I was darn happy when I finished the 24 hrs calls… I could enjoy a 34 hrs off and I felt so happy by just thinking of the spare times… however, the feeling was spoiled….
I was sitting over the desk when CM came, I stood and walked him toward the trolley and passing over the remaining 4 patients. I had completed most of the chart(meaning I had written the discharge medication). There was one problematic patient – a psychiatric patient who came in last night. He came to our ED 12 hrs ago with forehead bleeding. He claimed that he had fallen from his bike. He had a strange tone, high pitch mixed with low one. I did not bother to chat with him as he seems fine.
But I was wrong, 8 hrs later he was sent into our ED by the 911 rescue team and “2 policemen”. When the police came with the patient – that mean the patient is either a detainee or involved in a crime. I saw the patient and immediately recognized him as the wound look so familiar. I did a quick survey and history taking – the patient claimed that he had drunk some POLITA( loca1 red bull like famous ‘spirit’ booster ) and decided to take a jog and he had mis-stepped his foot onto a drain. He showed me a swollen right foot. After the survey, I walked toward the police and found out that he had gone to the police station along with 100k of cash earlier that day. He claimed that someone had cast a spell on him and he wanted the wired to some BOMOH(malay word for wizard) so that he could be safe . The police had found him laying along the road side moaning for his rt foot injury. He was a little bit irritable, apart from on and off self talking and shouting, he had even kneed down on the floor and started to knock his head over the floor asking for pardon. I ordered a jab of haloperidol and midazolam to calm him down. When we approached him, he had started to struggle claimed that he was so afraid of injection, by this time, police and the EMTs had gone and no one to assist us(just 2 nurses + 1 security and me). To restraining this kinda psychiatric patient, it would take about 7-8 persons to pressed him against the floor and get the injection done. During my service in Klang GH casualty department – the police had brought in a schizophrenia patient who ran amok. It took 3 policemen, 3 MAs, 1 doctor to complete the IM and IV injection. However the midazolam and haloperidol had seem to be an effective regimen which I learnt since my intern days. We were unable to complete the jab and the patient had run over to the betel nut joint opposite our ED. He had called for a cab and left.
15 minutes later, he was sent back to our ED by the rescue 911. Apparently he had hired the cab and headed to the police station. I did not hesitate to ask help from the EMTs but we did not performed all man pressed on patient method – by using violent language, the EMTs had managed to “ask” the patient to co-operate with the treatment. He was sedated and I had a good sleep then as the police promised to get his family later in the morning. I did my usual style of passing over and told them that the patient’s family would be informed later in the morning. I added that if he ever get irritable again, im haldoperidol and iv midazolam could be given. However my “advice” was cut off by CM’s words, “ok, I got it, thank you” before I finished the phrase. I was cursing in my heart as I thought it was my offer to help him. It is very rude to interrupt a Passover in such way. I went back to 175 getting my bag and asked lem if he spoken to CM about the CT issued.
Lem had told me that the radiology department and ED nurses had complaint about CM’s CT request. He had frequently placed 2 CT request in one form. The radiographer would have to do a lot of delete and adding job due to his wrong doing. Nurses had complaint about him and so do the radiographer. Lem told me that they had requested that CM to be informed about his mistake. Lem told me he had informed him in the morning and he had “choke” Lem – “who the hell had told you that ? it is the hospital supt. ?” He was pissed off and walk out.
No wander he was so temperament during the pass over. I was not pleased with the attitude. I thought he was just pouring out his feeling, after all, I had caused him a loss of 40k per month due to my change of shift. But I think more and more conflict in the future would be noted as he is stuck here with 30% less than what he had asked.
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