bitten

It was a last day of the "cold front" night - supposed to be a peaceful night - at least the "small night" shift(4pm-12MN) was... I had a 999(a.k.a code blue) and I managed to get a ROSC after 15min of effort...A CVP was inserted as hypotension was noted. After the CVP, I went back into the blanket and wished for a good night shift the rest of the night. But by wish lasted for only 10 min - > "ETT cuff leak noted with bed I X, might need a re-intubation...". I gladly complied and went back to ICU. The patient was struggling as the nurse tried to remove the ETT - no a good sign : "S n R" (struggle and resistance)...
I ordered a propofol - if muscle relaxant was ordered, the nurse would have to take a long time(ran to ED ... it was the hospital policy to keep it in ED and OR only) and  propofol seem to be a  good choice at the moment - and I was wrong....

  I waited for the patient to calm and introduced the blade... the patient suddenly awaken and started his "S n R" tour. He had caries and lost half of the tooth and the blade had sunken into one of the gap and my right index finger was bitten following the sink.... Luckly no wound was done but I had a bruise over my index finger's nail bed....

darn ... 3rd time since I got my license, reminded me to insist for muscle relaxant next time....

Best employee award again...

It had been 1 year and the election was on…Unlike the other hospital I work in. The best employee award was generated by election. The staffs vote for the best nursing personnel and the best employee…
Well, as the last year award holder, I was barred from being voted for the next 2 years. The nursing list was not surprised as the winner came from big unit(means unit with more than 10 staffs). These unit can “request” their member to vote for specific person in the unit….
The best employee winners went to some ‘rover’ … those who roved around the hospital…
The polite rover would attract enough vote as other staff would have a good impression on them...(I am a rover as well, I roved around in the night...)

well, a little bit unfair and much more to be improved, But I still felt that every winner deserved the award as they really work hard..

bone problem...

I had tried very hard to keep myself update on my job, however sometimes, I had doubt…. Thank god, someone had invented something called the internet.

We had this osteomyelitis case who was referred to a medical center for further management. There was a great chance for the patient to get the disease as she had rammed her bike into a drain and the bone was soaked in the drain for sometimes before she was dragged out. A simple trauma case who undergone surgery in our setting...

It should have been ok eventhough osteomyelitis developed. However we had pushed ourselves to the current ground. Proper communication was not done pre-ops - no one had explained the risk to the family. When the wound broke down and pus was pouring out from it the family was still hoping for a forever remedy - the family was polite : I just don't care how you all fix the problem, just healed the pt.... 

 The implant was removed and however a plate was re-planted on the second debridement. And weeks after discharge, pus was noted from the scar again...Well, this time, the patient was referred to a bigger hospital up north ... and more shoking news came later -osteolytic lesion was noted (so rapid...) . We reviewed our film and found that no xray was repeated on the latest admission...well, the worst is not another suit as one of the close relative of the patient was a ex-convict ( man-slaughter....)...

For a moment I was a little bit shock when I heard the whole story as it was not the 1^st time for the attending doctor to do so…(the last pt expired after a severe noscosmial infection) .

I had a discussion with Lem and we had re-confirmed over the net that the concept of removing the implant in an osteomyelitis situation was appropriate.

It is impolite to criticize our colleague…but I still felt someone should talk to him…..

Pain in the ear...

The H1N1 immune injection is available to the school kids since mid of November , I had my jab earlier this months – darn painful one, my arm sore for about 3 days. My heart sunk when I saw the milky fluid in the syringe. Must be a painful one, I grumbled as the needle penetrated my skin…But the govt provided the medical personnel with the Novartis product instead of the local made GG biomedical co….

Rumors had said due to the lack of the egg, the factory had utilized ordinary egg instead of customized egg for immunization injection production.

However as all the school children are scheduled for the injection. Each hospital was “allocated”(force should be the appropriate word)

A few schools for the injection. I was part of the injection team …

For the past 2 weeks, I had gone participated in 4 session and seen over 1300 students(primary and secondary school). The hospital was paid RM5 per student…The money did not slip into my pocket…I had observed a few interesting point during the needle pricking session..

1.   The student got the pain in the arm and I got pain in the ear – I had to put my stet on and off 300+ times each session…almost otitis externa…

2.   No student appreciate you service… only less than two hand full of the students say thank you to me.. I think those kids saw as “BULLY”…

3.   Kids gave every excuse just to escape the injection. The worst lies came from secondary school student – they often give you some story that was so inconsistent ( “I saw the doctor 1 wks + ago for flu and I am currently still eating his medication ::: taking my ass -> clinic usually give 3 days medication…)

4.   The kampong boy are braver …

Another few thousand awaiting me….

Zafira - salt eating experience....

My Z have undergone a major repair lately…

It all started around the 60000km service…. 60k km is one of the major hallmark of service for the Z -> the change of the timing belt. Unlike the Jap car, the timing belt replacement came in a set : the change cost around RM 1600… And it was the start of the catastrophe – the change required 1 full working day and I had to left my car in the workshop. During the service,  I was informed that 2 more replacement –

1.   brake lining shoe – fair enough after 60k km …

2.   Clutch pieces of the easytronic gearbox had worn off (the distant was 8.85 instead of the minimum 9 )…

The brake lining cost about RM500 and the clutch piece was about RM2600….

Well..as the Cantonese said – “when you wanted to eat salt, make sure you can tolerate thirsty..” so be it..I had to concurred with the changes…

The clutch replacement was a major one as the engine need to be lifted…it was a 3 days work : so my Z lay in the workshop for another 3 days…

During the replacement, they found that 2 balance beam had loosen and replacement was needed as well – the goes another RM360…

Well, the total cost was around RM6000….

But I got my Z like a new car – no more lililala sound here and there – and the sprint was darn smooth…better than ever driving experience….2 more years and hopefully the Zafira C is out by then and Opel is still available in Taiwan...

clever patient...

It was 6am in the morning....I had a good night sleep, 3 patients seen (and they all came within the same 30 mins) and no call from the ward after 2am. The patient was a 60+ y/o male sent into ED by the local 911 ambulance. The nurse had told me that the patient claimed that he had an intestine rupture. I looked at the patient behind my desk when the nurse told me that complaint. The patient is bed-ridden and he doesn't look like a "medicine man". "Another clever patient..." I grumbled as I walked toward him.
The history taking was long and unpleasent as the patient is a case of old stroke, bed-ridden and suffered from dysarthria. It tooke me a while before I get a incomplete image of what had happened. He claimed that he had constipation problem and use to enema himself. During the enema he had heard a "pop" sound and severe pain was noted over his lower abdomen. Indeed, he had an distended abdomen c rebound. But I also notieced he had a over filled bladder(up till the umblicus). I ordered a urinary catherization and gave him an NSAID jab. The catherization produced around 500cc of urine and his pain was not relieved. I ordered an abdominal cat scan and managed to get the full story this time. He did not use a glycerine ball nor evac enema(bottle of 118cc of glycerine) for enema instead he slided a hose(yes water hose) connected to a tap and inserted the other end into his anus. "Holy XXX" , he is right,  definitely a rupture in the colon. What amazed me was he had left side weakness and his left upperarm was contracted.

 I gave him 50mg of pethidine and called the surgeon. No free air was seen on the CT scan as I expected. The surgeon came and concurred with my decision. He was sent to OT and Hartman procedure was done.

 
Well, you don't need a scan sometimes - proper history and physical examination concluded your diagnosis. Sometimes I would tell my patient and their family - I take the image because I want to let you see the lesion....most of the time it was waste of money and time but it protect my ass  ....

Uninvited...

It was a quiet night until 2am.. I had been disturbed by call from the wards and the ED. Around 3:30am , there was this family wanted an explaination and I walked out from my call room. The explaination was short and I walked back to the office minutes later. When I opened the door, I had seen a shadow moved inside the toilet. The toilet just at the right end of the room from the room, I could see the toilet door just when I stepped into the office.

The ED office sketch.....

 

I was stunt and waited for a second, before I asked "who is there?" A voice anwser from the toilet and "I came for a pee". "PEE" my ass I grumble. A voice means he is definitely human and not any being that belong to another word. I walked into toward a toile and slice the pie. I saw a person about 175cm tall wearing a cap and blue jacket. He saw me and told me that he couldnt find any toilet and so he came here. I was a little annoyed, "WTF" I grumble. I chased him away in a unhappy tone. He quickly zipped his pants and I walked him out from the room. I sat down and had a quick thought that he might be a thief - but I was too tired. The next day, I shared the incident with Lem, and Lem told me that he was definitely a thief. I went to our engineer department and told the manager what had happened. We traced the surveillance camera. Yes, he is definitely a thief. He had entered the hospital 20 minutes before he walked into the office. He had wandered around and took the lift to 7 floors. The nurse was sitting in the station but did not ask him what he wants when he walked into the ward. Then he wandered around the registration desk and waited for me to come out and see my patient. Fortunately I did not take too long to do so and I walked back in heavy paces. If I had not make any sound when I walked back I might had caught him red handed searching for something -then a fight and someone may get hurt....well, I was lucky, nothing was lost. I had a couple of hundred laying on the table along with my laptop, mobile phone....... well, I was lucky I don't have to confrant him ... or else someone might get hurt....

We had actually hired a security guard 3 months ago. However he was sitting in the ED instead of sitting where he should be. If he had sitted at the security desk and questioned someone who had entered the hospital but did not seek help in th ED, the thief might had walked out straight. But it is not the time to make a big issue about this neglect of duty - boss might think it is useless to hire them and we would be back to dark age again.

Gadgets....

I had added the below gadgets into my arsenal during the past 3 months...

1.Apple macbook pro 15"
- Ving had wanted it badly... so a big big hole in my pocket and a load of point in my credit card account...

2.NXT robot x 2(8527 and 9797 )
- Yuns latest toys.....her dream: sumo robot...currently we were building an alpha rex..

3.Linkstation live 1TB
- wanted to backup my tivo program..I had installed the pytivo server on it and started to BT again..

4.Apple ipod touch
- I converted to my credit card point to costco gold coin and found that I could get an ipod touch for free... so it landed in our house...hell of the device, not only music, but endless hours of fun....

I had very best to avoid apple product in the past- but now, I am thinking of an imac later...

Evidence based

The H1N1 had disturbed most of the public... but I was disturbed lately during a debate in a forum. There was this chinese SJA forum which I discovered lately. One of a forumer (a paramedic I presumed) had posted some irritable message - wearing a mask in public area is a social obligation. I was irritated by his posting. I am one of the raw face tribe in the hospital from the first day stepping into medical field. I think not showing your face to your patient is an impolite act. One should know the look of who is going to treat/harm him - basic manner. I donned my mask whenever it is necessary.

Even after the SARS, I still keep my habbit until lately the H1N1 strike. We were requested to do so when seeing our patient.

The debate in the forum was unpleasent as the forumer started to comment and "adviced" me to see my patient correctly and nicely... I was irritated as all those sentences were unfriendly and filled with comment which was not true. Most of the facts presented by the forumer were so called common sense... just like those uncles chatting loudly over the round marble table in an old coffee shop.

I found out a few facts during the debate. Most of the public were frighthened by the government and they had no ability to verify what they read/saw/ heard.... My training had given me the skill of picking knowledge based on evidence but unfortunately there are a lot of peoples who don't... that was what my brother told me months ago. He told me detailing is one of the key to a person success.

However this evidence base stuff had sometimes make me look like a person without principle - when the guideline change, I changed..... had to live with it..it had become part of my life...

episode running...

We were back to square one next months.... O is going for his break again after 45 days of work. The gap was 30 days (better than indefinitely). Lem had shown me that roster and asked me to fill in what ever shifts that I could handle. I adopted a few and still there are 5 holes left to filled. Everything would be up to boss ...
Well, we were actually disturbed lately. Boss had informed that there is a board certified emergency physician interested to join us. The doctor was introduced by one of our head nurse. I chatted with the head nurse( is my nature to dig around...) and found out the below facts:

1. he is currently working in a small hospital nearby

2.his work is heavy - did most the night call

3.he wanted a change of job...

4.he is a filipino medical grad

We waited for a few days and someone had told us that - it was a misunderstanding... this guy didn't even hold a practice license...phased out immediately of coz.

10+ years ago, our hospital had stopped to placed doctor without a license working in ED... now the situation is even worse : any doctor working in our setting need to registered our hospital as his /her alternate working hospital with the local health authority.

Unlike the Malaysia, the practicing certificate here is not renew annualy. The so call practising license is renewed every 7 years. The renewal criteria include adequate CME points....There is a list in the local health bureau which specific where we practised. If we wanted to work locum elsewhere, we need to add an alternating practising site. Alteration of the list would need an agreement from the primary working hospital/clinic. We were strict about this regulation so we had problem to attract doctor for locum nowadays. Getting permission to work locum elsewhere is difficult....

Few days later, boss had told Lem that a surgial chief resident from a teaching hospital had decided to join us and  grab some big cash. He had asked Lem to re-arranged the shift so that this guy could share our load with a reasonable shift( that mean he does not come to join us and work only during weekend nor night shift). We tried to "squeezed" some daytime shift for him. However we were in doubt why did  surgical resident give up his training ...

But no news from boss since that day - both of us had agreed that it is just another faulty granade. This so called surgical chief resident grade doctor is someone without a practising license stranded in a teaching hospital. Teaching hospital are allowed to hire medical grad without license as "trainee resident". There are still load of such medical grad striving in some local hospital. This doctor may had  thought small hospital like us doesn't mind to hire doctor without license and came to approach our boss....

Well, looks like we have to clench our teeth and survive the next 30 days...

1st class service...

I had this alcoholic CWC disturbing me lately in the ED. He is a case of alcoholic liver cirrhosis who unable to get rid of his bad habbit. CWC is a person on social welface list. He enjoyed many priviledges. He doesn't need to pay for the registration fee, he is not entitled to the 10% payment of admission and his meal is pay for during admission.
What he did was begging for admission. He came to our ED and begging every single one of us to admit him to the ward. In the ward, he could sleep nicely (or get through his alcohol induced drowsy state) on a nice clean bed. Wake up and enjoy a good nice meal. Take a big gulp of rice wine in the fully air-conditioned room. When he is awake he would disappear elsewhere to get some money and continue his drunkard life.
He usually get admitted and would be discharged automatically on D2 and mostly D3 when the nurse found no trace of him around the hospital hours later.
He came on the few days ago and complaint about generalized discomfort and asking for admission. I told him I would take after him nicely. I explained to him that I would be in charge of all the patients of the hospital from evening to the next morning. So I would give him 1st class service. I would provide him with a 1 to 1 nursing care and he could chose to take the negative pressure isolating room or the ED room. He showed me an unbelievable look and was wordless. Despite my explaination that he would enjoyed the 1st class service in our hospital(that is no admission to the ward) he still hoping that I would admit him later and complied to my invitation to take a drip. After 1 hrs of laying and begging on the bed , he finally gave up and walked off....
I hope this would be the last time he tried to harrass me in the ED.... I would still provide the so called 1st class service for this kind of KNNECB scum bag(waste of the tax I paid...) and hope they would enjoy it...

 

Lucky people ....

I was lucky...there was no outbreak in the hospital. I could finally relax my crampy crossed finger. I was lucky - the child was placed in a air-conditioned room over night with 3 other peoples. Those who had contacted with the child was free of symptom until now. Well, pandemic it is however thanks to medical care - there is only 11 deads until today morning. More than half of the patients had chronic disease. There was this pregnant lady (20+ weeker) with respiratory failure(lung invasion). She was put on ECMO and survived through the critical period. However she lost her baby. ECMO have been last resort for those critical ill with cardiopulmonary collapsed. However it was not the magic wand of fairy. I had been through a lecture by one of the pioneer of ECMO in this country - Prof K of NTU. He had presented us with a load of patient survived with severe complication(gangrenous change of limbs with amputation). I had noticed there are intensivists who used double ECMO nowadays. Well, life is so precious here compare to my homeland. I saw flood refugee eating buffet style meal in the camp, those homeless were well treated.

By 2 more months, there is vaccine for us...I am still worried only 3 of us in the family are eligibled for the vaccination. Ving is not in the group. Well, would try my best to get her a jab...we are lucky, if I am back in Malaysia, I am the only one who could get a jab...

Outbreak it is and stand we will......

Cross my finger...

The flood had caused many locals lost their houses. These peoples were settled in the local school. However as the school opened this week, the homeless were forced to shift to the local army base. They were relocated to the gathering hall. Such living environment is definitely not an healthy one. The H1N1 flu had worsen the health condition. A simple case of fever had caused havoc among the medical staff. Patients were sent over for rapid test to screen for influenza A/B. We were disturbed as most of the case did not fulfil the criteria. We however had to comply with them.

 There were 2 medical depot in the army base near us. One is manned by a local teaching hospital and the other was the medical depot of the army. According to nurse from the civillian medical depot, the army medical personnel were reluctant to help out but very concerned about the fever cases. Well, our hospital was the 1st choice to run the civillian medical depot, unfortunately we did not have the man power. Doubling of patients had stressed us up. I had missed case 2 days ago....

Until today, 3 patients were tested positive. 1 army, 1 coast guard and the other child who I missed. It was my fault as the patient did not presented with typical sign of fatigue and bodyache. He was dsicharged with oral medication but returned hours later and requested for admission. I did not think twice and admitted him. I should have done a screening test. Later the attending pediatrician (also happen to be our hospital superintendent) was thinking of giving him a test as his fever was difficult to suppress with antipyretics. The test came back positive and he was referred to another hospital. My mistake....hopefully no outbreak would happen in the next few days....

post flood- the suffer begin

Our hospital was not threathen during the flood... but we were affected after the flood....

There were 2 xiang(or so call district) flooded during the typhoon. It was regular for the LB area to be flooded during the typhoon as the local govt could not restructure the landscaping. The LB district is packed with fishbed and no one could asked them to shut down. So nothing much to shout. However the dike along the JD district collapsed during the typhoon(it was bad time - high tide + typhoon). The seawater had poured into the village along the seaside. The flood had cause the mud to precipitate all over - including the drain. The whole drainage system was packed with mud. The water could not be drained and only the sun and natural absorbing power of the soil could do the job.

this was taken outside the medical depot I went to support..

mud and water....despite the hot sun..

The road leading to my ex-hospital(regional grade) was shut down due to the muddy condition and water(yes, dead water). Peoples around this area would had to spent 1 hrs+ on the journey to reach there. Those peoples had opted to come to us instead. The ED pt amount had doubled and sometimes triple since the flood. Those peoples living in the flooded area were offered free(yes no registration fee, no self burden fee) treatment - so they come as they like, if they are in a rush - they opt for ED; a really abuse of privillege but they were the ones who suffered most . As a resident who could still stay in his own decent house ( vs in a muddy house / salvation center ), I am in no position to tell this peoples to wait for OPD....
Well, the shifts were bad since then --- servicemen coming for tetanus jab(what can I said , the army medical corps should have given them a prophylaxis before they entered the region to help...), cellulitis , infected wound... and lately gastroenteritis....well, all sort of disease expected in a disaster area spreaded out in front of me...a real good experience to practice...

rumours said that it would take few months before the road would be reopened and till then, we need to tolerate... But I am sure our management is enjoying the current situation as the patients were pouring in like dont know what and we were always packed with in patient...

hospital evaluation

the final day had come... the 2 of the 3 connecting road were opened and the committee had decided to come for the review...

I was post call and had to stay back during the process...a stress for me... 

I was posted to ICU as planned. My official title was physician responsible for ICU. The title was set by the hospital evaluation committee and had to meet the following criteria:

1.Pt in the ICU had to be placed under the service of the physician

2.The physician could only had 2 session of OPD

3.The physician could not intake patient outside the ICU

that was the reason the management stopped me from doing any warded patient care since 4 months ago. As the hospital had tried to cut the cost and my overlap time of work with Lem was greatly reduced, caring patient in the ward had become a stress for me, eventhough those patient under my service were all from nursing home, mostly bed-ridden. My working hours could not let me to come everyday to see my patients. I did grumbled about the situation but I could do nothing - the cut of working hours was minor and I gained some from the Hemodialysis round ( still it was negative in total).

Post call with a heavy body and mind and I still did a solid round in the ICU. I was darn tired and slept in the conference room after 11:00am. The lunch suckes - a cake and bread combo box. The excuse was -  loads of oily lunchbox with rice would make the garbage bin looked bad.

 The committee member came to ICU by 1:30pm and selected a case. I was told he is a oncologist and professor in a medical university. He had asked a few question about the admin of the ICU and proceeded to his rounds .He had stood in front a bed who looked chronicly ill(medical case)...but fortunately for us, he took the wrong chart (the neighbour bed) and started to flip . The case of a patient with traumatic brain injury and liver laceration. The charting was done in totally POMR method and he could only pick some minor fault which I did not chart clearly. After some comments, he had looked at his watch and decided not to "torment" us any further...It was a relief, a lot of the charting was not done in the POMR form ( I had left the ICU for quite sometimes) and some of the admin malpractice would be noticed if he really looked into it...

 The evaluation dragged on till 4 something and the feedback session began. Most of us did ok (cant be flawless...) but one of the floor did a major mess up... When the nursing committee member asked about the nurse how they get their drug after the doctor prescribed it, one of the nurses was so big-headed and told the member that they could key in a temporary prescription to pick up medication- it was violation of the medical practice: prescription could only be written/issued by doctors... Well, a bad mark on our review....Hopefully the committee would taken it as a minor malpractice and would give us a pass. A fail would mean a review again in 3 -6 months time... there was a teaching hospital which did something similiar few years ago and suffered from it...

I did my part but I don't think anyone would really notice it, but the most important part was - I did not make any major mistake.... but the electronic prescription system was screwed up by a nurse and I felt a little drawback...a review of the system was needed and I need to do something about it

The 88 flood .. 2

Although the bridge was sealed and reopen, all of the staff physician/surgeon were still able to get to work…

The newly appointed minister of health had visited the south and came to our hospital. Lem had even shake his hand… He is one of the public health expect – most of us had bought his book during our statistic class. He had bought some news – intake every patient we could and unless necessary , do not transfer case, the 4 medical centers in Kaohsiung were packed with patients. The Kaohsiung county was badly hit at that time – a village was buried under a debris flow(massive land slide – mud flow like lava …) rumors said thousand were buried under. The minister had promised us that the medical fee would be paid under special scheme. We do not have to worry about hitting over the budget…a good news for the hospital.

The ED was crowded since that day , daily patient rose from 40 to 100 /day. Beds were always tight and patient waiting in ED become more. The key problem was the transport. The road connecting to the Dong Gang town was cut off by the flood. My ex hospital is one of the major regional hospital around our region. The local peoples who frequently travel there have to detour and spent more than 30 mins on the journey. These peoples had sought medical treatment to our hospital and our loading had doubled.

Well, the hospital evaluation was 4 days later after the flood. Nothing much we can do to help, as manpower could barely cover the hospital daily activities…even though the flood had heavily hit our area but the hospital evaluation committee had informed us that the evaluation would proceed as usual….a good and bad news…

The 88 flood....1

It was an ordinary typhoon day… I was thinking a piece and nice shift – when it is raining and windy, everybody stay in the house…but I was wrong..when I left the house at noon, the wind was darn strong and the rain was so heavy. I barely make it to the hospital. The news in the hospital was a little bit frightening… some of the nurse had taken leave as they could not make it out from the house…

In the night, the wind and rain did not get smaller. It was confusing, the typhoon was sweeping over the central part of Taiwan. We were at the outer skirt of the typhoon. But the weather forecast did warn the public about heavy rain in the southern part of Taiwan as the south west monsoon was harboring around the southern part.

The rain became more heavy but I did not have a good sleep as pt were pouring in despite the gust. I went to the car park to look at my car and I felt the strength of the wind… it almost tripped me over and me fall…

The morning was worst – 2 out of the 3 bridges that leading to north had been shut down. The LB bridge was always on the shut down list as the local area was always flooded during typhoon. The LB area is surrounded by fish bed …

This XP bridge I use regularly to work..half of the bridge was torn down and rebuild...

the XP bridge which I cross on a regular basis is classified as danger bridge years ago and when the river’s water level had risen to the naked steel rod (it is well below the supposed danger water level) it would be shut down. There was an incidence in the central part of Taiwan years ago when a bridge had fallen apart during a typhoon claiming life of a few car driver and passenger. So there was only 1 bridge left for me to get home. The locum doctor came a little bit late at 12:20pm and I started to rushed to the one and only bridge left (LLS bridge), rain heavier than yesterday. Unfortunately I was 20 mins too late – I was blocked by the police as the bridge was shut down 20 min before I hit the mark. I headed back to the hospital and slept at Lem’s quarters. I was depressed and did not get a good afternoon nap. I was thinking of reopening of the LLS bridge later on and enjoying a good father day’s dinner…

Well, my prayer did not come true.. I called the police duty center hourly hoping to get any good news of reopening of the bridge. I gave up at 6:00pm as the night was falling and rain was getting heavier then ever.

Our hospital superintendent and some of the staff physician had stayed back – a firepot dinner with bunch of good stuff but I was not in the mood of eating. I went to sleep by 10pm…The next day – the LLS bridge was reopened and I headed home by 8:30am… It was a shocking scenario for me when I drove pass the LLS bridge. I saw the river roaring itself passing under the bridge. A fall into the angry river would means fatal as even the best swimmer could not survive the current, further more there were rocks, logs and other materials which can give anyone an ICH/internal bleeding…

 

I was happy when I reached home… that was the worst I thought… but I was wrong again….The so call 88(Aug 8th) flood was much more severe then the 87 flood which hit Taiwan 50 years ago

Casualty department 2

Life in the casualty department was easy….. Most of the MO were easy going persons.. There was one of my high school senior working in the department then. SK was also a Taiwan grad. He had passed the examination and unfortunately 1 year earlier – his HO-ship was 3 years instead of One. The rules had changed 1 year later. Anyway, that was not his only bad luck – he was posted to KLGH and he had opted to travel to-fro from Klang. I heard that he was delayed in one of the department thus extending his HO-ship for another few months. He was competent as he had worked a few years roving in various small hospitals.

We helped out each other then.

There were 2 MO on each shift. Another MO was placed as duty MO. He worked from 8am-5pm. He would cover for all the post mortem case during the day time. The cases were triaged we would see the red then the yellow then the green. I dislike the system in fact. There was once a pakcik(uncle) who came for dizziness. A finger sugar was done and showed high. He was given a yellow tag and he was seen 3+ hrs later after registration.

I tried to see cases as fast as possible. But sometimes the staff couldn’t coup with it.

The medical assistants(MA) played an important role in the casualty department as half of the MO could not intubate properly. SK and I were the MA favorite as we could place any tube without them. I was not that happy actually as 2 things were bothering me then – my posting and part I(MRCP) examination.

I got my posting 2 months later and I was posted to Perak. I wanted Selangor badly as I thought living in my own house could save some expenses and household errand. I appealed but denied….

THE DAY...

The date is set – 13th August…. We were informed about the date last week…. DefCon1 now in our hospital. Everyone is reading over and over again. My assignment is simple, to be aide to KP.

KP is our cardiologist , ex-dep superintendent, Malaysian ..... He is in charge regarding the medicine part. He told me he wanted an aide. So I would accompanied him around. Ties and Shirt is mandatory as announced in the meeting. Worst part – I was post call and I needed to shape up. A tiring week for me though – I am doing EOD(every odd day call ) from Monday as Lem is enjoying his vacation back in Malaysia. Well, the 1st call was good and hopefully I am lucky during the 2nd and 3rd call.

Well, I been through the evaluation and I need to answer to the committee member regarding my program. I hope I can do a good presentation. After all , I got a medico-information manager certificate...thinking of doing master in medical informatic - my home medical college might be setting up one later....

landed - LCCT.

We landed back in LCCT on time - thanks for the bad weather(strong wind took the credit). It was a not a tiring flight. I took a nap and was in good shape when we landed. Well, it was quite a walk from the plane to the LCCT. I had read about "the march" - well, you get what you pay..

I was surprised when we reached the LCCT. There was this fever screening unit at the entrance. There was this long queue. The line was arranged in U shape and the line was not moving (STATIC !!!!). Violation of first rule in the fever screening station - static = increase risk of infection. There were a few staff nurse and MA assistant medical officer( they were renamed recently) standing in front. One medical officer was sitting at the end looking at the monitor. Taiwan had declared that the H1N1 is being treated like general influenza and no special measure to be taken just 1 week before I leave.
We finally passed the imigration and taken our luggage. I saw my brother in law - Wan waiting and we headed to Port Dickson - my uncle's house. It was 55 km away and I had not seen my granny for the past 5 years. I heard that she was in bad condition for the past 1 years. I wanted to see her. She cared for me and my brohter during our high school days - she often gave RM50 to us during our visit to her house. My parents was not doing well than...

I couldn't get any map for my GPS so Wan had did a sketch from the google map. I got a gonav S900 which run on papago R15 which I later upgraded to VRone. However the only Malaysia map I could lay my hand on was a R12 version. And I couldn't get any R12 Papago. So I gave up.
The navigation was easy when we passed by Sepang Town - it was a place I never forgot. I still remembered the incident - My dad was driving a Nissan C20 and we were on our way home from Chuah(yeap- the origin of Nipah Virus). The C20 was having problem igniting and needed a push-start. We were passing by Sepang town and there was this fire going on. Police was controlling the traffic. My dad was impatient as he was afraid that the car would switch off during the jam. He horned and one of the fat/hugh build , mustached police officer walked by - he asked my dad to pull over and ordered my dad down - he was taken to the balai(station). We had waited in the van for hours before he was released. I saw the disappointment and depress in my dad's eye but just didn't know how to support him verbally. I learned that he was the OCPD (officer in charge of the police department, 1 crown at least) of the town. I could imaging how my father begged for his pardon ... a sad one and my conclusion was  - PDRM sucks, he had no right to do that ... just a horn - and someone was detained for hours ...
The road was familiar and I saw development along the road. Shop houses were build and Apartment were placed.  When I reached my uncle's house it was almost 10... I saw my granny sleeping in the living room... She get old and so do I....

to say or not to say...

Well, I did my Mon, Wed, Thrs call last week... heck, it was worst than I thought.... it was no the stress of not getting any sleep, but time being wasted on resting. I rather go back to those 15 shifts per months scheme.
It sounded like a good news when boss broke the news during my weekly meeting. Someone is coming. I got the following info :
1.A board certified Emergency Physician
2.Working in hospital nearby
3.He is senior (means older than me...)
4.His current employer is willing to let him go eventhough his contract ends next year

I had a closed friend(senior) working in that hospital and he is currently holding very senior post there. I could have call him up but I didn't - I was afraid that he give me any negative comment and in that case I would be in deep shit. Boss might taken my advice and stopped him from coming and the lubang(hole,night shift ...etc..) still there. Then I had to cont my 10 shifts/month life. If I withhold such info, than if later boss know that I knew before hand and I am also in deep shit. So rather don't ask...
Well, unfortunately our nursing superintendent got a call from our ex-colleague ( she is assistant head nurse in our ED and late resigned due to family reason, she is currently ED AHN in that hospital) - our colleague to be is incompetent and having attitude problem. His current employer and ED staff just cant wait to sent him away...

Well, we had one hot potato at the moment and un-shakable as we couldn't get any replacement, now there is another one coming in.... our nursing superintedent would go and talk to our matron to see what can we do...
Well, 2 wks to month end...lets see.....

Lubang ( hole )......

I enjoyed a 10 days holiday and prepared for my 1st call…a relaxing morning, but still I was very tired after 3500 km of flying time and 400 km of driving – a 6 hrs sleep was not enough. But nothing like a heavy blow on the head during a hang over. I got a missed call from hospital and I called Lem ; bad bad news… our colleague Ong had asked for an emergency leave – or a so called “step out”. He had a bad week and his insomnia had worsen and he did not slept for 1 weeks. He decided to quit temporary on last Friday. Well, a 8 night shift “lubang”(hole) on this month call list. Boss had called for an emergency meeting to discuss such matter. I did a quick analysis and decided to share 2 of the shfits. That would my shift from 6 to 8 this month(minus the 10 days in Malaysia). The worse thing – following months to come, a 12 -13 night shifts to be filled. I couldn’t imaging how we are gonna survived. The meeting was not only about Ong’s leave but also something about the National health bureau’s budget for us. Well, a miscalculating leading to a major cut for this quarter. Negotiation was still going on and we might had to face some challenge in the future as we might have to opt for case by case reporting scheme instead of budget limiting scheme. Well, that was not my focus. I had a discussion with boss and our financial controller(boss’ wife) and I had told them that the ED physician is heavy paid in ex hospital and it had become one of the index. Well, I saw the financial controller punched her calculator ... When Lem rejoined us, boss had given us an option - 3 of us take over what had left over... Neither Lem and I wanted to commit anything... well, the pay is far too less and no worth of it to risk our life... yeah risk our life -from time to time, Lem had asked me in a joking manner - why not we take over the 720hrs shift(whole months), my answer was - when we would become human Ba Kuang ( dried meat in Hok Kian) in 3 months time. Life was hard but I rather stay alive - suffer or enjoy that was another story. I offered to take over 2 shifst and Lem would cover the Tuesday's call - for this months....

When would they let go ?

It’s look like still a panic situation here… the govt still considered H1N1 as a major threat as I read it from the newspaper, but most of the relative had no feeling about it – after all no one around them had hooked up with the disease. Well, 10 days before I returned, the Taiwan department of heath had declared that the H1N1 is no longer a major threat like SARS – our reporting system had shifted from daily to weekly and only the severe case with be posted. When I reached the low cost carrier terminal(LCCT), we saw this long line up at the entrance hall. The line up is just like a cribbage score board. There were a team of medical staffs collecting the declaration and handing out brochure. The line was static for 5-10 minutes. I said to Ving – “total wrong setting ,that is another way of spreading the disease”. The line was static and if there is one H1N1 patient – than we could be infected. So isolation would be more difficult as the front 3 and back 3 rows rule could not be applied in this situation. The Ministry of health is still spreading news of panic around the newspaper – well, don’t know when they would let go …..

i wanna fly ...

I had been an aviation fan for half of my life… I remembered there was this card game during my school days. There was a title for each card – cars, sport cars, plane, tanks… Different vehicle was printed on each card. The cards were distributed and one of player would be the caller. The caller would decide which item to be compared. I learnt a lot of info regarding vehicle/plane/tanks from it.

Later when I got my first computer(8088, 64k ram, 2 floppy drives, CGA monitor). I dipped myself into the world of flight simulator. I had failed a lot times (more than 100) before I did a successful landing. I had played many flight simulator games since then. I purchased paddle, throttle and a good joystick later on (With my own money of coz..). One of my favorite model was 737…I day dream that during one of my flight between KHH and KUL, I might have the chance to help the plane land if the pilots failed…(day dream only of coz…)

Since we had 40 min left before our check in, we decided to have a tour in the aviation museum just next to the Tao Yuan International Airport. I remembered during my school days, it was named CKS International Airport. But the green govt had wanted de-CKS-rization to be done, so it was renamed.

Apart from the poster based history regarding flight. There were these cockpits for the visitors to get a real feeling of being a pilot…

 

hell load of plane model...

fighter jet cockpit...

not F14 definitely..but who cares...

top gun ?

Any way we had a great experience….

 

 

ED is a mess

We had a discussion 2 days after the incident. My colleague had brought the problem up to the hospital superintendent. He is a surgeon and he is a man of principle. He had refused to provide the report when the patient asked for a referral. The act of our ortho man had irritated him – as the patient did not admit to my service than I am not his attending surgeon, so I have no responsibility to signed those papers.

If his statement is true, then my colleague CQ is not attending doctor(he did not see the patient at all), and the ortho man is also not his attending doctor – eventually I would be the one…I was the ED doctor that saw him.

I am not a man of trouble. When my night shift head nurse told me about the incident, I told her that she should have called me and I could have logged on to the hospital server and signed the report and referral letter from my house. (with full of grumble of coz…).

Well, what is the problem with our ortho guy ? Well, I had heard many rumors and most of them were negative one. Don’t mind and care about his act, but there is one tradition in our hospital – covering each other ass as you can. Well, I had not only once help my colleague signed the report.. So what was the big deal….

Well, he had skipped the discussion and we have talked freely, it seems that everyone was pre-brief(means gossip had become public secret). Our surgeons had decided to talk to him about the ecological situation in our hospital - hopefully he is smart enough to coup with us… I had told Lem if I heard anymore comment about “ ED is a mess” again(that was what he said during the surgery because the patient had changed his mind). He had blamed the ED for not persuade the patient to admission - my point of retailiation - the ortho man had no mouth ? he could have talked to the patient prior to surgery as the patient was given spinal aneasthesia instead of general. 

I would start my “messing up” – I would not help the ortho man to signed his surgical consent and would insist he come down to see the patient and signed the consent before he went in and scrub….

one should think big but not there

I had this unpleasant encounter days ago…I went off by 6pm and passed over a few patients. There was this patient who went to OT – huge popliteal fossa wound with tibia-fibula closed fracture. He had decided to admit after the surgery and I signed the admission form.

Just before I left, the patient’s colleague came to me and said they wanted a transfer (back to their hometown) after the ops. I told me we would assist the transfer after surgery before I left. 

The next day, I met our night shift head nurse and asked about the case and she spitted to me about what had happened…I was shocked when I heard it…

Our ortho man had grumbled in the OT about the patient not being admitted to his service and then when the patient came down from the OT , he refused to write a referral letter(form to be exact) and medical report for the patient under the reason- Since the patient was not admitted top my service then I am not the Attending Surgeon and why should I write those for him…He was stopped on the way by the head nurse and refused her request when she asked him to help.

The head nurse later had tried to keep the patient back to avoid such conflict(no one wanted to write those document…)

Crap shit kinda excuse – how the hack the ED physician know what he had done on the patient… Lem knew the incidence hours before I was told about the matter. (he is the ED head …). He was displeased but refused to comment and act any further. I told the head nurse, this man definitely to be educated properly… Our hospital is a very small hospital and no one is another person enemy…

Flight back home...

It had been a chaotic week for me… finally I am going to set foot again to the land where I spilled my blood(a malay way to say motherland)…Well, I had 2 shift to go from Mon to Thrs, then Friday would be THE DAY… I planned to put up a night in Tao Yuan where the airport situated…but later I found that it was not a good idea. The flight commenced at 4pm and there is still 4 hrs for me to “wander” around.

So I had a change of plan. I decided to move up in the morning. A risky plan but I thought worth every effort. Well, my plan was good – Ving did a last minutes packing. When I reached home by 6pm Thursday, no bag was packed yet..Well, the packing was completed late that night.

The morning drive was a sleepy one as I was so tired. 8hrs sleep for the past 48 hrs..I was exhausted. But the drive had to be done and Ving looked more tired than me…I had to take the last stand. Drive was smooth though, I took the 2nd North-South Highway where the traffic was less crowded. I completed the 380km drive after 4.5hrs(2 stops).

It was too early for check in yet(I tried a web-check in but failed instead). We took a tour at the aviation museum nearby..Very nice one , real cockpit and models. We left the museum by 1pm and when we arrived at the check in counter there was quite a crowd there. 4 counters were opened and I got my boarding pass 20 min later.

 We took our car to the car park and a van ferried us back to the airport. We passed the immigration without problem. I had been having problem with the security check since years ago. Always due to my St John Buckle. I had an bad experience on my last exit. The officer wanted me to take off my belt. I was very displeased about the action.

We had a snack at the restaurant nearby the boarding gate and headed to the C5 gate by 3:40pm. A totally different experience. A330 is a big airplane and with the 400 seats fitted in, it looks bigger. Now I am writing this blogs, squeezing my self with my 15’ ASUS (regret that my boss given me a big one instead of a 12’ one..) Anyway – 2 hrs before the flight land….

copyright?

I browsed the net aimless sometimes…but sometimes I would do some search regarding some topics( old ones … SJAM etc..)

When I key in the SJAM during my last call, I came across this SJAM area website and found that they had this Chinese translation edition of SJAM general regulation. I clicked and saw the familiar sentences… It was my work….yeap…I translated the complete SJAM English edition General Regulation into Chinese. I posted it on one of my homepage – lywuu.myweb.hinet.net

I almost forget this homepage I created many years ago…it consists my work regarding SJAM…

I did a further search and something in a Chinese forum of SJAM.  I saw my work…. not only GR was posted but some of my First aid competition note were used as well..

I am happy though although some of them just posted my works without asking me….

rumors ...

A rumor is currently spreading in the hospital – new building soon. It had been rumor, smoke screen for the past few years. The management had talked over and over about having a new building.

Our current hospital construction consists of 3 building. Two 3 storey buildings and One 8 storey building. All of the building had aged more than 20 years. The settings is currently inconsistent with the new requirement. However the management had kept telling the evaluation board that the plan of building new construction was undergoing then. This would be their last call… so a plan had to be on the way. The original plan was to build a new hospital not far away. Unfortunately part of the land fell within the urban country planning zone and the local authority had asked for a big “rebate” in exchange for the approval of building the new hospital. The rebate was inacceptable – indoor and out door recreation park for the local… and one of the shitty rule was hospital staff cannot parked in front of the indoor building. Most of us were against the plan though as the hospital would be 2 times bigger but as we were unable to get any more new staff – building a hospital might ended up with losing our job.

Now the new plan is to demolished the two 3 storey building and build a bigger 4 level building. Why 4 instead of 8 ? The answer is simple – building a 4 level building (plus G floor of coz) doest not need much approval. [there is a army artillery unit around our area and, we need to get approval from the Ministry of Defense to build something taller.] . Our boss had bought one of the house back of our hospital allowing the new building to building beyond our boundary.

The 1^st move is to build a temporary ( for 1 -2 years) building in our parking lot – the ED, office and registration would shift into it. Then the old building would be demolished and the construction would begin then. It would take 1+ years.

Hopefully we could survive….

Good citizen paper

I got a phone call 10 days ago from the Malaysia Friendship and Trade Center in Taipei. My letter of good conduct had finally arrived. I remembered at the time I went to apply my for papers – I was told minimum 3 months(which means more than 3 months it should be). I had read from the net that some had got it by 2 months time. I was hoping for some miracle. I waited impatiently and finally called the center 15 days ago(almost 2 months by then) and the nice lady told that all application done in March had not been returned. Finally I got it by 2 months plus a few days… well another real Malaysia Boleh…

The papers are important for me and Ving.. We are finally eligible to apply for a permanent resident status.- which means I could stay back even though I lost my job. A milestone for our family.

The application is simple – just download the paper and pay a visit to the nearest embassy /representative office. Fee was cheap – RM20 for an application. But I took the whole family on a high speed rail ride when I applied and it cost me RM1000+..(econ to and business back…). Well, worth every penny – kids got the ride and I got the papers…

This week, I am going up north again. I will stay until Monday morning- pick up the papers by 9am and start my journey back (with my Z of coz…). Hopefully I could reach home by 3pm and get some rest . Shift starts at 6pm….

Casualty department - 1

I remembered the 1^st day I reported myself as Medical officer. My posting was not decided yet and I reported my duty to the office. I asked the admin clerk that I wanted to go to the casualty department. Casualty department was an infamous unit in Hospital Tengku Ampuan Rahimah(HTAR) then. As a house office, we used to get in-appropriate admission – eg. orthopedic case admitted to medical ward…MO which no department wants ( or they have not interested in any department would be posted to casualty department). There were some training MO who called the Casualty department - Junk department.

The casualty department was short of MO then. The admin clerk typed me a letter immediately and asked me to report to Dr Mary – the medical officer in charge immediately. There were no specialist acting as head of department then. An U43 medical officer was posted as in charge instead. Dr Mary was happy when she heard that I had 2 years of working experience in ED setting and asked me if I could start working on that day. I told her why not… I was brought to ED and I started my day shift and went off by 2pm. I was like fish back to water then.

Unlike the ED which had three 8 hrs shift. The ED shift was 7am-2pm(7hrs), 2pm- 9pm(7hrs) and 9pm-7am(10 hrs). No call claim but you would get a day off for a night shift. No lunch/dinner break as well. Each of us worked 18 shifts per month… but going off by 2pm was luxurious for someone working.

Orthopedic - 2

It had been a long time I wrote about my days with the MOH…

The life of the A&E ward HO was easy compare to the forever busy surgical HO. The surgical cases in the A&E were more problematic than the orthopedic cases. I started my tagging in the A&E ward and later the orthopedic wards. I learnt to refreshening (aka amputate) fingers during the period. Well, handy skill for me later during my practice. As I had familiar myself with the system, my life was much easier. Most of the medical officers were Master students. Mr Ong left the department 2 weeks after I joined. He gone into private practice. The 2 specialist was Mr Muthu and Mr Yusof. Mr Muthu was someone loaded. When he got promoted he was posted to IPOH GH and he drove every day (or every odd day) from KL to IPOH(I heard he could make it in 2.5 hrs instead of 4… with a BENZ of coz…) He got his transferred back to Klang after 2 years… Mr Yusof is a Ilizarov man… he did a lot of Ilizarov…

Ilizarov apparatus...

the other 2 were clinical specialists – Mr Wong and Mr Ewe. Mr Wong was master graduate doing his 6 months probation and he is a Sarawakian. He planned to go back to serve the land with his wife(anesthesia master graduate) later. Mr Ewe was FRCS holder doing his 2 years under supervision training in orthopedic. Most of them were nice guys and easy going persons. I had a relaxing time working with them.

There was 1 part which I hate…preparing the OT list … I had to go around the ward and asked around those planned for surgery – weather they pay up for the implant or not…

There were kampung (village) folks that couldn’t afford a plate of RM200…

I learnt the final skill that I wanted badly– closed manual reduction….

At the time I left my orthopedic posting – my MO posting was not decided yet. I did not opt for my surgery and paediatric posting, instead I go to the administration and asked for posting in the Casualty department…I had heard that the life was much easier and I wanted to prepare my part 1 in such an department….

A place I never dream of going ....

 

I wanted to shift my POMR database from access base to a SQL server. I had discussed with my Dep Supt (admin) and got a green light. Now I am trying the connection and migrating parts…I have 900mb of data(after 1 years of implementation) and I am not sure if I could really do it…I had written a short program and upgrading my access base data once and I got it work without problem…

If I succeed this time then I am prepared to link it to our hospital database and the potential is unlimited….

I am making this major steps  which could lead me to a place I ever imaging of....

One....

1.... 

I had read about this 1Malaysia concept proposed by our YAB PM. I think it is not even a concept yet but just a slogan…I remembered back in my college days. There were few of us who were Dr M follower. Yeah, we didn’t like the ‘scale’ but we think that Dr M was a man with vision - but due to reality he was unable to execute out what he believed in….We considered ourselves as patriot, but I was the only one who really served my motherland(I dare not call myself a patriot now. During my first posting in Malaysia, a senior consultant of OBGYN had told me – “with that kinda of pay and training environment, I don’t know why you want to come back”, I dare not reply her as my houseman duration was at her mercy then, but in my heart my answer was “Bcoz, I love my motherland…)...I was in the civil service and could understand the helpless situation..

In a developed country, minorities are well taken care of, they are provided with scholarship, advantages in joining higher education, aides financially etc….it was vice versa in my motherland… from time to time, some important person would come forward and ‘remind’ us – the right of majorities should not be challenged. I just wanted to say – no one wants the so called ‘right’… but please look after the minorities…..until the country is mature enough – there is NO ONE------- for everyone….

I really wanted to serve the land again, but I don't know how ? so many negative remarks from my relative .

Going back to have a good look in less than 30 days...

Losing....

 It was still a very hot afternoon… 18 hrs had passed and I was still hanging around 175 trying to catch some sleep.  A call from our asst head nurse , “OHCA, 15 mins”. In the past, we had used DOA(death on arrival) but now the term had replaced with “Out of hospital cardiac arrest”. Confusion had arisen in the past when we used DOA. We had had a case in the past – a family had question about the medical bills when they saw the diagnosis of DOA. The itinerary included CT, sonography and lots of medication. The family had asked us ,"since the patient was death and why so many procedures and medications were provided. ?"

It had been lots of dispute here and there and the department of health had decided to have a shift.

Even though I had tried  the path of ACLS instructor, I am not a faithful follower of the guideline. I always intubate first – an average of 10 sec. ( no kidding, I actually timed my performance…, but so what, those are chosen are still chosen….). I hate those standard procedure – bagged, medication , trial…Especially when a code 999 was called. Other doctors(anaes, boss…) would come and “demonstrate” their standard procedure. Normally I don’t called the code and if could I would ‘tube’ in before they come down,

The patient was a case of liver cirrhosis. I had admitted once for cellulites. She had been drowsy and sleepy since morning. In the afternoon, her husband was unable to wake her up and the rescue ambulance was summoned. No sign of life was noted at scene. On arrival, the body temperature was 40C...a case of sepsis(severe one definitely). The EKG wave was flat after 30 mins of effort, I decided to give as call. I talked to her hubby and he looked at me with a confuse look. I knew the question he wanted to ask me, “ is that it ?”. I led her to his wife and told him that nothing more could be done. I dare not look into his eyes again when he started stared at her(not cold one, she was still 39.7C when I gave it a call.). I tapped on his shoulder and told him that my nurses would help him with the rest. This was my standard practice, a way to escape from such a scene…Life was very very cruel and I had to face the families who had lost their love one and I am not good at it, the worst part – I don’t know where to learnt…..

From the movie “Fireproof” I learnt something – you can’t give what you don’t have. I have never lost someone close, the closet were pets ( Mimi(wifey cat), Lasy(a mixed breed K9, we used to have during my schooling day…)). The sensation was weird....

When I shared it with Ving, that was her answer :” a pets where something you used it as spiritual bailment but someone close maybe a person that you relay or entrust.., and it is totally different thing…” She had always given me some alternate thoughts, and I agreed with her most of the time… she is an emotional and perceptual person…facing life and death in my daily works (lucky I don’t work everyday…), I tried to hide it but I still seek a balance between job and my daily life – trying not to be so cold hearted….

 

 

shimofuri meat in the hospital...

shimofuri human flesh....

I couldn't recognized the patient when he was brought to our ED...Chief complaint - intermittent bleeding of wound. He was a patient with epilepsy and presented to ED for conscious disturbance. He was found drowsy in his house and his family had sent him over. No proper history was obtained as he was intubated and never regain his conscious. The attending neurosurgeon had speculated many causes but nothing was confirmed.

He was bed-ridden and the local Penghulu(chief of village) had got some fund and sent him over to a local nursing home for care. The money was less and the care was poor of coz....

He had developed some pressure sore when staying in our hospital during his multiple admission for pneumonia and others problem. But now the wound was intolerable....

quality of Life = ?????

Well... just admit him and see what he can do --- we owed it to him...(some ward had worsen his pressure sore during his admission...)

 

- Ward job

I met the hospital superintendent few weeks ago. He told me that he had sometime to go through with me the day after. However I never got the chance to speak to him. I was in a mist and anxious about the meeting - either a cut of wages or adjustment of working hour....
I finally met him during a pass over - he told me that I would be concentrating my job in the ICU and ED. No more patient would be placed under my service as the hospital evaluation was on its way. I was happy though..... finally I could start my teaching session again in the ICU. It had been > 9 months since my adjustment of duty and I was unable to give any teaching to the ICU staff. ICU was packed with 1/3 of new nurses and their knowledge were way below average.
The relevent head nurse had been telling others that I did not see my patient in the ward on a routine basis after the prepruce incident... truely, covering the ED was tiring and I had an agreement with the hospital that I would see my patient from Mon to Thr - the rest would be covered by someone else. I did not get extra pay for such additional work and it was supposed to be a combined care and when incident happens, I had to be part of the blame....
Well... nothing much to explain anyone.... the consultating firm had considered me as ED physician instead of ward attending physician and I had not been playing a good part squeezing between the two roles. Lots of paper works to be completed in the coming few months...hope I could able to survive it...

Square one and the half ...

Our new orthopedic surgeon reporting in on Monday. He is currnetly staying nearby the hospital. The hospital had arranged an apartment ( owned by our hospital superintendent) along the sea side for him. He was considered lucky as the apartment was well renovated ( price of renovation = price of the apartment, long long story ...).
Some had said he is a nice guy(info from his previous colleague of coz.). My major concern is - nerve/vessal repair capable. The old fashioned one were mostly trained with such skill thus they would take any case up( hand, possible nerve and vessel...) to OT. But those trained nowadays are reluctant do so - either not trained or afraid of medical legal or any other reasons.  Working in ED, sometimes we were stuck with those equivocal case and some of the ortho would ask if any nerve/vessel injury present - if yes, they don't even come to see the consult and ask you transfer the case stat.

My question was answer during my last call - we need to transfer such case...
well, at least I could call someone to reduced hip dislocation in the night...

Master of the trade

We had gone to this half day trip last Sunday. A small recreation park 30+km from our house. I loaded all our bicycled ( Strida, F20W, 2 kid's BMX) into the back trunk.  Amazing a 4.4m wagon could hold such a load.
I took the highway and 2km after we got down from the highway. I noticed the red "flat tyre" lamp was on. Darn, I grumbled. We were at the country side. Although the manual said the Z could do 80km with the speed of under 80km/h, I was still worried about getting to the nearest tyre shop. I took a quick glance and saw a tyre shop 50m away. I drove toward it and the gate was closed. I drove further and saw a tyre shop with it's gate half open. I approach the shop and a 60+ yrs(or maybe 70) old lady came out. I asked her if she could get me someone to check my tyre. She gave me a strange look while looking at my car. Yes, no flat tyre... I told her that the car alarmed me that one of the tyre had a leak. She was still confuse about the technology - if I knew one of the tyre had leaked than I should know which one. Unfortunately the Z did not have such high tech - its detect only the balancing of the suspension system. A leak means imbalance cause by one of the tyre (or maybe 3...). She finally took the pump cum gauge and checked my tyre. The left front(driver side) was 28psi compared to the others(33psi). A possible leak and I asked her if she wanted to call the SIFU(master or the expert). She told me if patch is needed, she would call for the SIFU. I had a big "?" in my brain for a moment until I saw her pushing the car jack towards my car.

similiar jack she used

She jacked my car up and I was in an embarass situation then - to help or not to help her ?. But within second the car was lifted. She used the air-powered drill and got all the nut out. While she was getting the nut out, I told her that my tyre was tubeless( Bridgestone Turanza ER 300) - another stupid move by me... she told me she knew in a polite way. By the time I should have known that she was the expert, still I played smart and embarass myself.

The rest of the drill was routine: she checked the tyre with some soap water and got the small puncture hole. No nail was noted and she called her son. While leaving the scenario to her son, she told me that the tyre need to be patched from inside and the cost was higher. Her son took over the job and removed the nail. A long and tiny one. My wheel was back onto my Z after 15 mins. The charge was NT 200( darn cheap, tyre patch from inside and filled with N2).

2 stupid move in a day, never judge a person (especially old lady) from her looks.....the old lady was Yoda type of person.....

Master

We had gone to this half day trip last Sunday. A small recreation park 30+km from our house. I loaded all our bicycled ( Strida, F20W, 2 kid's BMX) into the back trunk. 
I took the highway and 2km after we got down from the highway. I noticed the red "flat tyre" lamp was on. Darn, I grumbled. We were at the country side. Although the manual said the Z could do 80km with the speed of under 80km/h, I was still worried about getting to the nearest tyre shop. I took a quick glance and saw a tyre shop 50m away. I drove toward it and the gate was closed. I drove further and saw a tyre shop with it's gate half open. I approach the shop and a 60+ yrs(or maybe 70) old lady came out. I asked her if she could get me someone to check my tyre. She gave me a strange look while looking at my car. Yes, no flat tyre... I told her that the car alarmed me that one of the tyre had a leak. She was still confuse about the technology - if I knew one of the tyre had leaked than I should know which one. Unfortunately the Z did not have such high tech - its detect only the balancing of the suspension system. A leak means imbalance cause by one of the tyre (or maybe 3...). She finally took the pump cum gauge and checked my tyre. The left front(driver side) was 28psi compared to the others(33psi). A possible leak and I asked her if she wanted to call the SIFU(master or the expert) - my 1st stupid move..... She told me if patch is needed, she would call for the SIFU. I had a big "?" in my brain for a moment until I saw her pushing the car jack towards my car.

same kinda of jack she used

She jacked my car up and I was in an embarass situation then - to help or not to help her ?. But within second the car was lifted. She then used the air-powered drill and got all the nut out. While she was getting the nut out, I told her that my tyre was tubeless( Bridgestone Turanza ER 300) - another stupid move by me... she told me she knew that in a polite way. By the time I should have known that she was the expert, but I still wanted to play smart by feeding her with such information....

The rest of the drill was routine: she checked the tyre with some soap water and located a small puncture hole. No nail was noted and she called her son. While leaving the scenario to her son, she told me that the tyre need to be patched from inside and the cost was higher. Her son took over the job and removed the nail. A long and tiny one. My wheel was back onto my Z after 15 mins. The charge was NT 200( darn cheap, tyre patch from inside and filled with N2).

2 stupid move in a day, never judge a person (especially old lady) from her look.....the old lady was Yoda type of person.....