the new one which come too late....

Grand starex	T5 transporter

After 8 months of dragging on…I finally saw the new ambulance ….a Hyundai Grand Starex… Diesel version. It had been bothering us for the past few months as the old one had been causing a lot of problem. The old one was a Volkswagen transporter. It was spacious and very suitable to utilize as ambulance. Parts are all around as the vehicle were so popular in this country serving as 12 seaters van. Indeed it had good suspension and chassis, that were the advantages of European car. However since it was design for use in the cooler Europe, the hot summer here make it an unreliable car after few years of use. The owner would start to experience small problem here and there – small parts to be replaced and the cost is high if you use original parts, however as it was so popular you can get second hand part “butcher” from some scarp off one. However sometimes it just break down without any warning and making it very unreliable especially using it as an ambulance. You just can’t leave the car along the road side with the patient on it…. Well, eat salt and resist the thirst. I had an encounter with our ambulance years ago, I was cruising at 130km/h at the “air-strip” speedway(claimed to be F-16 landing/take off capable , in doubt of coz….) our ambulance “slide” over my starboard side (yes, from the out side of the road as I was driving at the outer lane).

The management had chosen the Grand Starex as it had proven to be a good investment in the past. They had purchased a Grand starex diesel as a transportation van for hemodialysis patient 1+ years ago. Not much problem and the only complaint was it’s suspension that was a little bit soft. The management doesn’t mind a bit as they are not in the vehicle most of the time…. It was the price which makes the different and make the choice easier , almost 40% cheaper than the VW counterpart. I had ridden the Grand starex for a few times and found that it is a good van – spacious and comfort to be in… Well, it came too late – our late EMT was so looking forward to it…..

square minus one...

Well, I was at my 55 hrs of shift( I had a 10 hrs break in between). Our Dep Supt(admin) had come toward me and said,” the person had “Failure””. I immediately acknowledged what he means… the ED physician is not coming … well, I showed a disbelief look and told me, “No way, I got a call again from my ex-colleague telling me that he is leaving definitely today morning.”. The reply was not stunning,” well, he is leaving of coz, but to another hospital in the town , not to us..” Well, I would be damn, after all those strategic discussing about salary and shift arrangement. All had become bubble….It was still explainable as he stayed in KHH and why should he want a longer drive and he is a golfer who likes to take a break from time to time for golfing… coming here would be an end , as he would taking over as head… He had used us as a chip for bargain a better place…

 well, really a big problem in the future, we are not only back to square zero, but to square minus one… Not sure what would be happening as boss is still keeping quiet…

Definitely cannot leave at the moment…another 12 more months I presumed…..

Dead threat.....

It was another weekend call…no ones like to do weekend call, it was not only the feeling that everyone is on vacation and I am the only one who is so dumb to be working, but the feeling of tiresome. The so call weekend calls are unlike the normal shift. The whole hospital is left to less than 1/3 of the usual man power. The working cannie had to run here and there to manage patient that he hardly knew and to explained the condition to so family that sometimes were so malignant you that you hope you had never chosen this profession....  But a  Sunday call with a dead threat ?  really one hell of a call of the life time...

I had 2 weekend call this month… both covered Sunday morning. Ong had gone for his 3 weeks break. I had to do back to back call(Sun-Mon) with a 10 hrs break. Last one to be exact and I am not going to do it in the future. I had a confirmed from my ex-colleague that the board certified ED physician is coming over from her side. A controversial person who is going to take over as head of department. I just don’t bother who I am working under. But the shift is what I concerned. I am going back to my “no weekend” policy as the management had promised me. It had become worst from occasionally one to permanent and later increase to 2….I want a restructure of my working plan and pay as well if new rules is going to be implemented in the future. I just don’t want to be the joker getting 40% less than other working under the same environment. But still one more Sunday shift to go...

Well, anyway, I saw this lady during the busiest hour in the evening. She is a case of newly diagnosed congestive heart failure who had been non-compliance to her medication. I had to admit her as she had noted with orthopnea. After the explanation and consent of patient for being admitted, I turned my back and walk toward my desk.  “what you think you are doing, how could you be so rough on seeing the patient”. I stopped and tried to find the person. I saw a young male in his 20s staring at me. I walked toward him and asked him what had I done. Apparently he was the son to the lady, I had told me that I had explained clearly to the patient and asked him if he wanted a further explanation. However he seems to be under some drug influence and kept focusing on my roughness, he even throw the word,”this is my only mother and you should have treated her properly, do you believe, I can make you a dead man right now…”,

 

he just add another finger to my dead threat count....

 I looked into his eyes and said to myself, “ KNN, do you believe I can dislocate you shoulder and blind you eyes within a glimpse, MFK SOB…”, be patient and control your temper is what I was thought, but unless he make the first move, I would give him a pass...

I was a little pissed off and so do those patient and families who was crowding the ED. I continue with my job seeing the endless patient. Later when the patient was on her way to the ward, the patient and her husband had apologized to me about their son attitude. I told them that no to worry as I am not really angry with them…. Later in the night when I managed another patient in the ward, the nurses had to me that the malicious son had even asked money from the patient…I shook my head when I heard the news, no wander he wanted me to treat his mother “well” so that he could dig cash out from her – Axx fxxking jerk who can even feed himself  

the almighty....

Well, as I thought my shifting of database was flawless, but actually I was wrong….

I came to work in evening and no one complaint to me…but later some of the nurses had started to tell me that the some of the order had “disappeared”… I had this idea instant flashed through my mind – failure of upgrading , those disappeared order must have been written to the old database….well, I did a tour from one ward to another and noted half of the program were not properly upgraded….spent sometimes and told myself that will be it….

 

Well, today morning, one of the nurse practitioner trainee had told me that the sorting of medical record was out…there were not in proper order, mixed to be exact…

apparently the “copy and paste” to the new harddisk had caused the disruption – a shock for me as I knew sorting a listbox is not an easy task. So, need to find a script that sort the collection before I write the name into the listbox….

 

 

I had to “google” again and after 1+ hrs of hard work, I finally got a solution…darn easy one… thanz again to Al Mighty GOOGLE…I had it fixed 30 mins before I go off…

 

Guerrilla warfare....

I had this 14 years old boy who was brought into ED by his father around 2am complaining about fever. He was seen in local clinic and discharged with antipyretics (TID dose). He had taken his last antipyretic more than 8 hrs ago. I examined the patient and the preliminary diagnosis was influenza as he had most of the cardinal sign.

I offered a suppository voltaren and explained that it was the dosing interval that cause the fever to recurred. The father after hearing my explanation had ask me, “Is that it ?”. Well, since he wanted to go further, I had told me that – why not an IV , the child is really dehydrated. But still the father repeat the question, “is that is?”. Some irritation but I knew what he wants – he wants an injection – no way of giving any aspergic…. Ketoprofen ? IM is to painful for a child, not my style of punishing a rude father by hurting his child…. So here come the guerrilla tactics of mine – I offered him a influenza rapid test… few months ago, the department of health had stopped providing free rapid test- patient have to pay for it…. NT400 it is… When I told the father – he show a queer look after knowing the NT400 charge… After pausing a moment, he had agreed with the test and I saw his disturbance and forget about the injection...

The test had come back positive of B 30 mins later, I informed the father and discussed about the use of Tamiflu with him. I strongly advised him not to use it and he concurred with my suggestion. I had put the child on a adequate dose of parecetamol with proper dosing. Prn Mefenamec acid was prescribed as I knew it would be difficult to suppress the fever.

 

Well, sometimes you would need to treat the family; confronting them would only increase their disbelief and only to show that you care the patient more than he does, you have their trust to treat the needed…..so much for the guerrilla tactics…