荒山冷月

被三合一咖啡荼毒許久的味蕾，總算又再喝到新鮮的黑咖啡。多虧明天白天沒診，今天才能放肆地準備熬夜（結果還是被阿母吩咐明天一早一定要去探訪某個親戚的親戚…唉…）


晚上跟家裡通過電話，並沒有反對我跑到離家這麼遠的地方工作。


然而他人一句本是來恭喜的話：「將來你必是這邊的第一人，要提拔一定先選你…」


一句「官哪！」又浮現心底，敲中我一直告誡自己別觸碰的警鈴。

名與地位，讓人又愛又怕。

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好冷啊～～～ >﹏<

明明應該是氣候溫暖的中南部，怎麼會有一個冷到讓人傻眼的地方，這裡既不是山上，也不是北部，怎麼這麼冷啊！？



為了配合大頭們要讓我們增廣見聞的要求，我們全台走透透的畢業旅行實習目前是來到了嘉南平原。四周都是空空曠曠的馬路跟荒地，就這幾棟新建築突兀的平地起高樓。白天能曬到陽光的時候還好，黃昏之後，逼骨的寒意又從地面滲出來，放肆的野風在窗外盤旋呼嘯。


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BBS上很有名的一篇「末期銀蛋症候群」，
作者Dr.Aribuda Wulumoje Chou這位仁兄的唬爛功力實在太強了 m(_ _)m

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Terminal Intern Syndrome(TIS)
==============================================================

This new developed syndrome is defined by Dr.Aribuda Wulumoje Chou in Journal of TIS 2002-April. It was defined as:

(1)general weakness, unliking to move, and hiding in Doctor's reserch room or Duty room, keeping from from ward round and meeting.

(2)bad temper,loss of patient, easy angry, especially when in busy or doing bird thing

(3)elective deafness, hear BB-Call selectively

(4)careless and loss of responsibillity, being easy murmuring



It may be terminal, but never being expired.(except commiting suicide)

And according to it's etiology, it devided to two types: Primary TIS and Secondary TIS.



A.Incidence:

TIS is foud in 70% of Intern doctor population, in some hospital, such as CMCH and KMCH, it may approch to even 85%. female to male ratio being: 1:1.5, relates to Intern Doctor population ration (male to female: 1.5:1). Primarry TIS to Secondary TIS ratio be 0.05-0.07:1.

B.Risk Factor:

1.Being a Intern Docotr:

if your are not an Intern Doctor, congraturation, your are free from TIS

2.Once a bussy Intern Docotr:

a bussy Intern doctor would be 9 times to develope TIS then easy one, but there would be a case report(Journal of TIS ,2001-May, by Dr.Aribuda Wulumoje Chou)recealed that someone may being terminal when he is an easy Intern Doctor (now corrected to be "Primary TIS")

3.Hospital that abuse Intern:

A hospital that abuse Intern would increase incidence rate.

4.Nurse that show no respect to Intern Doctor: Especily in Internal Medicine Dep., a Intern Doctor would loss his name and even his familly name, and just be called:"Intern".

5.Personality problem:

May related to personality of Intern doctor himself or from the out side circumstances.



C.Nature Course:

People being a Intern Doctor can be devied in to three groups:

1.Primary TIS:Who just being terminal when being an Intern Doctor,and may associate with Refusing Being Intern Syndrome(RBIS). An Intern Doctor that being always easy, but become terminal near ending may controbute to this group.

2.Secondary TIS:

Intern Doctor that initially worked hard and studied hard in clinic affair, and as times goes by, progressive general weakness and loss of patient, gradually elective deafness somtimes happened. then developed into terminal stage--TIS.

3.Rare Intern Doctor free from TIS, may due to easy compromised personality.



D.Diagnosis:

1.TIS in the asymtomatic Intern Doctor:

May showed arrised of serum GOT/GPT, and BUN/Cre. due to over-working and no time for hydration and urine voiding. Decrease of serum glocouse due to no times to eat always occured. And may increase of serum anti-Nurse Ag and present of TIS-DNA expression.

2.TIS in syptomic Intern Doctor:

may showed increase of serum glocouse(pc) and normal range of GOT/GPT.

Hyper-antiNurseamia, and TIS-DNA related TIS-protein-Chou may hyper-expression and somtimes cause shock, whitch called Chou's phenomenon and remains mystery for it's reason.



E.Menegement and treatment:

1.Injection of Anti-anti-nurse Ab:

may be response sometimes but recurrent rate would be 85% in 5 days. Now clinicaly used only when acute group transmission.

2.Free of Intern Docter's duty:

Intern Doctors are student and doctor, and when be a student should keep from clinic loading.(ex. forbindden calling when Intern being in meeting)

3.Show basicly respect to Intern Doctor:

An bussy Intern Doctor would be more confored when nurse treat him kindly .

4.Psychologic treatment may be indicated and should use under the recommendation of psychologist.

5.A CD team would be heplful but limitted.



F.Prognosis

1.All TIS are self-limitted, and currable when end of Intern-ship.

2.All Intern Doctore that ever suffered from TIS, would suffered from Terminal Resident Syndrome(TRS) occasionally in their furthure life.



G.Relative syndrome:

(A)Refusing Being Intern Syndrome(RBIS):

Lots of Clerk Doctors suffered RBIS, he posible cause of RBIS may relate to the risk factors of TIS they will meet.

(B)Terminal Resident Syndrome(TRS):

Residents would suffered from TRS due to large loading of clinic affair and paper works.May relate to TIS, and when TIS acute group transmission happening would increase TRS incidence rate.

==============================================================

值班的人要到5/19早上值完班，沒值班的人5/18傍晚下班之後，就算結束這一年的intern生涯，然後住院醫師就開始陷入沒有intern的黑暗期。

其實最後這個月的班雖然還在上，但我早就已經心不在焉，直奔向結業示當天了。

想起去年此時即將面臨intern生涯的忐忑不安，如今再來回想這一年的點點滴滴，當初的自己似乎太過緊張了。

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13:30

 

裝個白開水順便晃到護理站看看

護士妹妹走過來小聲地說：「L醫師，她家屬走了耶...」

我眼睛一亮，「好啊，我們再來試試看，我現在去把她O2拿掉。」 

  

14:00

「妹妹，我來pun gas囉～」
護士妹妹一愕，脫口說出：「你要自己pun喔？」她已經不相信我能pun到了
「O_O  那..那..你是覺得我應該是找幫手來囉...」
她雖然低著頭，但是我也看到她羞怯地輕輕點頭 
 T___T 淚水往肚裡吞，我知道我被拒絕了，我去找『gas強者』來就是了

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在快要結束chest的生涯之前，我還是不會完整地讀CXR，ABG data也也是馬馬虎

收穫最多的，就是pun gas
上禮拜的成功率是耗30 min才勉強pun到1.5cc的血（還不知道是動脈血還是靜脈血）
到現在幾乎百發百中，抽一大管10cc都沒問題

甚至每次摸到正常人的pulse時，也都有拿針戳下去的衝動
尤其是血管淺，跳得又有力的pulse，深深覺得沒抽個一管血實在太可惜了

不幸地，我以為的百分之百是在遇到她以前....

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這個小病人已經快一歲了，但卻長的只有一個月大的樣子

圓圓的頭，圓圓的眼睛，長長的睫毛，不開心時會嘟起來的嘴

細細的手，細細的腳，還沒辦法坐起來，也還不會爬

常常肚子餓，結果一哭鬧起來血氧濃度就掉到八十幾。

照顧他快一個星期了

現在看到我已經會向我伸手要抱抱

 

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雖然在ICU可以準時上下班，雖然在NS ICU時好像天天都輕鬆愉快的像在放假

但是現在換到GS ICU之後，整個心情就不一樣了....唉...

大概GS病人本來就比較多狀況，事情也比較多，心情就跟著差了

好像監獄一樣的ICU，把病人綁在床上，即使cons clear也一樣被約束著

除了打針換藥拍痰會客才有人進去跟他說說話

大多數的時間，病人只能自己跟病痛相處

即使有人去跟病人說話，也都是講的人顧著自己講，

因為病人身上有endo, oral airway, NG.....一堆管線，他也無法說話，

無法向家人或醫護人員訴說自己哪裡痛苦，只能皺眉流著眼淚

 

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雖然今天值班比較忙，推了好幾床CT、OR

不過ICU的班過了下午五點之後還是只剩NS要去IV push

意外的是，半夜burn center說有一床expire，所以call我進去

我：......expire..那call我去幹嘛？

Nurse：ㄜ...是學長姊要你進來....

不會吧....我可沒對病人做什麼喔....(該不會正好是今天換藥的那床吧)

...還是因為我沒對病人作什麼所以被叫進去？

正好我在NS ICU剛IVpush完，直接晃過去，小姐還被我的迅速出現嚇到

看到學長人影晃進去的那一間...還真的是今天幫忙扶endo那個阿龍expire了...

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實習的生活，已經邁入第八天

遇到不必值班的晚上就好開心，彷彿是與久違的幸福重逢

用力推開積滿塵土的窗戶，掛在窗邊的風鈴就跟著輕輕搖了起來

視線前方都是低矮的房子，所以我可以享有一大片天空

正前方的上弦月劃破黑中帶紅的天幕，掙出一道銳細的光亮，聯想起開刀房的縫針...

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