New year's joke and jokers...

There was this female patient admitted to a local regional hospital for facial cellulitis. She is a k/c of diabetes mellitus and hypertension. On D2 of admission, a computer tomography was done and the doctor (? infectionist) had told the family that a great amount of pus /a.k.a abscess was noted in the face and debridement was needed. Unfortunately no plastic surgeon was around and a referral was needed. 2 place was offered - another regional hospital and a medical center(medical center > regional hospital > area hospital) . The family opted for regional hospital as there was bed available. The patient was seen in ED and later admitted to ward. In the ward, the atteneding physician/?surgeon saw the CT and told the family that massive pus is also noted and debridement is urgent and warranted but again they were unable to perform it. So the patient was again referred to the medical center. As no bed was available - the patient was placed in the observation ward in ED. However in the observation ward, the oncall CR told them that only a samll amount of pus was noted and no surgery was needed...

Facts of the day -
1.Physician/ Surgeon cannot read CT without the radiologist - the medical center had 24 hrs coverage of radiologist and the smaller hospital did not...

2.General surgeon trainning is not sufficient - I+D of face could not be done by a board certified surgeon(general)

3.The doctor cannot differential diagnose an abscess from a cellulitis -( or maybe too cold this few days - the doctor thought that the abscess will be iced and stoney hard on palpation...?)

well - there is still someone who earn something in this case - the ambulance driver... 2 referral cost the family at least NT 5k....

this happened to a friend's mother......last night.....

anyway  - happy new year....

Taiwan Medical Grad in Malaysia....

 

I met with one of my old classmate 2 days ago. GSW had been my classmate since med school. He is a Sarawakian. Unlike most of us who get into med school after high school. He was from govt school stream- completed form6 and work as a temporary teacher with the Ministry of Education. He had then come to Taiwan and study in the pre-U course . He gained his seat 1 ys later and I met him the first time in KMUH North Hostel. KMUH(Kaohsiung Medical College then....) North hostel still stand today,eventhough KMC had become KMU and many old building had been demolised and new one established....... He is much elder than me... A nice person , Christian who really care. He is just like a big brother to us. He was elected as North Hostel in charge during the old days... a nice person who helped the Malaysian to secure a place to stay...

After we completed med school. He worked in Pingtung Christian Hospital for a year and went back to serve the MOH. He was posted in Kuching GH then Sri Aman District Hospital. He served his time and open up a clinic there. His wife is a Taiwan Dentistry Grad and both of them shared the same building and practice. I met him once in Malaysia during my service. He had come to KL and I gave him a small tour around KL in my Kembara .... It was 6 yrs back....

He is a all rounded GP who served the Sri Aman Area. He had a successful practice ... I envy him really - if I had gone into private practice instead of coming back for my specialistship  - I might lead a life like him...... well, nothing much to regret....of 9 Malaysian in my class - 3 went back to served the mother land and I swayed away from what once I believed just to pursue my personal achievement....

 But Syabas GSW ..... keep up the good job....

 

the end of the year....

This is the end of the year....

I had spent less time on blogging for the last few months.... Domestic disturbance mainly but now I am better and hopefully would improved more...

I had done a lot this year... passed some exam and failed some - but more confident now... I am turning 39 next year and the learning process is still going on.... I am planning to swtich field next year - maybe joinning a resident program  but still the economic situation is so bad and my current hospital is doing well and stable. We had achieved most of our target(health insurance agency)  and gained some extra budget next year. Well, not a bad performance in this economic storm.... hopefully the bonus is big this year(we get our bonus on the chinese new year eve....)

My job is secured - we had a new locum ED doctor (Emergency medicine certified) . He was quite ambitious initially. Trying to ask as many shift as he could - the deputy superintendent even asked me if I could spare my Wed night shift to him. I gladly concurred and looking forward to enjoy life in 1-2009. However, my dream was blasted out lately. This locum doctor had done a few hanky-panky act and nurses from ED and ICU had complained vigorously... he had also stepped on my foot - moxifloxacin was prescribed for UTI ( my patient !!!!)... Well, one can be lacked of knowledge but most of the complaint was about his attitude. He is still on our locum list but definitely would the first to be stripped off....
Well... I would stick to my current schedule and grab as many cash as I could....

Farewell 2008....

1 arrow 2 hawks plan....

 

It was a hard mission for me…

I had 2 objectives to accomplished and hope to complete them in 1 shot…

The first objective was to attend the exam of Health Information Manager certification exam. The exam was organized by the Medical Informatics Society. The exam was fixed on the mid of the November. I had an advantage for the exam – 20 % of the examination was about medical term and another 20% about medical ethic and health insurance. I thought I need something to justify my position as a programmer in the hospital – I am not a computer science/engineering grad  , really inappropriate for me to such job...

On the same day the internal medicine society(SIM) was having it’s annual conference. I am still 2 credits short from my practicing license renewal. This 2 credits was specific credits that means only I needed to attend specific courses to get them – the sex and infection control credits. The sex credits was required as too many of sexual harassment occurred in the medical field recent few years. The infection control credits was required due to the avian influenza and SARS outbreak. The SIM annual conference had organized such course during the 2 days conference.

The challenge – the courses was held during the morning session. The sex issue in the morning(8:30am) and the infection control in the afternoon(3:30pm) in the National Taiwan University Hospital.(NTUH) The HIM exam was set at 2pm at the other end of Taipei City(Taipei Medical University). I made a call to the SIM and the SIM had claimed that they are not very strict about the entrée and exit time for the courses(we need to sign in and out during the course to make sure we actually sit in the classroom…). So I decided to rush and see if I could get the attend the examination and still collect the 2 credits. I came out with the 1 arrow 2 hawks plan…

I took the 1^st high speed train up north – it was the biggest Build-Operation-Transfer plan of Taiwan and the dream of 1 days traveling for North and South came true. The 6:36am train would arrived in Taipei by 8:15pm. The 1^st course started by 8:30am. The Taipei main station is a joined station of train , HSR rain, LRT. The NTU is LRT station away from the Taipei main station. I arrived at the station on time and hopped onto the train. I did some reading and the was shocked as I heard the train announcement. I was on the wrong train – the announcement said it would be stopping at all station and would arrived in Taipei by 8:30am… Definitely no my train. I jumped off the train and found that my train was actually at the other dock. I ran up the stairs and cross to the other dock and managed to get on the proper train 2 mins before it departed. Not a good start definitely and “I had a bad feeling about it”…

I slept during the journey and the train arrived on time. I found the LRT dock and get on the LRT and arrived at NTUH by 8:25am. I went to the registration and went to the class room at level 5. The next 2 hours was not that boring as I imagined. When I went off by 10:30am. I found that we did not need to sign out…good news. I could go back earlier. I collected some free gift – a VISA electron card from a local bank, a blood sugar machine(free of coz….)…I took the LRT again to the closest station near National Taipei University. I took a bus instead of a cab. Lots of time for me to spare.

I had lunch at one of the shop outside the university – there are always lots of restaurant/food stalls outside a university…. I had an hour to go through everything again…

A 50 questions MCQ paper. I did a count before I passed up my papers – 70+ .. The passmark was 70 and I think I could do it.. at 30mins, I handed out the paper and rushed back to NTUH… I managed to get to NTUH by 3:40pm and signed in.. I left the NTUH by 4:10pm and got to the HSR station by 4:20 pm. There was a long queue in front of the automated ticket selling machine and even a longer queue in front of the ticketing counter. I quickly glanced through the train timetable and I thought I should take the 4:45 train. There were 3 machines in front of the queue. A female worker was standing around it and trying to help out those with difficulty of operating the machines. There was this man in proper suit(coat with ties) who tried to buy a ticket with credit card and kept having error and retrying. He had however turned down the offer when the lady tried to help him…He had stand there for almost 10 mins and finally gave up…I observed the buying process and found that the credit card route took the longest time. I decided to use the ATM card instead but then I would lost the credit card insurance coverage – but what the hack ,time is gold ( I need to go back and look after my 2 kiddo)… I managed to get my ticket by 7 mins before the train departed.

The course was smooth – I got home in time…

 

I accomplished all my objectives….I got the 2 credits and I passed my examination(got my cert last week…)

Well what a day…next year I need to go for the analysist examination....

Light and dark - chapter 1

Finally I acted....

Ving and I had a good week together and we had a small disagreement over a small matter... she started again .....digging out the past and she acted violencely. I was due to work at noon and was unable to left her in the house. I told her she had 2 choice, one is to go north to a place where she might be healed and there other was go back to Malaysia... she opted the 2nd but went into amok after  she opted. I knew I had to do sometime at that point. I made some calls during the next 2 hrs... I managed to give her a sedation and knocked her out. She was sent to the psychiatric hospital and admitted.

That night was a chaotic night. She kept calling me , begging me to discharge her. She told me she saw lots of spirits around her and she was touched and harrassed by them. I was oncall and nothing could be done. She had also called a few members of the church. She finally told HX she wanted to go north instead of staying at the place.

The childrens slept with me at the hospital and I took a 1 hrs break sending them to school. By noon, I went to hospital and had a long chat with the psychiatrist. He had a long talk with Ving. As usual, Ving had rationalized her violence behavior - all she wanted was "pamper" from me.... I told her if she wanted to go home there should be no more violence in the future. However she had a 180 degree change of attitude during the ride back. She even wanted to be re-admitted when we reached home.... There was another existed issue. My dad was coming over. She was very tense about this as the unpleasent feeling of the past had haunted. She was wanted to leave during the period of stay of my father. She called up HX and wanted to go to Hebron Holistic Care Society.

2 days later, I was post call and 3 of the church members had accompanied us up north. I was lucky to have good sleep. The drive was a long drive 340 + km and my heart was heavy... I need to let her go for the 1st time. She had never left the family since we came back to Taiwan. I had to left her in a place where I had never been to...

Ving was ok during the drive... the society was situated in a community. The community was formed with a few blocks of apartments and lots of terrace house. We took a wrong turn in the community and ended at the other end of it. We passed a temple and Ving started to act strangely. She said the place is filled with spirit and she no a suitable place to stay. We walked to the office and had lunch there. Ving had took double amount of what she could eat and finished it. We were joined by the pastor during the lunch. She finished her lunch and walked out from the office and claimed that she wanted to go home.....She sat at one of the bench outside the office. The pastor and wife talked with her and one of the spirit had spoken via her mouth. However this time no exorcist was done. The pastor asked the spirit with a firm voice and the spirit just went away.... We walked back to the office and chatted for 1+ hrs. Ving had regained herself and agree to stay there... 
A room was arranged in a terrace house opposite the pastor's home. We left the place after everything was set. We walked Ving back to the office and I hugged and kissed her before we left. Every steps was stoney hard for me... I broke out in tears when I walked to the car...
I drove all the way back by myself .... The pastor told me before I left :
1. I had sent her too late - I should have noticed and realized the matter earlier
2. The power of dark side had influenced her too depth  - It might take a long time to recover
3. She would be having recurrent episode and she would be hovering between 3 places - home, hospital and the society.

I had then 2 problems to face - 2 children without mother , My future shifts....