1/2 New year holiday....

I finally survived the new year’s shift….well, unlike other business, who could enjoy the full length CNY holidays of 9, we could enjoy only half – 4/4.

We splitted the 8 days into 2 partitions : (D1 is 1^st day of Chinese new year.)

1^st shift D-3,D-2,Eve, D1

2^nd shift D2, D3, D4, D5

 

For the past 4 years, I had been working 1st shift and Ving had the kids had some opinions about my shifts. So this year, I opted for the 2^nd shift and enjoy a gathering dinner.

Well, I work Day shift (10hrs) on D2 and a 24 hrs shift for D3. Well, the ED saw over 290 patients on these 2 days. I survived the shift and still having hanged over for it. Well, next year maybe I would find a excuse and skipping the shifts.

This year, lots of AGE.. but no burn case. In the past, we get 2-3 trauma cause by fire cracker daily but none this year; I think it is due to the poor economy – no parent want to burn any money…..

I got a small bonus but still double of what I get last year – still a good gain, I would keep it for now (maybe I would use some of it to upgrade my Z with the EDS chip…)

Need to get some sleep and prepare for my ACLS instructor pretest… I had failed twice and hopefully I can pass this time….

WII and Google....

 

We had this WII for more than a years…really enjoyed it – anyone who asked me about buying a TV game. I would strictly recommend WII to them if they are buying for their kids….

But I hate Japanese games – before the WII was launch, there were rumors claiming that there would be no region restriction – I was happy to hear that. I learnt some Japanese during my college day but I need to refer to my dictionary for gameplay….

I bought the WII c D2Ckey mod chip. The pirated copy game was 10+ times cheaper than the original one. Later the Nintendo tried their best to barricade people like me(mod + pirated ) by upgrading the firmware.

I knew about the homebrew channel stuff a long time ago, but as my mod chip was able to handle most of the game I did not bother to install it until lately when I bought this 2 games from Yun and Xian. Yun’s favorite was Cakemania and Xian favorite was Raving Rabbit. Well….I had this black screen when we tried to load the cakemania. The WII refused to read the raving rabbit TV party title( can’t even load it into the channel).

Yun favorite - from the era of PC....	the balance board is supported....

I decided to install the homebrew channel….I surfed the net and lots of how-to-install blog and gathered enough information to do it. I waited 2 more days as I need to purchase the Famous Zelda : Twilight princess to proceed with the Twilight Hack.

The process went smooth. But I was unable to load the 2 games with the Gecko program. I surfed the net again and found that the Homebrew channel beta9 I downloaded came with the regionfree 1.5 instead of the Gecko 1.07. ( the regionfree 1.5 is the older version and Gecko 1.07b is the latest. ) I reloaded my SD card with this Gecko 1.07 and presto ----- I solved my question but only partially : Xian was happy but Yun was not. The black screen was still there on loading the Cakemania game…..

I went back to the net looking for answer. I did not come up with any direct solution but someone had claimed that deleting the WII fit (jap version) save game could do the trick if any black screen occurred when running US WII game with Gecko. I tried the suggestion and everyone is happy now….

Well, Great Mighty GOOGLE GOD.....,thank you…( sorry guys at the Church of Google – just can’t join you all for prayer…)

Stabbed from behind by....

 

We had a referral few days ago down south…

 

The nurse called up our ED and Lem was doing the shift at the moment. The nurse told Lem that the patient was a old-aged female with a pressure sore. The wound looked bad and debridement was needed. However no anesthetist was available so they need to referred the case. As usual Lem asked about the vital sign and GCS. The nurse said the GCS was 10 (not sure about the detail) and Lem asked about the further and the nurse couldn’t answered the question. The nurse then turned to the ED doctor and asked him. The ED doctor took over the phone and answered that the patient was stable and she was “alert” and rudely hung up the phone.

The patient was sent over and ended in ICU. I saw her and the GCS was merely E1V2M2…. She was in a sepsis state.

When Lem shared the referral process with me – I gave him a grin and pacified him… Well, not the first time – it is very impolite for nurses to do the pass over during a ED referral. I had a few bad experiences and usually I won’t asked much when accepting case from the south side– I just told them apart from AMI (EKG showed STT elevation) and patient who need cardiothoracic surgery, we can accept any case….

The next day – during the case conference , the hospital superintendent had told us that the hospital down south had complaint that we tried to push case away …. Well, being rudely treated and stabbed from behind. Lem explained the situation and everyone of us shared a laugh. Our deputy superintendent (Neuro-surgeon ) X had told us that the doctor in ED that day is a orthopedic surgeon and also the deputy superintendent of the local govt hospital(Ops, now everyone knew who he is…). And he happens to be X’s ex classmate….

Today Lem told me that he had another good referral – “There is a XXXX patient who need ICU care and ambulance is on his way….” (Our ICU is +2 at the moment…..)

I do not want to be served by them - but can I choose ?

I went out earlier as there is currently 10 patients under my service. I need to do rounds and attend the govt specialist clinic by 8:30am. So I left home early.
I saw this accident scene at the T-junction not far from my house. I stopped my Z along the roadside and approached the scene. There was a middle-aged guy standing beside a lady who was lying on the ground – she hardly move.
I introduced myself and approached the lady. The lady was alert but confused. The accident involved 2 bikes. I did a quick examination – C-spine injury and Cerebral concussion at least. Weakness of limbs over left upper/lower and right lower. Her vital sign was ok and I thank god that no one had moved her. I hold her hand and tried to pacify her. She told me that she was working in my ex-hospital and wanted to be sent there. I called the ED and told them that I am sending someone over. The police came minutes later but the ambulance arrived late – 8 mins later. One of the EMTs(the national service man) came down with the C-collar. The senior one took the trolley stretcher and came to us. I told them who I am and brief them with the scenario:
Me: “the casualty (bla, bla ,bla)…”
EMT: “then we need to sent her fast …”
(EMT walked faster toward the patient)
Me: “Do you have any scoop stretcher ?”
EMT: “No, we didn’t bring any…”
Me: “then we need to use the long spine board”
The EMT unwillingly walked back to the ambulance and took the long spine board.
Then I saw him put the long spine board beside the lady and waited. I asked him where was the “head cushion”(head immobilizer to be precise but it looks like cushion). The EMT gave me a queer look and I explained that I need something to immobilize the head. He finally realized what I said and went back to the ambulance.
I saw him opened up every cabinet but did not seem to find what I want. I approached him and he grumbled that the ambulance went to an exercise yesterday and the immobilizer might be left elsewhere. I told him to call the HQ and ask someone to send it over. He answered that it might take a long time. However he complied and call the HQ with the cellphone – but they had radio ?!!!
After the call, he lifted up the EMT’s seat and retrieved the immobilizer from there.
From the preparation – I could see that he was not very familiar with the use of the long spine board. We finally get the patient onto the ambulance…
1st class equipment – 3rd class service…

Day of Zero....

It was Friday – Specialist Clinic day… well., unlike the klinik pakar of the MOH, I hardly(that means zero at the moment) see any referral. Handful of patient (one hand not full sometimes) and I had only 3 patients routinely seen in my clinic for DM and hypertension. Well, although the govt clinic is fully free of charge – others charge at NT50-200….Drug is the key problem – you can do nothing for any acute patient – no nebulizer, no captopril(my favorite) nor other acute antihypertensive drug, cheap OHA and antihypertensive drug… ….

Well, this week I went to the Autumn Sun govt clinic – this clinic is nearer to our hospital – 10min drive max). No patient came … ZERO ….

But the next 2 hrs were a rush for me… I left the clinic by 11:45am and sprint all the way to Yun School – 23 km drive. Then we hit back to the hospital for my award ceremony – best employee award…. There was a simple buffet lunch and the food was ok….

I was a little disappointed – I was expecting a 5 figure cash award plus some holiday(just like cermelang award of the MOH) … There was a cert, 2 pieces of paper currency and a trophy(in the shop, still)…

new toy....

New toy in the house …. a big hole in my pocket. Well, we had a piano before – a closed friend had lent it to us. Unfortunately the person who lent it to us was not the owner. The rightful owner ( her ex-husband) had asked us to buy it or returned it. He said it in a very polite way , “ I had someone wanted to buy it and payment is not a problem – you can pay whenever you like…” He claimed that his neighbour wanted to pay NT 50k for it… The piano was local assembled(although they claimed it was imported from Japan) and it was 15 y/o old. Some of the tone was unable to be adjusted….. The price was estimated at about NT 30k max…. We decided to return it. So the next 6 months, Yun had to go the Piano teacher’s house for lesson. She had progressed slowly as she could not practice in the house.

We decided to buy one – we hesitated between the old one and new one… We were eyeing on Yamaha but later I saw a blogger who shared her view- the Yamaha sound was clear but too sharp (I am not good in describing music) but the Kawai sound softer. So, I buy this top model of Kawai – the price I paid can’t even buy a Yamaha intermediate product….Yun was happy but I had another problem – Xian, he is asking for a drum set : Still under family discussion – an electronic roland v drum or a acoustic drum…maybe a WII drum set first....

T minus 10 months

I had more than a hand full of patient under my service… well, I am still a physician by training. My agreement with the hospital was : 2 night shift per week, no shift from Friday and Weekend and I had to care patient from nursing home….

Well, everything had changed for the past 4 months, shift was less ( 8 to 9 -> 6 to 7). I need to attend the specialist clinic in the rural govt clinic(Extra pay….and nothing to shout and spit). But now, I covered for the Sunday night shift(Monday nightshift waived)… monthly Saturday afternoon shift…. I worked from 6pm to 6pm on Monday. My commitment to the ICU is interrupted under such setting…. Things are changing, I am not sure the current situation would last how long…..Boss is ok, the management is ok and I am doing well – my involvement in the MIS is currently smooth. But I am not sure that I would shake out from my night shift – as a ED guy, night shift is a must but 8 shift is too much… I am thinking of less – working as a physician post much challenge, but I would need a sub specialty. Either way lead me to a path of training. I am seriously considering a training post – I had a few in mind…a sub specialty in internal medicine may lead me to a very rural area…Emergency medicine is better but I would land myself again to endless night shit. I am jumping into a bush and the thorn is everywhere..

I have seriously considered my plan and the T minus is 10 months from now …. The MIS project need to be completed – the process is more on thinking now, I had most of the skill I need at the moment …. Formulating the interface is my main focus at the moment. As a user cum programmer, I know what I need and hopefully the final product is --- physcian friendly...

I had begun my physician training late - 33 y/o, no remorse....

21,180 and 13,120 ...

It was a hot night - yes, at this time of the year, you could still get 23 in the night at the southern tip of Taiwan. I had this couple with MVA. A young man and a girl  - I considered 21 y/o as a man and a female below 16 as a girl. The girl was only 13 y/o. They was riding a bike and fallen. I had this young man admitted 1+ months ago for UGI bleeding. Gastric ulcer due to alcohol... alcoholic at the age of 20+ : not surprise if he is an aborigine but nope he is a local. I was not sure with the relationship when I examined them both. When I sent the young man to radiology for imaging, I asked the girl what was their relationship ? The girl said friends - when a male and female is not relative that means they are couple. The nurses and I looked at each other with a queer look.... well, the girl definitely look like a girl - she is merely 120cm and the guy was 180+ cm. Well, I grumbled with the usual cantonese proverb - "Kam Tou Tak ?!!"(like this also can ? ) and hoping they are not having the relationship that I thought ( sexual relationship of coz, what do you expect from this kind of couple ? puppy love ?)
I insisted the girl to give us her parents phone. She had resisted once when the registration asked for her details - "I forget"(how could you forget where you stay and your house phone no ?) . I threated her that if she refuse, I would have to handed her over to the police (by law yes - but I doubt the police would comply with the law and dance along..). She gave in fast and I called her house the next minutes. I called the house and a very young voice picked up the phone - I asked if that is XXX house and I got a positive feedback. I told the kiddo that I am from FL hospital ED and asked her if any elder person is around. She told me that no one is around  - and asked me about the detail - I told her the situation and strangely she told me to hang on.  Seconds later - a male picked up a phone and identified that he is the father. I told him the detail and he said he would rush over and asked me to keep the young man.
The police came to  ED later - the police had a link with the ambulance service - they would come over for investigation. They police asked around and requested an alcohol breath test and the young man refused. You could refuse a breath test provided you agree with a blood test and the police love blood test - no arguement. The police equipment was not properly maintain and there was a case in the past which went to court as someone had found out the breath test machine was not sent for recalibration for a very very long time.
The young man absconded after he went to toilet. The police had to issue him a fine of NT 60000. Another maroon who think he is smart - NT 60000 is the highest fine and he doesn't look that drunk.... he might get a less fine if he took the test.
The girl family came and the father was quite pissed off. After some Q&A about her medical condition. I chatted with the granny. The girl had been with the young man for sometime and the girl's family had went to the young man's house and proposed a lawsuit. ( the girl was under 14 and it is a crime to have sex , consent or no consent). The grandmother(I knew her as she brought the young man over for UGI bleeding last month) had kneed down and begged for pardon. The girl's granny told me that the young man was very spoiled.
I thinked of Yun after the girl went home ... I need to spend more time with her - I am those kind of dad who would break those young maroon's leg  who dare to hurt Yun....