Choke...

I had this old lady who came ED present with chest discomfort 4 days ago. She was already resting on the bed when I saw her. The lady told me that her stomach might have been "hurt" after eating eating her lunch. "hurt your stomach" is local taiwanese way of saying I eaten some irritating food and also it could mean anything... When the patient presented with such complaint, I would always asked deeply as it could be anything. When I asked her to specify her problem. She told me that she had 'choke' and vomited. She had also complaint of some dizziness. The rest of hx was unremarkable and a quick PE did not give me any hint, the gag reflex was ok. The vital sign was ok(sl elevated BP of 145/89mmHg) but I was not feeling easy with the word 'choke'. I ordered a brain CT and some blood test.

I then proceeded to 175 for a rest. 10+ min later, I got a call and the nurses wanted me to the resus area. I was surprised when I saw the lady being bagged. The nurse told me she had passed out on the way back from CT room before I asked. Another nurse than sticked her head into the resus room and told me that the radiographer said ICH was noted. I left the room and opened the PACS - a five star pentagon shape hyperdense line noted over the skull base - the bomb in the lady skull had detonated - aneurysm rupture. 

 
I intubated the lady and consulted our neurosurgeon...  we both agreed that the prognosis is poor and either vegetative or heavan. The family had however wanted a transferred. No NSICU was available in the 4 major hospitals... but however they opted to go to one of the hospital and waited in the ED...
The word 'choke' save my ASS -- if the brain CT was ordered after she had passed out the family might had made noise claiming that we had missed the diagnosis...

Wait until the rock hits

The working moral was low lately .... wage slashing, tax scheme adjustment by the consulting firm had bothered us. Those senior attending staff suffered the most. The ED was spared until now. But Lem told me according to some reliable source in the management  if Surgeon X had not react so vigorously, 3 of us(ED doctors) would have been interviewed. The firm had considered that our pay per hour was too high - they wanted a reduction. Frankly said, if they wanted to cut down my overlapping time with Lem, I would gladly comply- I work less, I got less....but reduce the pay per hour is a little way to far ...

"Reduced my ASS.." I grumbled. In this Sourthern part of Taiwan - we are still below paid - compared to the other 4 hospitals around us ( same pt vs doctor ratio). However both of us are not that optimistic about our current situation - the management had pulled their brake and slower their steps doesn't mean that they have changed their mind. Sooner or later the day will come.

Sometimes this kind of consulting firm acted with figure but sometimes they don't - they just tell you their decision.... I don't think I am in any ground to argue with them if they decided to cut our pay. Lem had another worry as he had a good tax scheme at the moment and the management had eyed on his scheme for a long time.

For the moment - I shall work as usual... until the rock hit. Maybe is time for me to consider a change of field.

possessed by EDS....

I finally went to tune my Z….. well, I had wanted to act a very long time ago... there are many workshop which do engine tuning but I had only a handful to choose from. The chiptronic is not suitable for the 1.8 easytronic version and the EZ-Kbox is a local product( the price is sky high NT 60000!, darn... the dealer boosted that it is from Germany but actually a Belgium product and modified by locals). I opted for the EDS chip tuning. The EDS tuning was recommended by the local Zafira Fan Club. I wanted to tune for 2 reasons - fuel efficiency and the grab of pickup. The pickup of Z is sluggish at low speed - but remarkable after 80km/h. Most of the time, I would " lagged" at the starting point; unless I really stepped on it, My Z is always a chaser.

The EDS tuning increase the power from 140ps ->155 ps(A Head so Big (Toyota la..) Wish is 150 bhp, some said bhp is more superior than ps but actually it is 2 different unit to compare  ) and the torque is increase by 25Nm… minor improvement from the figure but according to other club members who tuned their car- the tuning is worth every penny.

I had had my Z for over 1 year now and driven 37000km before I had the chance to act. There is one workshop who deal in EDS tuning. The workshop is located around outskirt of Taipei. I had this chance and visited the workshop last weekend. I left Ving and the children in this Babyboss city and headed for the ‘holy EDS shrine’. The tuning took around 2+ hrs and it could be started only by 3pm as the workshop would need to upload the data from my car chip to Swiss for remapping. Later the data would be downloaded back and remapped into my car. I reached there by 3pm and headed back to downtown Taipei via MRT leaving my car with the workshop.

When I headed back to the workshop by 6:45pm the process was almost finished. My Z was well polished(complement by the workshop – IPO polishing cost about NT 2000). I waited for another 30 min before I left with my Z.

A different driving experience after the tuning:

1.No more dragging sensation with low gear.

2.The 2nd and 3rd gear is no more sluggish.. 

3.The pickup of 5^th gear is better

I haven’t try the sport mode yet … and

The EDS for 1.8 is all time unlike the 1.9D version(work only in sports mode) and I am satisfied with the result – every penny well spend…

I did a very gentle cruise on the way back the next day – the mileage was fantastic: I had a 16.2km/l with air condition turned on ( no heavy stepping on the oil pedal of coz, cruise speed 90km/h)

On the second half, I stepped hard on the oil pedal and the mileage was 14.0km/l/. My record was 12+km/l on aircon and 13+km/l in the winter on the highway.

next year ....

It was a bad week for me… well, I survived the 2 days of ACLS instructor course but did not pass… well, my heart sunk to the bottom of atlantis when I saw the result over the net… well, 3 out of 14 from my group failed. I don’t think it is a fair game although it looked fair – but all I could say – “ I would be back…”

Learnt a lot from the course – we were not teach to teach but somehow, we learnt from others fellow students. I knew how to prepare next year…. And I understand the whole ACLS in and out after the course…

safety feature are good for safe driving only...

I had joined a car fan club since I bought my Z. There was this discussion regarding safety electronic feature of car lately. One of the members had suggested reading some post from another forum.
The post from another forum was about a Lexus GS 430 which involved in a car accident.The Lexus driver crushed his GS 430 onto the divider at the speed of 160 km/h(some said he was having a speed chase with a nissan march atht he time). He claimed that the electronic system of the car had not assisted to stopped the car and instead made the brake failed.
There were detailed discussion in the forum regarding his situation and many of the forumers have accussed him of mis-stepping the oil pedal instead of the brake pedal. He had defended himself in a rough way(afterall, he is the one who lost a GS 430...)
All I wanted to say was - crusing at 160km/h on any road in Taiwan is something against the law and anyone who did it have to take their own risk...

Wind of Change....

We are losing our orthosurgeon by the end of the months... when Lem broke the news to me, I immediately asked him if it is due to the adjustment of Operating time. 2 weeks earlier, our superintendent told us that all surgeon would need to start their surgey in the morning. Our orthopedic surgeon X starts his surgey at noon and his OPD usually commenced late in the afternoon. He came to work by 11am and go off by 8pm. It was a part of the condition when he was hired. However the management think this affect his OPD work and the OR was not occupied in the morning(waste of manpower of coz). So a decision was made. When I heard the news, I thought X would be displeased as it disrupt his locum as well.(The hospital agreed for him to do locum in other hospital in the past...).
Lem said no and told me that the consulting firm had irritated him and he decided to leave. This was the first time I heard about the 'consulting firm'. Lem proceeded to update me with what was going on in the hospital. Appearantly the hospital had engaged with a consulting firm months ago. Those office ladies who wandered around in the management office were staff from the firm but I had mis-understood that there were experts to help us with the hospital evaluation. In fact they are here to 'help' the hospital to be more effiecient (more profitable in a sense).
After probing in and out, I finally got the full picture. The hospital had signed a long term contract with the firm aiming to re-shuffle the hospital. A few units had been interviewed by them and their assignment was re-defined a.k.a more job added.
I had chatted with our nephrologist after Lem told me the news and he told me that he was being affected as well.
The atmosphere was bad for the next few days. I was called by the management and assigned some extra works but however there was a small cash reward for me doing the job. But I knew the rewards was a small piece of a big slash of somebody else.
Lem and I had discussed over the incidence. He felt he is gonna be next on the list.
I was one of the victims months earlier but I did not know it was the masterpiece of the firm. I had a meeting with our Deputy Superintendent(admin) during the absence of Ving. I asked for an adjustment of my working time to look after the kids and he had told me that he had been underpressure for sometimes and it was about time for us to do so. The management had asked him if he could cut down the overlapping working time of me and Lem. When I came back to work, the management had wanted me to cover for the ICU and put some  patients under my service- I worked from noon to noon (24 hrs shift) from Mon to Thr so that I could be present in the daytime for my ward job. However later they felt that it was a waste to let 2 doctors who had similiar function working at one time. One of us must work less

So I gladly complied and I lost 3 hrs of working time per week. (a 3-5 % cut of working time and pay). However, I had still 7 hrs/wks of overlapping working time with Lem. We thought this should be their next target. Lem had his own disturbance as well - the management had been eyeing to restructure his pay/tax scheme for a long time....

Up till now, we had lost our Orthopedic surgoen and our Deputy Superintendent(admin) is at the verge of leaving (rumors said that he had passed on his resignation). If Lem is touched, I think he would be moving as well....as Lem had said - no one is irreplaceable. I am not that passimistic at the moment but prepared to face the worst - lower of pay per hours and a switch of commision scheme.

haunted

I had spent most of time mumbling for the past 2+ weeks... The ACLS instructor course has haunted me - course by name, by I thnik the term "EVALUATION" is more appropriate. The 'course' lasts 2 days. After an short introduction, we would be rotated through multiple station. The participants are required to 'teach' in 4 of the skill/megacode station. Each of us is given 20 topics/scenarios and we are required to present 4 topics/scenario during the 2 days course. When others are presenting , the rest of us would act as student. "Bag Valve Mask - demo station" 8 minutes ......TIA case - 8 mins.... I had been under severe stress preparing such case....I been to a ALS workship organized by Mr Abu Hassan((Sr Consultant of KLGH trauma service, he is a surgeon by training) many years ago; lectures were given to us so that we learn how to teach adult... but what I am going through now is different - I think it is some sort of phase 2 selection rather than a course. The real course would be 2 months later from now : a ACLS provider demo course would be held at the end of May... Tomorrow is D1 ... I hope I would survive .... 2 yrs ago 33 participants were slashed, last year it was better - 13...