BKK....prelude

 Planning a family trip before Xian’s leaving was on my mind for the last 6 months. However, everything was tied up and the family trip was not feasible. 

The next trip after Xian leaving was Malaysia and later on London. I had noticed a slot on my roster which lasted for 6 days; I had taken a bald move and mastered a trip to Bangkok with Ving. The tour was later expanded and included Yun and her mate. 

It was a 5D4N trip. The planning part was actually filled with struggle. Initially I planned to take a budget airline but their scheduled really sucks; late arrival to DMK and red eye flight back to K city. And there were actually first freedom flight  connecting DMK - KHH - elsewhere in Japan. Delay of flight is actually possible due to involvement of a third destination.

I finally given up the thought and opted for a traditional airline. I opted China Airlines so that we can push off in the afternoon and arrived late in K city on the day of return; maximizing the duration of stay in BKK.

Lodging was a pain as locating a 4 person room was actually very difficult; especially if you want something not that entry level. 

It gotta be transportation hub friendly and could housed up to 4 persons. The difficult part was I don’t know where to start my search. 

I could only tapped into each of the options suggested by Trip.com/Agoda/Booking and see what kind of room they offered…. Only 2 choices left after the 1st round of selection. A room of 4 and a 2 room apartment was left for me to choose from. 

The selection process was simple as an apartment would come with a kitchen and maybe a washing machine. Although it might not have the luxury feel of a 5 star hotel but yet the facilities that it provides would be so convenient for our stay. Our last trip to Beijing was a memorable one.

A list was made out while we started to trolling the youtube for Bangkok tour.

Most of the tour was about shopping centers and foodies, but my focus was museum. It had always been museum for me; those exhibition items were good media for one to learn about another country. 

We had compiled a final list:

water market, railway market, night market, museum (national, art, moca, bangkok) and some shopping center.

Food wise, we had chosen only one signature restaurant: Copper beyond Buffet. The rest of the meal would be walk to where eat to where basis.

The list was revised and revised as Yun would have to attend meetings and online classes as we travel. I had made adjustments to accommodate all the items on the list and the list was finalized 2 days before our journey.

As usual, it was a long course of shifts before the journey begin.

It was a shame that Xian did not make it with us. For him another great journey had begun far far away and all I could do was to pray for him. Maybe next year, we would team up again and walk down a path. 

It was time to let go, and entering a life that I had never imagine….

shortage

 The issue of shortage of staff had emerged since last year. G had asked for a reassignment to OPD and later S left us for his children. Well, 40% down of man power and we started looking for locum. We had a few good hands who came for our rescue. They are competent and physicians of good standing. However we were unable to secure any new staff. Part of it was the salary. EP pay around the rural area at some central part of the island had risen to an unbelievable level; we were closed but yet still a fragment less. 

A few had come to ask but none of them opted for us. After the CNY, our HOD had finally asked for a 10% raise and finally the hospital agreed for it. More pals came for interviews but none of them stayed.

Distance was the main concern as most of the well paid didn’t want to live around rural areas. After some begging and persuasion, we finally got a senior physician to join us; A Sabahan who had worked nearby; the hospital had a crisis and a large part of the staff EP left( we could manage to grab one….)

Well, hopefully I gotta make my trip to London in October….

Visa run...

 The rest of the 70+ days was multitasking; decision, decision, decision and only guides were info over the net.

The most heart pumping session was the VISA application. 

The CAS was issued within days of submission of IELTS result. However the challenging part was the on-line visa submission.

I am not unfamiliar with such online applications but yet the info required to fill in was massive and some of the information needed to submit was massive; eg. travelling record of past 5 years. Exact date of in and out was required. In the past, you just flipped your passport and everything was there for references. However with the e-gate implementation, it would be difficult to trace every single entry and exit. 

A record from the local immigration department had helped with the info gathering mission. Combining with the flight ticket record on my email, we had managed to compile the full travelling record. 

Another issue which disturbed me greatly was about the medical check up needed. 

For visa application, a medical check up was needed for some applicants. As a Malaysian, an Xray will be needed, but for a Taiwanese, medical checkup was exempted. Well what about Malaysians staying in Taiwan ? No relevant info was found over the net….

The worst thing was if an Xray is required, where should the xray be done as there is no authorized clinic in Taiwan.

I had to keep my finger crossed for such issues. We would only know when the biometric was taken.

The other issue was the bank statement about sufficient funding. The fund was banked in since last year but yet the format provided does not fit the requirement of UKVI application. The statement would only state the amount in the account as of bla bla bla date. It was a standard format and it could not show that the account had held such amounts for how long. Luckily the bank could provide a transaction record for any duration. So it was a separate documentation for this proof. Would it satisfy the relevant authority ? Fingers crossed again. Luckily, it was not mandatory for Taiwanese applicants; but again, we were Malaysians living in Taiwan….

Too many uncertainties and I was unable to make it 100% proof and had to live with it. Another round of agony for me; compared to what I had for the past 12 months…it was nothing actually.

This first round of filling up the visa form  ended up in a chilly back situation. It was a post 36 hours shift for me and we started the session at around 11pm and it took us 40 + minutes to complete it and upon completion a strange feeling had haunted my nerves and a quick check had revealed a silly mistake. By that time, I had paid up the process fee and NHS fee which summed up to almost 100k NT. Luckily, withdrawal of application with full refund is available prior to biometric collection. Although many had said that an undercover letter on submission of biometric could pave the error, but we did not want to take the chances. The refund was quick and only took us less than 2 days to get the money back.

We decided to cool ourselves down and proceed with the application 2 weeks later. The rest was actually quite straight forward and mostly focused on gathering information.

The final submission of form was done and we did a don’t know how many times check and recheck before pressing the button. It was smooth but yet it was slightly more than a month before the travelling. The official statement was maximum 3 weeks for approval. Some gotten it within a week and some got delayed.

Xian had gone to Taipei with Ving for the biometric submission. I paid up for premium service so that it could be done on anytime of a Monday. They completed the submission before noon. Later that night, while travelling on the HSR, Xian got an email confirming his visa approval .

So the verdict; those requirements were not nationality dependent; it all depends on the submission of your document. 

TORMENT

 It was a time of despair for me since last July. It all started from Xian acceptance to the UAL; the rest of the journey was filled with agony. 

Xian had a short time frame to meet the language requirement. As he applied late, the  pre-sessional course was closed and the only way was to attain the requirement.

Xian was over confident with his ability and failure had struck him again and again.

Even though the administration had granted a grace period but yet he had to forfeit the acceptance. 

The path was tedious and filled with sweat and tears .. and also lessons beyond money can buy. If money can settle the problem; it would be fine but yet you can’t buy time….

It was a down time for Xian and me as well. I tried to persuade him to give up and maybe get a hit on the local graduate school. However he is firm with his decision and nothing could rock his will. 

No tuition, no agent, no change of destination. No matter what I said, that was his bottom line. It was destined since his birth; my teacher had told me that he might look normal in the future but yet he would still show some features of the spectrum. Well, minor conflict and lots of talking during this period.

Months had passed and I was consistently haunted by what would be coming. Although I had said I would be prepared but yet I was not; I didn’t know what would be heading toward me. It is not up to me to decide, it was Xian that needed to withstand the impact. 

The first question to concur was if he would be accepted into the program since he had forfeited the first offer. Frankly speaking, I had no confidence at all. I had prepared for a premature end for this attempt. Xian had however  focused on the preparation of his portfolio and English. 

Day and night passed and 1 day after CNY,  Xian had gotten what he wanted AGAIN!!!

An offer letter was served to him and he started his next tour of preparation; the ILETS.

It was another warzone to struggle since then. The ILETS was taken late and Xian hit the mark for the 7 weeks pre-sessional english course on campus. The joy was later struck off when we applied for the combined CAS for the pre-sessional english course and the main course.

CAS would be issued only if we had ILETS UKVI Academic. Unfortunately, Xian took the ILETS IDP(not because it was cheaper, but the oral part was done face to face rather than in front of a monitor remotely). 

So we fell into another round of ILETS run. 

At that point, pre-sessional english course was booked and confirmed and we need a combined CAS. If we had applied for an independent CAS,  Xian would have to come back to Taiwan and apply for another CAS and visa again after he passed the pre-sessional course. It would be only 3 weeks to go to apply for a CAS and visa plus one more to and fro ticket. 

Collapse and lose faith was not an option as we had come so far. 

The offer was truly a gift as previous forfeit was definitely a minus point during the 2nd application. 

The first attempt was a disaster as the remote oral session was something new to Xian. The 2nd attempt was much better but yet the result was similar. Xian decided to appeal and finally a +0.5 was awarded 3 days later and he had made the cut.

We had 2.5 months for the final preparation.

The list was not long but traps were noted everywhere. 

1.Booking of 2 lodgings

2.Flight arrangement

3.Arrival Arrangement

4.Money transfer arrangement

5.Luggage preparation

6.CAS and VISA application

The worrying went on and I wandered will it ever end???

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.