mg BD?" she asked in return.

"Then why 160?" I asked back.

"Why 100?" she challenged.

"I based it on the patient's body weight, and his weight is only 46 kg," I replied.

"He's a full-grown man, how can he be 46?" she snapped with a frown upon her face, then she took me to the central screening counter, asking a guy. "How heavy are you?"

"65," replied the guy.

"How heavy are you?" she turned the question to me.

"63," I replied.

"I am 55," said a pregnant lady out of thin air, and everyone laughed, making a fool out of me.

"See," said the clinical pharmacist with pride in her eyes, implying that she I was proved wrong.

"So, you want it to be 160 mg BD is it?" I asked her.

"I don't know ah, I didn't suggest anything ah," was the reply I get from her along with her innocent fake Hello Kitty imitated face.

I could only go back to my counter and recalculate everything using her 60 kg estimation to get around 160 mg BD, targeting 10 μg/ml which is double the recommended peak level. 160 mg BD it was that I suggested to the doctor. Then the phone rang, and it was from that witch.

"Yeah, I took the patient to weight, and he's really 46 only," she said as if nothing happened.

SWEAT!! What was worse, when the TDM pharmacist queried us why he was given such a high dose, guess what that witch said?

"No offense ah," the witch looked at me before continuing, facing the TDM pharmacist. "HE overestimated the patient's body weight... .. ..."

I was like, what the fish!! You were the one who overestimated the patient's weight and now you wanna throw all the blame to me? I kept quiet only because I'm a houseman, you're my senior, and I'm your mentee. I respected you all these while even though you're younger than I am, and this was how you treated me?!!


♪ So what happens now? Where am I going to? ♫