what is the good ?

It was a busy night and there was a long list of pending being seen was noted on my computer. A man in uniform was rushed into the ED by EMT from local mountain area.

A police man in his 50s was crying loudly for help. The patient was hysteric screaming about backache. He was like a child who cannot reasonable his parent refusal for his wishes. Patient was paraplegia and his lower limbs was flaccid and movable. Back pain with paraplegia had limited our differential diagnosis. I had called an immediate CT scan with enhancement without waiting for the renal function test.

A lax anal tone was noted after Foley catheter insertion and confirmed my suspicious of spinal cord involvement.

Worst of all, he was bradycardic and complete AV block was noted.

The CT revealed a type B aortic dissection and nothing could be done here.

Patient was intubated and ventilated with fluid support via central line and inotropic agent for the crushing BP that noted after the CT scan. A temporary pacing was done for the bradycardia. Apparently the dissection had involved artery supply to his heart and spine.

It took me a whole hour preparing him for the transferred. The ambulance arrived minutes after his wife came with his colleague. His condition had improved with his limbs moving and he was more conscious with all the life support effort we provided.

2 hours later, the nurse accompanied the transferal had come back and told me that he collapsed instantly on arrival at the tertiary facility.

It was double jeopardy for me; QF and this policeman. We managed them promptly and we had done everything we could but yet, patients did not have a good outcome.

QF had noted with seizure on D4 and we knew that he would not wake up anymore. The policeman had collapsed despite of our effort.

Right diagnosis, prompt management and ....

still not our call for the result..

I hate this job sometimes...

Hope for the best

The heat had built up again since the last raining episode and it was “summer arrived” day when I did my 10-10 shift. It was quiet until an ambulance call which brough our attention. A traumatic OHCA patient was being sent over to us and we had prepared the resuscitation area for the patient as usual.

An elderly male was pushed into the ED with the LUCAS on his chest and LMA in his mouth. I was not the designated attending physician to the case but as usual, I stepped in for help. While my junior colleague doing a FAST echo, I had moved to the head side and started the airway replacement. No rapid sequence medication was needed and I removed the LMA and found out blood secretion was filled over the oral cavity. The intubation was smooth with the aid of Glidescope. A great tool but yet over relaying on such tool would definitely spoil one skill. After the intubation, I swapped my glove and did a PE. A right femur fracture was noted. Within minutes after the airway alteration, pulse was noted. From my past experience, swapping the LMA to endotracheal tube was a crucial step as most of the time, the LMA does not do what it should have; the most significant evidence was the follow up chest xray post intubation which would reveal a severely bloated stomach. Securing the airway was the crucial step for return of spontaneous circulation from my experience in the past.

While we continued with the survey, I heard our triage nurse brought in a lady to identified the patient. I was shocked when I saw the lady; she was wife of our ex-colleague QF. It could only mean on thing….the patient is QF. I quickly take a good look at our patient again and spitted out the 4 letters word starting with F in my heart.

My heart sunk as I resumed my position at the head side of the bed preparing for the central line insertion over the neck. It took me under one minute to complete the procedure and all I could do was prayed as I am not the attending physician. Normally the attending would complete the procedure, but in this case, I just stepped in.

I knew QF for more than 2 decades. He was the senior maintenance technician of our hospital and we had helped each other during the past few decades.

His wife had told us that he had gone for a hiking trip around the mountain area today morning and was hit by a superbike during his return.

The CT revealed intracranial hemorrhage and pulmonary contusion. Our senior neurosurgeon on call was reluctant for the surgery but yet I had urged my junior colleague to ask for one. As usual, the orthopedic surgeon would go in if the neurosurgeon wishes to go for surgery even if something as simple as an icp monitor placement. The latest ATLS had prioritized the management of circulation and pushing for surgery had become the top mission. My colleague had done a great job pushing for the surgery.

QF’s condition was not stable as he was put on double vasopressor during the surgery. A drain was placed despite the ICP monitor and the brain damage was worse than what was shown on the imaging. Luckily the fracture was fixed without difficulty.

He was still 3 over 15 today morning when I visited him in the ICU. BP was still less than 100 despite double vasopressor use.

Later today evening, he was able to furrow his eyebrow when I called him; tapering of vasopressor was done as he was more stable.

I hated it when I had to attend to whom I knew as I realized the fact that the final result relied upon the great one.  

Jupiter Collision

 

After the turbulence CNY shift, I had started my preparation for the IPSC world shoot which would be held at late June. The venue lasted for 9 days and I would need to cleared out a 11 days window to attend it. I am definitely not up to the standard but yet would like to join such event; the local association had set out some rules initially and requested all of us to attended the event as a squad. A go in and out in one policy was set down.

I had paid up the guarantee participation fee as soon as it was announced. However the announcement of itinerary and tour fee was delayed until March.

I had lost my patient and started to tour around the net and found out that association of nearby region had announced that participation had been opened to any member who was interested. I contacted some of the shooters and found out that some of them had started to booked hotel and even air ticket by themselves. It appeared that they would be ignoring the association requests of going out as one team.

Accommodation within walking distance was cheap as 4 stars hotel nearby cost about RM300 per night.

I had contacted the person in charge and was told to stay calm as everything would be in daylight in the near future.

After discussion with one of the gunmate at the club, we had decided to give up and forfeit the event.

I notified the local association of my decision.

It was a shame to missed the 4 years once event but yet pending the method the association’s way of organization the team; I rather give up  than find myself stranded in an embarrassing situation after paying up a handsome amount of tour fee.

I had struggled with the decision of participating the event it would be a bad year for me; according to the tradition, this year would be the Jupiter Collision year for me. Not smooth , not smooth and not smooth for everything. Well, looks like things had streamed down the way as prophesized.

2025 CNY trip - the rest

 

After a good night sleep, three of us had gone out seeking some yummy breakfast. Upon return, Ving was much better and started to some liquid diet and she was strong enough to make it to the flight.

I had brought my nephew and niece to the Setia mall where we patronized the bookshop; the Nasi Lemak The Game had caught my sight and I grabbed it without hesitation.

We had a good game before we headed to airport.

The drive was smooth and I only filled up RM20 of petrol for the 100+km drive. I delivered the car and proceed to the check in. Prior entering the restricted area, I had taken a sip of old town iced cham and Ving had bought some fries from the Burger king outlet. The Oseltamivir worked great and Ving had started her tour of junk food…

Flight was on time and we met our parents later and we had our dinner at Aeon Mall. The food joint selling a variety of Malaysian cuisine and none of them were up till the standard. As usual, I slipped to the non-Halal area and grab a six pack of Shandy. Out of my expectation, no shortage of stock as in the past.

We slept early that night; frankly said, I haven’t recovered from fatigue aggregated from those long streak of shifts.

I brought my mother to the JPN the next day to obtained a letter proving that she had lost her thumb print. She was actually frightened by the bank staff on her last visit to bank. She was told that she might not be able to withdrawn her money if she was unable to past the bio-metric check next time.

During the journey, I was disturbed by the new parking payment system implemented by the local administration. The app supporting the system was not available to the mobile phone bought from outside the Bolehland. I had to installed the app via unauthorized apk site. Not easy to operate and I think old folks who is not good at using mobile phone would have a hard time parking their vehicle without getting a red ticket later. A good way of stopping old folks from driving to street….

As the main event, we visited my columbarium the next day and stopped by uncle hwa fire steamed chicken restaurant for lunch. A Balak factory turned into restaurant with no air-con; food was great and the price was affordable.

The rest of the day, I had wandered around the housing area, playing with my bro’s pet dog and spent my time recovering from the fatigue that accumulated from the past.

The return trip was uneventful where we put up a night sleep at the Tune hotel before we continue our trip the next day.

Food at KLIA1 was really disappointed as OldTown was replaced by another all rounded but so so restaurant, I would usually ordered a dried hor fan and half boiled egg before I left the Bolehland. Shop and dine wise, KLIA2 was still the best.

The uncomfortable ride on the A320 series was masked by sleep on the flight.

We had a 3+ hours stopover at CLK airport with grilled goose as our lunch. My comment was just like the last time I tried it 10 years ago, “last time, I would order this meal”. Tasty, juicy but not my cuppa of tea.

Final ride back to K city with the more spacious plane but the wait at the luggage belt was longer than usual due to large amount of passenger flying the same flight.

We arrived home later and I had prepared myself for the dooms-day like CNY shifts.

you can run but cannot hide

 

Weather had become extremely chill since December. Patient with URI symptom had flooded the ED initially and later, diarrhea and vomiting patient joined the long queue.

You can discharged fever patient with a jab but yet you need to make sure your patient overcome their vomiting to take up oral medication when they reached home. The ED was flooded with patient due to the excessive parenteral treatment being ordered. 

The worst part was as regional hospital around our area had met a disaster few months back leading to a massive bed reduction.

The hospital who was hit by mischief was the hospital I had worked in for more than 3 years before I came to my current job. A fire broke out 6 months ago causing a fatal scenario claiming 9 lives. The investigation had led to a major fraud with the building structure and setting.

Excessive extension of the hospital wing and the power center was done about 10 years ago. A building of 5 level on the original architecture plan was extended to 10 floors and the power center which was supposed to be 1 story height had been expanded to five.

The fire had started from the power center where the ventilation and backup power were installed. A typhoon had struck the power line and the emergency generator powered with diesel had overheated due to rapid switching on and off. Fire was noted and the smoke had later spread through the ward via the ventilation system.

The construction, supervision and finally the certification of fitness of the relevant building would need a load of peoples stamping those documents. String and connection were pulled through channel and interest exchange. The overbuild area was 3000%....

As my ex-boss was a political figure and the local county government was not on his side of the faction; the hospital was bashed violently without mercy.

The wing involved was sealed and later torn apart leading to closure of half of the bed and 60% of its ICU. Patient had floated toward nearby hospitals and part of the load had spilled to our setting.

During the period, I had been very careful; constantly washing my hand but yet I was hampered 10 days ago by the tiny viny malice organism.

The first episode was hoarseness after few days of shouting in a chaotic market like environment ;our ED was crowded and filled with patients stranded in ED waiting for slot in the ward. 

One night, I had left the desk voiceless and I had taken 30mg of prednisolone just to make sure I could able to commence with my job with hiccup. The next day, part of the voice had come back and I continued my shift for few more days before I had a severe crampy abdominal pain with nausea noted prior to starting a long string of night shifts.

Xian and Ving sent me to work later that evening after I slept whole day without any intake. I arrived early and ordered 1000cc of fluid with parenteral antiemetic before the pass over. I finished the 12 hours shift with a branula over my left hand, accompanied by low grade fever that chills through my shift. Xian and Ving picked me up and I gone into limbo for the next 6 hours before I drunk some fluid and headed for job again.

The symptom continued for the next 3 night shifts and I repeated the go back- home - sleep - drink and go to work event. Every sip of fluid would accompany crampy abdominal pain minutes later and I refrained myself from taking any large amount of intake. The best part of poor intake/fasting was sharpening of sense and apart from the bodyache, my mind was clearer than ever. However, the biggest achievement was preventing other victim in the family – Ving and Xian were good despite of my diarrhea x 15 times per day.

I had refrained from taking any antidiarrhea but finally gave in and taken some kaolin based mixture during the last day. As expected diarrhea was less watery but yet pain in the ass was noted….definitely a wrong choice.

Even though the diarrhea and nausea was better after 1 week of torment;  my hoarseness persisted with phlegm that was difficulty to cough out, occasional wheezing was noted and I tolerated with intermittent antihistamine only.

However strange sweety smell was noted yesterday when I cough out my sputum. Time for antibiotic and I had swallowed a 750mg levofloxacin before I hit dreamland.

Dxmn, no more cough nor sputum since then….

Life goes on and so are the suffering….

CNY 2025 - the return trip

Having a united dinner during CNY was one of the important matter for Chinese and I had been struggling to comply with this arrangement since my return to work in the Ghost Island.

These years, I had strived to arrange a trip so that the whole family would returned and had a united gathering.

The planning was disrupted as I had to wait for Ving’s examination date to be fixed. It was quite late when everything was sorted out; double A was out from the preference and I could only place my hope on the CP.

The ticketing was complicated one as Ving and Xian would be travelling back earlier and Yun and myself would be back 6 days later.

The purchasing process was a heart pumping one as the returning date should be on the same day and I hit the hard deck during the last phase while I booked ticket for Yun and myself. The failure to entering the final payment phase of purchase was noted and after 40 mins of struggling; I finally got it through. Average price was rm2500 per ticket and I was glad to be able to closed the deal safely.

It was a lousy plan; the returning flight from KUL to HKG was A321 and from HKG to KHH was A330 which was vice versa from the home going phase. We had to be trapped on the smaller A321 seat for 4+ hours. But nothing to complain as I consider myself lucky to secure a seat doing a late hour booking.

For the CNY escape to materialized, a long streak of shifts had lined up for me prior to the takeoff.

I still remember the day of Ving departure. I slept by 11pm and woke up by 3:30am. I helped Ving and Xian doing the final preparation and left the hut by 4:45am. The airport was crowded with passengers leaving for Korea and Japan. The CP counter was quite empty and we were third in the line. The check in was smooth and I had given Ving and Xian a final hug before they entered the restriction area at 5:45am.

I had headed back home and sunk into the sofa for the next 30min before I headed to job again at 7:05am.

It would be another 5 shifts before my turn of boarding the plane back home.

The next 5 days was a streak of long and boring shifts. I traveled between home and the desk and utilized most of the time in the house placing everything in order before my departure.

Meanwhile Ving had attended her cousin wedding which was broken into two part, the pre wed party with open house buffet dinner and a ballroom wedding dinner at a luxury restaurant. She had however fallen ill after the ballroom dinner. From her symptom, I presumed she had influenza however I was still D-48 hours before my flight.

Yun had joined me for a late dinner D-30 before departure while she wrapped up her project and came home. It was a memorable night where we were shattered by the most stunning earthquake since 921. The quake lasted for more than 5 minutes and it stopped before we decided to evac from our home.

Shaking continued for the next 20 hours and I finally reached home from job 8 hours before our departure. Leaving home with wave by wave of earth quake hitting was an unpleasant feeling, but as there was no turning back for me at the point, I could only surrender my faith to the Great one.

I glanced through my luggage and double checked everything before I headed to bed at 1am. I was truly disturbed by Ving’s illness. I loaded whatever it was necessary hoping that I did not miss anything.

I had bet my luck driving straight to the airport parking zone that day. There were many parking slots when I sent Ving and Xian off. In the past the credit card offered a great deal of goodies when you pay the flight ticket with the card. However goodies were shredded to kacang putih; no more Priority Pass, no more free parking even you owned an Infinite card. The goodies were reserved to superior infinite grade holder who need to pay a non-negotiable annual fee of at least 1kRM; not my cuppa of tea at the moment.

I spotted a spot near the international terminal and headed toward the counter. I rested at the gate by 6:30am. Unlike the last year heavy queuing session at CKS; everything was smooth.

I fell into dreamland before the flight take off; even though the seat size of A321 was slightly better than the double A. The fatigue aggregated from the past 3 week of straight shifts had finally crushed my spirit and I was awakened by Yun when the staff served the meal. Shaomai with fried noodle, favorite for both of us. Sadly speaking, it is a shame that no coffee nor tea was served after the meal. Cheap coffee or tea doesn’t seem to be a great offer but yet it was enjoyable taking a sip of some sugarless drink after meal.

CP landed promptly at HKG airport. Yun and I took a slow walk to the transit gate and passed through the gate smoothly.

It was another 2.5 hours before the next flight. We tour around the Disney outlet and eaten a snack meal at one of the food joint. Expensive as usual and frankly speaking, Malaysia Cantonese food are still the best….

The flight to KLIA departed on time and the meal was surprisingly nasi lemak with a small scoop of sambal; definitely beyond par but yet no fish prawn also ok la…

We landed on time and boarded the KLrapid to KLIA2 to picked up our car from PRAC rental.

The process was not smooth as I finally realized that PRAC doesn’t have an office at KLIA2 and the car needed to be sent over from KLIA1. However, if I had picked up the car from KLIA1 and returned it tomorrow at KLIA2 it would be a surcharge from different pickup and drop off location.

I had booked an Accord but a new Camry hybrid was delivered instead. It was my second drive with Toyota’s hybrid and the driving experience was great and fuel efficient.

The evening jam was packed as usual and I managed to reach home by 8:45pm.

Ving appeared weak and had been laying the whole day with minimal food and water intake.

I fed her with the Oseltamivir and crossed my finger she would be well before tomorrow afternoon...

The night ended after we had a great meal at a local mamak shop. My bro in law Tango, Xian, Yun and I had placed order 4 rounds before we stepped out from the shop. All kind of roti, mee goreng, nasi lemak and 2 glass of drinks per person....

When we reached home, Ving was much better 3 hours after taking the medication….

last trip of 2024

had done a short trip back to Malaysia last year during November. I had to settle with double A again for the same reason.

I was lucky to get a connecting flight which arrived late at Senai.

The connecting flight was operated by MAS and we had to transferred to KLIA1 with the KL express. 

The flight was uneventful and we had arrived slightly late at the KLIA2. As I had opted for the “Xtra carry on” with the double A. I had no  baggage to wait for and we cleared the entry gate in no time.

We had the luxury to enjoy a good meal at the KLIA2 and I had opted for the ABC one bistro at the L1.

All the staff were of south asia origin; the food was darn spicy even for someone who had spoiled tongue like me. The mee mamak goreng was actually not as tasty as I had tasted previously at the food garden but the roti canai and nasi lemak was up to the standard. It was just like the old Genting highland taxi stand canteen.

After the satisfactory meal, we had proceeded to KLIA1 and boarded the flight on time. The kite airline had maintained its standard even though negative news had struck them since months ago.

The trip up north was actually a packed one for us; a drive up to KL then stopped by Seremban and put up a night in Malacca which lasting more than 450km in a day.

We pushed out early and reached OUG garden slightly late after mid day; traffic was heavy and we had encountered a few jams on the way. Later someone had told me that jam on the PLUS highway occurred without any cause(no construction work nor traffic accident nor other bla bla bla reasons) during the weekend.

On arrival at OUG garden, I had found a BKT shop near my aunts house and everyone had put up a thumbs up about the meal. A good BKT for every trip back to the homeland was one of my wishes…

We arrived at Seremban at 4pm to visit my big aunt.. My big aunt’s health had deteriorated markedly since 1+ year ago. My cousin is a retired senior manager with the GE insurance company and is currently full time looking after her. I had been visiting them for the last 2 years. My mom feared that it might be their last chance to meet and she had requested the trip. 

Our trip landed in Malacca and I had booked a luxury lodging to put up a night to make up for the lousy stay on our last trip.

I had booked a service apartment at Casa de Rio. An excellent riverside residence that was located near the Jonker street.

Spacious 2 rooms apartment which was very well maintained. We had our dinner near Salud Tapa; a spanish restaurant offering nice food. It was a special meal for us as we had never try out any spanish food in the past.

After the good meal, we had picked up some nyonya kueh on the way back while touring the Jonker walk.

The next day started with a average breakfast at a restaurant near the apartment and we had tasted the gula melaka cendol at the Jonker street before we headed to meet my cousin and their parents. The strong gula melaka aroma was not my cuppa of tea; the aroma would mask the taste of cendol itself.

The meeting with my cousin and their parents was enjoyable and we had left Malacca after lunch.

We reached home before evening as the traffic jam continued along the plus highway.

My dad did not feel well that night and he was struck by giddiness the whole next day. I prescribed medication and acupunctured him with clip and his condition had improved before I headed to the airport. His condition had deteriorated as well and not fit for a long travelling trip in the future.

The flight up north was slightly delayed and we had checked into the Tune hotel after midnight. The check-in was not smooth as usual and we hit dreamland soon after we unlocked the door.

A good Malaysian breakfast at Tune hotel before we boarded AK170 heading back to the ghost island was the most graceful part of the journey the next day .

The Xtra Carryon package was a good option for travelers not wanting to wait for luggage. However you no liquid nor handy tools is allowed if you do so.

The next trip back home during the CNY would be a great challenge for me as I had to wait for the part II of cloth making examination date; Ving was sitting for the exam. I had to try CP again as it would be difficult to secure any seat on the appropriate date if I booked the ticket after November.