Monday, May 10, 2010


I am down with URTI again (upper respiratory track infection).

My ward had H1N1 and H3N2 flu cases for the past week. I wore a surgical mask at work most of the time for the past 2 weeks. Mainly out of fear of sneezing, coughing or dripping fluids from my running nose in front of the patients and spreading my pathogens to them. Afterall, the surgical mask does not provide adequate protection to the wearer from airborne pathogens. No one in my ward wears the N95 mask since the H1N1 flu was downgraded in severity. The only exception that I have seen recently was a respiratory specialist consultant while attending to her adult patient at my ward. [Note: Doctor JY also happened to be my attending consultant for my pneumonia episode.]

Back to my symptoms. Had been having running and congested nose on-and-off for the pass 2 weeks. Appetite is less, but still Fair. However, from Thursday onwards, the symptoms took a turn for the worse. I had an acute sharp pain at my chest where I had a history of minor atelectasis. Onset of cough which became more chesty over the days. Mucus and phelgm turned yellowish and of mucoid consistency which is worse in the morning. [Note: Not uncommon, given my history of asthma.] Thankfully, SpO2 is within normal range. Significant drop in appetite. I only manage to take 1/2 share of 1 main meal each day. Thus, I supplement my intake with snacks, juices, electrolyte drinks and nutritional supplements.

Finally, this morning, my sleep was interrupted at 3+am due to nasal congestion and a painful, itchy and scratchy swollen larynx (i.e. sore throat). The throat was so bad that I could barely take some fluids for breakfast. I couldn't get back to sleep, so I did my laundry and other chores instead. Then around 7am, my tired out body finally rested for 3 hours. I woke up to run some errands before I went to my hospital's A&E.
My hospital's HR is more willing to accept MCs (medical certificate for excuse from duty) from its Medical Officers. Up to 3 days of MCs from GPs (general practitioners) are accepted by HR. Thereafter staff are required to consult with the hospital's A&E MOs for an extension of MC.

Although the A&E was not particularly crowded (maybe around 20 patients), the combination of my low-severity and my arrival at 1+pm led to a long waiting time. According to the agency nurse at triage, the A&E staff held-up the cases from 1pm onwards until the agency nurse started her shift at 2pm. Thus, my hospital visit took 3+hours. I requested for Doctor Y, one of the Medical Officers on-duty, since he is somewhat familiar with my medical history. [Note: He happened to be the attending MO when I had pneumonia, and was also my pre-Employment check-up doctor.] Besides auscultation and the visual throat assessment, his check with the otoscope reviewed that my ears are also partially blocked by mucus. He asked how many days of MC I needed. Ha ha, typical of the service-oriented doctors in the private sector! Anyway, I requested for 1 day of rest for tomorrow, since it's my day-off today. If needs be, I could always return to the A&E for a review.
My ward manager had mentioned previously that, due to an increase in staff MCs for respiratory infections during the past months, the DON had requested the admin staff of every ward to report all respiratory MCs directly to her. Guess I'm on the list now! The increase in respiratory cases amongst staff does not surprise me given that ADON G discouraged staff to wear masks at work, other than for Isolation cases. She claims that the it muffles the enunciation and blocks-off the lower facial visual communication. Now her direct report, the DON, has to personally track staff's respiratory MCs. What a farce!

I wore an N95 mask from my entry into the A&E until I returned home. I was offered a surgical mask at the A&E entrance, but I wore my own N95 saved from a previous training session instead.
Yes, I know that the N95 and other masks are supposed to be single-use only. But to save costs for the hospital, the Infection Control Officer instructed us to save the "clean" N95 masks for a future use.

On my way home, few people noticed that I was wearing a mask. And even if they did, they turned their gaze away quickly. Most are absorbed in their own worlds. I wondered what makes Singaporeans, myself included, reluctant to wear masks in public whenever they have coughs/colds? A lack of awareness on the purpose and usage of a mask perhaps?
E.g. While I was at the A&E Isolation Room, a family -- consisting of grandma, mom, daughter and son -- arrived after me. They were there because the boy was coughing for a week without improvement after several visits to their GP (general practitioner). Initially all 4 of them wore surgical masks. When I informed the grandma that she was wearing the surgical mask upside-down, she cheerily disregarded the information saying that she's not the one who is sick. Subsequently, while waiting to collect the medication in the general A&E area, all of them took off their surgical masks. The grandma even chased her coughing grandson out of the Isolation Room to join his sister and mother in the general A&E area. Sigh! Infection control failed.

Sunday, May 02, 2010

New rooms opened

The inevitable has arrived. The new rooms at my ward were opened 2 days ago. There was a demand for single rooms and an upsurge in admissions. Thus the management gave the go-ahead to open the new rooms for use.

It was a whirlwind morning -- a mayhem of room transfers, discharges and admissions. I lost count of the actual numbers, but I think it was 7, 6, and 5 respectively for the ward, of which majority affected my side of the ward. Lucky for me, I was the runner, SN L was the staff nurse handling medications for the team. The other team's runner Senior HCA M and the admin staff assisted with some of the room transfers. Also fortunately, SN O was the other team leader (i.e. SN in-charge of medications) and SSN Y was the overall in-charge, thus everyone remained professional (but brisk) even though we were flooded by the workload.


The patients and families who got the new rooms were initially very happy. The new rooms had Disney cartoon wall murals, brand new furnishing and were better equipped. However, it became apparent by early afternoon that the toilets' plumbing were choked.
The admin staff confided in us at the staff room, "Apparently all the new rooms on the other floors also have the same problem. That's why the [note: plumbing dept] staff is under tremendous stress to fix it."

I asked, "Are we the first to open the new rooms?"

She replied, "No, we are the last."

I asked further, "So all the other floors had choked toilets when they were opened, and management is aware that the problem is not fixed [yet]?"

She nodded.

I asked rhetorically, "Why then did management approve of opening our [floor's] new rooms when they know that it will cause more problems? Now, if we need to find rooms to temporary 'park' the patients while the problem get fixed, we cannot, because the hospital is full!"

The admin staff gave an exasperated smile.

Near the end of my shift, the admin staff informed me that I had "lots of double shift next week" due to a shortage of staff. [Note: SEN L is officially transferred to another department and SN RB was scheduled to clear her annual leave next week.] I simply told the admin staff that I will not accept any double shift assignment because the stress of taking the additional workload [note: 14 patients per SN] is not worth the additional shift allowance.
The admin staff said worriedly, "Then we will have to call in agency nurses."

I replied, "So be it. Management have to be aware of our staffing shortage. If we continue to pick up the slack [Note: i.e. cover the shortage of staff by doing double shifts], management will simply assume that we have enough staffing and refuse to hire more as [i.e. which] is the situation now."
Apparently, SN L, SN RB and I were the last few trained staff still willing to do some double shifts. All the other trained staff [Note: ENs and SNs] vehemently refused to take on any additional workload.