MHON

I very out of touch, so if I name can't remember, pls dun f3 me. Xxlll


Nice pale coloured spathulata dendrobium


I love this nice shade of pink. most of the time see more fuchsian or purple. This one is light and just right. Apparently it's the papa of the next plant of which LMH is very proud of.



Arrangement orderly and shape round round and full.


Some green dendrobe which PP said that the shade of green is nice

Bellina:








Phalaenopsis amboinensis var. flava




Some Vanda coerulea f. Burma hybrid

The blue colour very subtle with loss of tessellations

Dunno what:


Another Vanda hybrid

Very hard to control the purple tone on digital film - came out very flashy

Amesiella monticola:

Dun have yellow throat like A. philippinensis

Phalaenopsis Dunman High:


Dunno what novelty phal hybrids




Curcuma dunno what which some of the people went gah gah over



Nice shade of orange though

Doritis pulcherrima var chumponensis (last time known as var. chamberlianum)




Bought cuttings of these:




A lot of the bunch have colours that would have failed judging but I like their flowering habits - like dry hot and sunny.

Big big flowers of a Trichoglottis brachiata hybrid. But sadly no smell =/




Nice 2 tone dendrobe hybrid:


Some Paravanda hybrids:








Likely a cross from Paraphalaenopsis laycockii var. alba

My first break in ages

No graduation vacation so dun KP me hor. My current rotation boss so nice to let me take 1/2 a day leave. Pre-reg so poor thing - all Sat have to work or go so ulu hospital for training. Not like HOs so good can go for HO teaching during office hours =(.

My regular Sat schedule is either stay until late late after work in DDMS, squatting thru' case notes or I go training then u-turn back to hospital to squat over case notes - what to do? : I'm known to have this pageant for tedious stuff.

So today met up with AG, Li^2, MMS, PP, Joshy, etc to sapu plants.

Too bad milo field not open so cannot go sapu more antelopes.

The regular species snob decide to sapu so Dendrobe hybrids to plaster on wall. Not so much appreciated for their spindly flowers but I like them. Concentrated colour and nice gek huay smell.

Bought 2 sets of Dendrobium Enobi Purple "Splash" for a PT and our admin officer - 2 diff strains - one from Thailand and one from Taiwan. Let them fight it out =p I personally preferred the more subtle Taiwanese strain.

Spend spend spend and bought a stand by spray bottle and in the end have to IOU Joshy when we went for makan @ Penang Place. I think I either full of water (today verli hot) or I'm out of my youth - cannot eat a lot leh.... Also did not buy their nice chunky coconutty kaya, but neber mind, next time can also buy.

Yeah !!! Got space liaoz

No space? Throw the dead plants away - no need to keep souvenir. Can't resurrect most of the time. Also do not recycle the mounts - it's like recycling needles - euuuu so unhygienic

Back track: Joshy's Mooncake

Big big one = the really really shiok rose infused mooncake with red bean paste. Not so sweet sooooo nice

White small one = wine soaked raisin filling

Red small one = with macadamia nut filling

Pack of tea = steely appreciation of music (last time I tot was iron goddess of mercy =/)

Price = 2 near blooming size Paph seedlings grown from flask by yours truly =)

Wah!!! Winning translation

This happened way back in OP:

Mother given Vagifem(TM) to strengthen the uterine area to decrease incontinence. Mother only speaks Hokkien and the accompanying son knows Hokkien and English. The filial son offers to translate.
.....
Me: This is Vagifem. Place one tablet into the vagina everyday.....
Son: tak meh jik liap bang c%^& b#$%
.....

I can only !!!! in my head. But the more polite way of saying vagina in Hokkien is ying ting - corresponding to the Mandarin ying dao.

Wah!!! Can get heat stroke ah!!!

Today got miracle - our always full wards suddenly emptied! Not for cleaning but just emptied - likely due to PSLE

Seriously, guys like me who have to wear the thick thick long sleeved jacket with a long sleeve shirt with tie are at serious risk of having heat stroke in the non air-con wards. Pls Pls let me wear short sleeve w/o tie like the loo-goons and perhaps just give me a coloured tag to mark me as pharmacist instead. Can can can? The jacket exudes professional image but then I risk being coded.

I think after encountering something, I'll make an initiative to nag at docs and nurses when Is tart my ward checks - PLEASE INCLUDE THE CORRECT DOSAGE FORM IN THE IMR!!! Some patient used miconazole powder - IMR oni wrote 2% miconazole. Patient used 2% powder in the ward, doc transcribed as 2% cream and I'm just lucky they never used 2% oral gel on the privates! It's for both the patient and the doc's benefit as it avoids embarassing events.

My dosing still not up to par. Today kena wacked 2 questions that i've not encountered yet during my OP stint - neonatal procedural prophylaxis (I apologise because I can't understand the Dx wrt Indian accent), had to pass over to my senior pharmacist who have chatted with the doc b4, afterall ICU was her war ground, Usu I get malathion scripts for scabies but some patient got permethrin - neber used before this marigold extract on human beings!!! So luckily SP came to my rescue - apparently, the protocol for use is like that of Malathion.

Need to read read read read read read read read and memorise...

The T1/2 of Chocolate seems to be very very the long

Until now still feeling very maniac...

Must be the massive OD of chocolate fondue which I made for the dept for our mid autumn fest. Steamboat with herbal soup stock which had to be ended halfway because we ran out of fuel. But still got chocolate fondue anyway.

How to make? Dun tell euuu but I can make for euuu.

One of the MOs as how come we so good got chocolate fondue one? "Because I decided not to do medicine?" *run and hide before a COW or a metal thing attached to a "Y" shaped tubing flies towards me.

Too bad the OP TKN no chance to eat the ripe red strawberries she bought for the fondue. Always so self sacrificing - admirable.

Luckily got work a few hours of OT so I can erhm... buy chocolate for fondue?

One PT tried to do something similiar ended up with crusty chocolate >.<. Had to present a paper - Panax ginseng - a Place in Cancer therapy at 8am so had to leave house at 0630hr - very grumpy very grumpy. Day was not made better with a lot of change orders in D/C medication. Wanna bang wall. The HOs comphrening that need to reprint or type eRx. Boh pianz, need original to do drug counselling and give meds.

Yyy some MOs dunno how to smile one?! Chewren ward lehz. But you'll realise soemthing - when you laugh or smile, people laugh or smile with you. But of course dun goondu and do it during a code, TOD or during a funeral - straight off to IMH.

OMG met my first brat on9 after a nong nong hiatus

Oo

Saw her again when I went upstairs. She also went up for her rotation about the same time as me. She said hi, I said hi. I said bye, she said bye. Too many people around =(

My preceptor decided to toss me to do bedside counselling oreadi. Did a few on Friday courtesy of my ICU pharmacist. Luckily my OP training quite thorough - action packed counselling. I was reputated to be a zhao cai mao. Every where I go seem to get flood. Now at upstairs my preceptor pointed out, " So it's you ar?! The other day I MC but my phone ringing non-stop that there's not enough beds!"

May be I should have worked for a big chain pharmacy instead? But then what for? Pay still the same.

I wan more pay:

Why pharmacists resign

TodayOnline Sep 21, 2007

Better work conditions, pay may help stem high turnover rate of these professionals

I refer to the report, "MOH to recruit more pharmacists from overseas" (Sept 17). It was reported that of the 1,482 pharmacists on the register here, less than half are involved in direct patient care, such as practising in hospitals, polyclinics and retail pharmacies.

This is a worrying figure. While I applaud the ministry's efforts to recruit more pharmacists from overseas, it should also delve further into why pharmacists are not practising and find ways to stem the drain.

I know a pharmacist who has worked in a retail pharmacy and in one of the restructured hospitals. During her stint with the retail pharmacy, she worked from 10am to 10pm, with only half an hour's break for lunch and dinner. This included Saturdays and Sundays, when business is most brisk. Most times, she was the only pharmacist during that 12-hour stretch. When she was working at a hospital, it was common to see her and her colleagues having lunch at 3pm, after they attended to the last patient from the morning crowd. At times, she was called back to the hospital even though she was on leave. She worked till 3pm on Saturdays, even though the official knock-off time was 12.30pm. Sundays could become working days when duty called — working one Sunday per month is common.

Such is the life of a pharmacist, be it in hospitals, retail pharmacies or polyclinics.
Increasing demands on pharmacists without adequate compensation leads to many leaving the profession.

Perhaps it is time to review pharmacists' salaries. They are, after all, highly-trained medical professionals who run specialised clinics and make rounds with the doctors to ensure patients fully benefit from treatment.

Until we address the concerns of pharmacists and plug the outflow, increasing the number of pharmacists will not ease the crunch. Sourcing from foreign supply is but a short-term solution to a long-term problem.
-------------------------------------
Letter from Darren Chong

Link: http://www.pss.org.sg/main/content/view/558/2/

I was told now that's now a drought at OP because one of my fellow pre-reg is a DCG. If not, every Wed can collect at least 20 interventions liaoz.

I missed the big space for dispensing in OP - got dispensing bench for you. But now upstairs no space to display your wares. Totally messed up my routine - my asthma counselling very the messy liaoz. So more got TV distracting in the A class wards @@ Just 2 weeks no dispensing can be come ga-bra verli the fast.

<3 all the "P" prescribing licence holders who call to check dosing before prescribing. Lidat better for everyone. Dun shy, I wun eat you or scold you one. Afterall, that's what pharmacists are for - rational drug therapy.

Need toilet

For women who compren not enuf toilets in their workplace, come to my workplace. I feel very deprive with the need for me to control my bladder, running to the different floors to look for a vacant cubicle to let go. If I were on diuretics then gone case.

Still very gong tou with my administrative roles in the upper floors as there's not much of those below.

Met some nice nurses and doctors but some just wanna AHHHHHHHHHHHHHHHH

So missies, misters and loo-goons which cat do you belong to?

Wah liao eh

A few days no do drug counselling already seeing oneself off the mark liaoz.

I need practice if not I'll start muttering jibberish in front of the patient.

My new rotation seems very interesting. Interventions largely done by the pharmacists while the PTs do nearly totally technical work. Very often they prefer to leave the higher level work for the pharmacist. Checking of doses are more controlled and stricter. A lot of HOs prescribing @@@@@@@ and can be a headache at times when they are too yaya until we have to call the MO or the registrar or the consultant. They need a gentle notice that they do not do pharmacotherapy in skool not like the pharmacists. A lot of delays.

Not so fast paced but very intensive. <3 the sign that one of the senior pharmacist placed on the dispensing window:

"90% of medication errors are due to interruptions"

More peace to do our clinical work and less interruptions and other nonsense.

I really feel sorry for the Missy and Mister students who have to act as kah kia for the RNs - have to run up and down to the pharmacy to collect meds - my advice to them, bring a note pad just in case got some things you need to convey or you need to remember bed number =/

Met a nurse who likes to feed me alhabet soup and one super kang jiong MO who did something really unprofessional - he used his consultant's name to press our pharmacist down. That consultant is caring and nice - way to go to bring down the consultant's reputation. I really recommend that MO to have a sit in with the pharmacists so as to understand what we are going through and our workflow. Never gave us proper notice in therapeutic changes then start nagging away. Quit watching too much House - we are not pushovers - we are crossovers.

Badly need company for dinner on Sat. If not I'll face the four concrete walls of DDMS again. YYY they all on call or fasting @@

I spared a mother further sleepless nights

One mother came in to see specialist. Her child also took medicine from a GP. Came to my bench and I went thru her child's current meds and asked if the child is taking any other meds.

She was wise enough to draw a list. I went through with her the drugs and which not to take together. Saw triprolidine plus pseudoephedrine (Actifed). Pointed to her that when child takes this, child may not go to sleep easily.

She looked at me, then look at the child then gave a face and said ,"Doctor never told me."

Then told her to give it to child 3-4 hours before bed time.

Adventures in Coamoxiclavunate and Amoxicillin

Scene 1:
Doctor came in to fill own prescription due to an Infection. MO currently in paed round.

Dosed self with a very high (1250mg BD x 7/7) regime for Augmentin. My PT recommended to go down to the regular adult 625mg BD

Script sent in for typing and packing. I got to dispense it. Then the doc pulled out Frank Shann then point to dosing .... That's the problem with paed MOs trying to dose themselves - they forgot that they are adults and there's a different dosing regime. If doc gets 1250mg BD, I congratulate doc for making doc's potty doc's second home for at least 7/7

Scene 2:
Patient came in with prescription.
Can't see the weight clearly and called the patient. Thought 7.3 kg, turned out to be 73kg (for a 9 yo!!!)
Doc wrote Augmentin 500 mg TDS 14/14. Thought he must have confused with amoxi and augmentin. So called up and ask whether want to change to adult dosing for augmentin - 625mg BD. He gives ok.
Patient called. "Hi, got any drug allergy?" "Amoxicillin" @@
Called doctor, "Hi did the patient tell you he's allergic to amoxicillin?" "He neber tell. So what's the matter? "He's allergic to amoxicillin and you prescribed augmentin." "Augmentin corect loh" @@
Later changed to clarithromycin 500mg BD

Scene 3:
Doc wrote script for self. I got to dispense. I saw Amoxicillin 500mg TDS 10/7. Got worried because of compliance issues and doc doesn't look so bad. I asked doc whether wan to continue with such a long course - doc shoots back "I will keep the rest of the meds when I feel better. I AM A DOCTOR!!!" But I think this doc doesn't behave like one - problems with sitting in clouds tsk tsk. But then got meet one super nice doc, only thing is that doc not ready *sad sad*

First day with PS

The paperwork siao4 one?! No wonder the people at purchasing so stressed up at times

I already missed dispensing to patients face to face

Tried to make microwave cake today - semi sucessful. If not made properly, may turn out to be chocolate kueh

1 cup chocolate unsweetened 70%
1 cup milk
1/2 cup sugar
3 eggs
vanilla
1/2 cup cooking oil
1 cup SR flour

Today last day to burn paper - tomorrow surely CEP flooded with chewren who kena nebbed.

head tilted down

Just feel so down down down

I know got a few peeps comprening I neber update this space for some time already. Was disappointed with myself, very disappointed with myself these past weeks for a bug boo boo that I made.

Unlike some other place of practice, even the OP setting is like intensive care - things can go wrong due to teeny weeny mistakes. It's life and death situations like they call it. One mistake and you wished that you were strangled at birth and do not wish to see the light of day. It can be that bad. I want to be the best there can be and any spot I trip over really is a very painful fall. But then like our chief pharmacist of Singapore had said, "Competence before confidence"

Reminder to self and to everyone else:

Chewren onco and prevalence of diseases are very different from the adult meds that we were taught in skool:

Dexamethasone + ranitidine used as lymphocyticide in ALL c.f. most adult onco use for N/V purposes.

Very disappointed in self.

Saw one person whom I liked, even though saw oni twice. Check if attached, the person was set to go, but then for some reason, dinner was turned down. Boh pianz, at this timing, I also cannot commit - but then I find that person ideal for me, but can I reciprocate?

Lidat, got more excuse to squat in DDMS to go thru' case notes - never knew a 40 DAY old kid can have 7 volumes to go thru'.... YYY pharmacist dun have time allocated like the loooh goons to do research one - the irony of having better research backgrounds but not being able to practice it.

Last day at OP today. Next week start at PS, then CIP with the viva in between. Can believe my OP ic soooo evil - give one tablet/ capsule and have to ID. @@

I think recently got a lot of changes in MOs ? HOs as I had to call new numbers to do interventions. Some got confuse over chewren and adult doses until they wan to dose themselves like big chewren @@ overdose liaoz. Should I call one or 2 of the time to hang out ? May be not. WE are all too busy.

I like peds because of the challenge of handling the chewren of today but then hor, the auntiez easy to talk to. Poly pharmacy can be prevalent in our setting as our patients visit use as the last resort after seeing a chain of private GPs or other centres such as NHC before having their gyane problems inspected her. Verli the scary. I really appreciate the patients who lug the drugs to my bench to let me go through to check for duplicates.

sia suay

Today sat in Endocrine clinic. Studiously prepared for it the night before. Thyroidal disorders, growth disorders, glucose metabolism, blah blah blah

First patient = one rare but increasingly common case of ricketts. Neber studied (last studied in yr 2 Physiology), knowledge in vit D metabolism all SK2. So dunno how to answer about the various forms of vit D - got at least 4....

*shakes head*

I am pathetic

I am hopeless at personal relationships but more firm with my work. I have courage when dealing with adversity in work - difficult patients, drug orders and faulty scripts- but I dun even dare to ask a lady whether she's attached or not.

The concession is that I've only met her twice. Not bad in appearance and vocal presentation. Personality mroe to dig into. I've been asking about her with a classmate who distantly knows her but apparently my dear doctor friends in my hospitals dun quite like to reply SMS or phone calls. Skarly, one of them whom I called is her stead @@ - that's why dun wan reply.

Just got a reply from one of my pharmacy lecturers stationed abroad. Apparently, pharmacists have a very active role in specialty practices - they sit in with consultants. The other lecturer (the bak chor mee lurvin' one) boh reply.... skarly in junkmail @@

Over here, those sitting with consultants are usu those on attachments @@ - not powerful enough. I did enjoy my sit in - I feel that we have an active role to play. Most of the doctors just tell the patients that medications will be given and prescription given and just lidat. Occasional brief med usage instructions given. Patients may appear blur blur with such abrupt stuff.

Pharmacists are there to ensure compliance and rational drug usage. We have to ensure that medications are used appropriately and when required together with doctor's monitoring. And there's no point giving patients something that does not work or some drug that is rendered harmful or useless by the patients own cocktail of daily chronic drugs.

This week

Verli busy and tired, got a few headaches here and there. Photophobia, need ice pack on cheek for sinusitis.

Got another clinic round with our HRT clinical prof together with a dermatologist. One patient got bonus pharmacist-in-training and dermatologist with her HRT visit.

Never knew women can put on weight once they are off HRT. Saw some bone benefits with early intervention in women in perimenopause. Also saw some cases where patients trust the newspaper reports more than the doctor.

Next monday will be sitting for a UG clinic with the "Just let it come out and give it a name" doctor. Hope it would fun - was told that he rather frank with patients and enjoys potong potong.

Perhaps if possible, I can also pop in for the a round of pediatric endocrinology - now dunno which doc yet - may be the MP (lidat must seal my political thoughts).

After this week can wake up a little later as I start my emergency pharmacy rounds for one week hengz.

Yyyy I still having so many patients during 7th month?! My throat wanna die liaoz. Then one PT tell me that the latter half of 7th month more suay so they come first.

Got a few polypharmacy cases picked out last week - even within the hospital (patient seeing a couple of docs at one shot). Another one with very high BP wan go for AHM w/o telling doctor - nearly went on my knees to tell her to rest first. Got a few cases of underdose with MDI picked out as well. But then hor, it takes a long time to get patients to reveal these nonsense in order for me to dose them and counsel them correctly. My TKN will kill me for waiting time soon. So how now? Fast brief service or slightly more time consuming but more complete service?

Sometimes dun like docs interupting my counselling with another patient and telling me "I know how to take my medicine, just give it to me" machiam I bang open your door and say "I know what's wrong with me, just give me my prescription."

Went out with my Maple khakis to Ichiban Sushi @PS for makan on Friday night - realised the standard now dropping - very fast. Perhaps it's time to switch to another restaurant. Soo many people going NIE to find job - the market seems baaaad.

I really hope the other ministers could be like our CJ - increase the pay of the professionals to make them stay and practise correctly. Everytime my pharmacy admin see the falling numbers of pharmacists, she shakes her head and sigh.

<3 doc who listens to pharmacist for drug therapy. I think all the docs should concentrate on diagnosis - get the diagnosis right rather than rack brain to think of appropriate drug therapy for wrong diagnosis - let me handle the pharmacotherapy.

This month the AJOS people have a bumper crop of flowers -http://www.orchid.or.jp/orchid/people/walke/AJOS2007-08.html - verli swee.

My bathiorum

Verli led led

What the Missies got for Missy's Day

Now the wards and the SOC counters semi-plagued with AVs