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....