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.....