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.

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….