post intubation tetanus jab....

A short break follow by a stressful week….I had been back to Malaysia for my holidays(to be exact, I did not have a good rest…) and came back 2X fatigue than ever. A few events had occurred but the track was not affected. Everything was working fine... It was long but not physically stressful shift; after 20hrs in the blue working suit, a nurse in the respiratory ward had called me….A patient’s endotracheal tube seem to slogged off and I told her that I would come up and had a look.

Indeed, there was noise from the tube and I thought the nurse was right. One of the nurses took out a long stylet and asked me if I wanted to replace the tube with it…I was in a good mood than and told her that a 50% chance I would pass the tube into the oesophagus if I did it with the long stylet. I told her I would do a direct intubation. She ran to the station and prepared a tube for me. From 10m away, I saw her passing a “brown” stylet into the tube. Well, I grumbled to myself, ”since when we had this brown stylet?, MS golden plum should have informed me and Lem earlier[we were the major ‘intubator’….]…” (Ms golden plum is our purchaser cum store keeper). The intubation was smooth and when I removed the stylet, I was shocked when I saw the stylet...…..

 

 

 

Well, it was “rusted”….lucky I was as it did not “break” during the removal or else I would need to call the chest physician for bronchoscopic removal…

close up look....
 

Well, I had later informed the matron and acting head nurse later called me up and explained that the stylet was in that state when the store keeper given the tube to them….Well, I told her that I would look the matter up and pay a visit to Ms golden plum and she told me that the ward had applied the stylet 2 yrs ago…really Crap and Meat SXXT….I had shared this incident with Ong and this was this joke of the week response, “ Well, a jab of tetanus toxoid will be enough after the intubation…”

 

tough ride..

CM had left us and we had our roster out… so many LUBANG(hole, in malay) left over, Lem had did the roster and filled out whatever we can. The rest is up to boss and he managed to fill up the vacant. It is a tough ride, for everyone. A 24 hrs is truly not acceptable and healthy, I had to do 2 weekend shift but nothing to complain as I had a long vacation ( is 8 days long ?), I had left over 2 shift for them.

The worst is the coming august when Lem and Ong had to go off. The were 4 days of overlapping and it would be tough challenge.. no obligation for me to cover them up but I did tell Lem that I am gonna do 1 weekend only next months – enough for the “lending a hand” story. It had been more than 1 year doing a favor and the management had taken the favor as granted and placing me routinely on 2 weekend call. Well, there were ED physician who come to us for application with a rocket high pay request. (almost 2x what we are getting…) No way the management going to accept the terms, but our working environment is truly more demanding than others – Apart form ED, we had to cover the ward/ICU, only 1 doctor at a time and the nearest hospital(my ex-) night shift come with a acquiescence 3 hrs sleep and it is 20 km nearer to KHH… I I am not sure , very tired about the present situation – hope for a change in the near future…

Staying in but not admitted...

There was this 8 y/o girl who suffered from fever. No cough nor running nose was noted initially. She was seen by her family physician and ? common cold was impressed. Syrup acetaminophen was prescribed. Her fever had worsen and prn voltaren use was warranted to ease the fever. 4 days later non productive cough was noted and her fever was still stationary with no improvement. On Day 5, decrease air entry was noted over her rt lower chest and she was brought to ED where a chest xray was taken. The chest xray revealed right lower lobe lobar pneumonia and she was admitted. Parenteral augmentin and oral erythromycin was prescribed; fever had subsided on D2 and she was discharged well on D7. A simple history but a stress for me….Yun was the patient.

I had accompanied her in the hospital during and after my calls for the past 1 week. Yun had been admitted multiple times since her birth. Roseola, viral fever, bacterial tonsillitis, febrile convulsion…. And now pneumonia. I had no explanation – just a act of god, some people never get admitted but some suffered from wave and wave of disease. Yun was a healthy girl in general, but fever was a nightmare for all of us. Her fever was so difficult to control in the past. Acetaminophen(full dose of 15mg/kg) q6h and voltaren supp q6hrly. We really had a hard time with Yun as she got admitted on a yearly basis, most of the time was before her birthday. Well, she had overcome her major fear during the admission, she learnt to drink grinded pill with yogurt during this admission. A great leap for her as her body resisted of taking any medication except syrup…. Well, nice to see your child taking their step one at a time (or maybe a great leap)…

I had some thought during the stays in the hospital. The hospital had too much space to improve. The room was not cleaned properly before we enter. There was this blood stain over the curtain extended straight up to the wall and ceiling. I had to tell the head nurse before she sent the cleaner to take off the curtain and take a good clean over the wall. However the new curtain was never installed before the discharge. The fridge was not clean, ice perk over the cold storage making it not cold. The dust bin was not cleaned at a regular interval… I think something should be done – after all service is one the key factor to attract people. I considered the medical industries had no different than the hotel service. Comfort and hospitality(after all we are really a hospital…) is key to success….

As a attending physician in the hospital, I think it is a basic ethic to get admitted to the home hospital if care is available. Our fellow cardiologist had chosen to get admitted to our own hospital during his last admission – he could have stayed elsewhere nearer his house, he even had to share a room with another patient as no single room was available…